Skip to main content

Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases


A retrospective follow-up study of patients who, having undergone instrumented posterior spinal fusion for scoliosis, experienced late infection and then underwent either implant removal alone or implant removal and instrumented refusion. We conducted this study to determine whether it is possible to avoid loss of correction by a single-stage implant removal and reinstrumentation procedure. There have been a few reports of late-appearing infections after spinal instrumentation. Implant bulk, metallurgic reactions, and contamination with low-virulence microorganisms have been suggested as possible etiologic factors. The clinical symptoms include pain, swelling, redness, and spontaneous drainage of fluid. Complete instrumentation removal and systemic antibiotics is usually curative. We retrospectively reviewed 45 patients who underwent instrumented posterior spinal fusion for scoliosis and experienced development of late infections and, after a mean of 3 years after the initial procedure, either underwent implant removal alone [n=35, instrumentation removal (HR) group] or additionally underwent reinstrumentation and fusion [n=10, reinstrumentation and fusion (RI&F) group]. Three patients were reinstrumented 1.5 years after instrumentation removal, and seven underwent a one-stage rod removal and reinstrumentation/refusion procedure. Allergic predisposition, protracted postoperative fever, and pseudarthrosis appear to increase the risk of late-developing infection after posterior spinal fusion. All wounds in both groups healed uneventfully. Preoperative radiographic Cobb measurements showed no statistically significant between-group differences. At follow-up, however, outcome was clearly better in the RI&F group: Loss of correction was significantly smaller in reinstrumented patients. Thus, the thoracic Cobb angle was 28±16° (range 0–55°) in the RI&F group versus 42±15° (21–80°) in the HR group, and the lumbar Cobb angle was 22±11° (10–36°) in the RI&F group versus 29±12° (13–54°) in the HR group. The results of our study demonstrate that wound healing is usually uneventful after instrumentation removal for late infection, also when patients undergo instrumented refusion in a one-stage procedure. Reinstrumentation appears to achieve permanent correction of scoliosis.

This is a preview of subscription content, access via your institution.

Fig. 1 a
Fig. 2 a


  1. Buchholz HW, Elson RA, Engelbrecht E, Lodenkämper H, Röttger J, Siegel A (1981) Management of deep infection of total hip replacement. J Bone Joint Surg [Br] 63:342–53

    Google Scholar 

  2. Buchholz HW, Engelbrecht E, Röttger J, Siegel A (1976) Erkenntnisse nach Wechsel von über 400 infizierten Hüftendoprothesen. Orthop Praxis 12:117–120

    Google Scholar 

  3. Clark CE, Shufflebarger HL (1999) Late-developing infection in instrumented idiopathic scoliosis. Spine 24:1909–1912

    Article  CAS  PubMed  Google Scholar 

  4. Dubousset J, Shuffleberger H, Wenger D (1994) Late infection with CD instrumentation. Orthop Trans 18:121

    Google Scholar 

  5. Fischer K (1980) Das Immunsystem—Grundlagen und klinische Bedeutung. In: Feer E, Joppich G, Schulte FJ, eds, Lehrbuch der Kinderheilkunde. Fischer, Stuttgart

  6. Gaine WJ, Andrew SM, Chadwick P, Cooke E, Williamson AJ (2001) Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction? Spine 26:583–587

    Article  CAS  PubMed  Google Scholar 

  7. Helenius I, Remes V, Yrjönen T, Ylikoski M, Schlenzka D, Helenius M, Poussa M (2002) Comparison of long-term functional and radiologic outcome after Harrington instrumentation and spondylodesis in adolescent idiopathic scoliosis. Spine 27:176–180

    Article  PubMed  Google Scholar 

  8. Lukaniec T, Menartowicz P, Koltowski K (2001) The infections in 667 patients with spinal deformities operated on with CDI. Eur Spine J 10 [Suppl1]:52

  9. Muschik M, Schlenzka D, Kupferschmidt C (1999) Surgical treatment of adolescent idiopathic scoliosis: Segmental correction versus rod rotation. Eur Spine J 8:93–99

    Article  CAS  PubMed  Google Scholar 

  10. Perdriolle R, Vidal J (1987) Morphology of scoliosis: Three-dimensional evolution. Orthopedics 10:909–915

    CAS  PubMed  Google Scholar 

  11. Richards BS (1995) Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg [Am] 77:524–529

    Google Scholar 

  12. Robertson PA, Taylor TK (1993) Late presentation of infection as a complication of Dwyer anterior spinal instrumentation. J Spinal Disord 6:256–259

    CAS  PubMed  Google Scholar 

  13. Schlenzka D, Poussa M, Muschik M (1993) Operative treatment of adolescent idiopathic thoracic scoliosis. Harrington-DTT versus Cotrel-Dubousset instrumentation. Clin Orthop 297:155–160

    PubMed  Google Scholar 

  14. Thomas P, Summer B, Przybilla B (2001) Allergische Reaktionen auf Metallimplantate. Deutsches Ärzteblatt 98:1699–1702

    Google Scholar 

  15. Ure KJ, Amstutz HC, Nasser S, Schmalzried TP (1998) Direct-exchange arthroplasty for the treatment of infection after total hip replacement. An average ten-year follow-up. J Bone Joint Surg [Am] 80:961–968

    Google Scholar 

  16. Wimmer C, Gluch H (1998) Aseptic loosening after CD instrumentation in the treatment of scoliosis: a report about eight cases. J Spinal Disord 11:440–443

    CAS  PubMed  Google Scholar 

Download references


The authors wish to thank Prof. Dr. H.W. Buchholz for a critical review of the manuscript. Prof. Buchholz was the founder of Endo-Klinik, Hamburg, Germany, and developed the surgical management of infected hip replacements. He died on March 24, 2002, at the age of 91 years.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael Muschik.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Muschik, M., Lück, W. & Schlenzka, D. Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases. Eur Spine J 13, 645–651 (2004).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Scoliosis
  • Spinal fusion
  • Late infection