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Surgical site infections in early onset scoliosis: what are long-term outcomes in patients with traditional growing rods?

Abstract

Purpose

Deep surgical site infections (SSIs) are a common and potentially severe complication in early onset scoliosis (EOS) patients. We sought to identify the long-term outcomes following SSI, specific risk factors associated with recurrent infections, and if instrument retention is a prudent SSI management strategy in EOS.

Methods

We performed a retrospective review of all EOS patients who underwent traditional growing rod spine procedures from 2003 to 2017. Infections were categorized as single or multiple SSIs. All infections were treated with operative irrigation and debridement (I&D) as well as antibiotics. Univariate analysis was performed using chi-square and ANOVA tests to assess differing factors between patients with single versus multiple infections.

Results

Eighty-one patients underwent 638 growth-friendly traditional growing rod procedures. There were 21 patients (26%) who developed a total of 27 SSIs (4.2% SSI per procedure). Fifteen patients had a single infection and six patients had multiple infections. Demographics were not significantly different between these two groups. Patients with multiple infections had a significant difference in the number of procedures after initial infection (p value = 0.025) and positive preoperative nasal Staphylococcus aureus screen (p value = 0.0021) when compared to those with a single SSI. Of note, these results were not available at the time of pre-operative antibiotic selection.

All 21 patients had resolution of their SSIs. Twenty patients reached final instrumented fusion. Two patients, both of whom had multiple infections, underwent complete removal of instrumentation. Reasons included one each, parental request resulting in termination of treatment and infection > 7 years after final fusion.

Conclusion

Most patients who develop SSIs during growing spine treatment are able to remain instrumented. Risk factors associated with developing multiple SSIs include infection earlier in the course of growing spine surgery, a resultant higher number of procedures following the initial infection and having a positive preoperative nasal Staphylococcus aureus screen.

Level of evidence

IV.

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Availability of data and materials

Not applicable.

Code availability

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References

  1. 1.

    Thompson GH, Poe-Kochert C, Hardesty CK et al (2018) Does vancomycin powder decrease surgical site infections in growing spine surgery?: A preliminary study. J Bone Jt Surg Am 100(6):466–471. https://doi.org/10.2106/JBJS.17.00459

    Article  Google Scholar 

  2. 2.

    Mistovich RJ, Jacobs LJ, Campbell RM et al (2017) Infection control in pediatric spinal deformity surgery: a systematic and critical analysis review. JBJS Rev 5(5):e3. https://doi.org/10.2106/JBJS.RVW.16.00071

    Article  PubMed  Google Scholar 

  3. 3.

    Thompson GH, Akbarnia BA, Kostial P et al (2005) Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine (Phila Pa 1976) 30(18):2039–2044. https://doi.org/10.1097/01.brs.0000179082.92712.89

    Article  Google Scholar 

  4. 4.

    Yang JS, Sponseller PD, Thompson GH et al (2011) Growing rod fractures: risk factors and opportunities for prevention. Spine (Phila Pa 1976) 36(20):1639–1644. https://doi.org/10.1097/BRS.0b013e31822a982f

    Article  Google Scholar 

  5. 5.

    Bess S, Akbarnia BA, Thompson GH et al (2010) Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Jt Surg Am 92(15):2533–2543. https://doi.org/10.2106/jbjs.I.01471

    Article  Google Scholar 

  6. 6.

    Watanabe K, Uno K, Suzuki T et al (2013) Risk factors for complications associated with growing-rod surgery for early-onset scoliosis. Spine (Phila Pa 1976) 38(8):E464-468. https://doi.org/10.1097/BRS.0b013e318288671a

    Article  Google Scholar 

  7. 7.

    Teoh KH, Winson DM, James SH et al (2016) Do magnetic growing rods have lower complication rates compared with conventional growing rods? Spine J 16(4 Suppl):S40-44. https://doi.org/10.1016/j.spinee.2015.12.099

    Article  PubMed  Google Scholar 

  8. 8.

    Choi E, Yaszay B, Mundis G et al (2017) Implant complications after magnetically controlled growing rods for early onset scoliosis: a multicenter retrospective review. J Pediatr Orthop 37(8):e588–e592. https://doi.org/10.1097/bpo.0000000000000803

    Article  PubMed  Google Scholar 

  9. 9.

    Kabirian N, Akbarnia BA, Pawelek JB et al (2014) Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: risk factors and clinical consequences. J Bone Jt Surg Am 96(15):e128. https://doi.org/10.2106/jbjs.M.00618

    Article  Google Scholar 

  10. 10.

    Centers for Disease Control and Preventions (2019) Surgical site infection (SSI) event. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed 14 Oct 2020

  11. 11.

    Cahill PJ, Warnick DE, Lee MJ et al (2010) Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine (Phila Pa 1976) 35(12):1211–1217. https://doi.org/10.1097/BRS.0b013e3181c212d1

    Article  Google Scholar 

  12. 12.

    Akbarnia BA, Marks DS, Boachie-Adjei O et al (2005) Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine (Phila Pa 1976) 30(17 Suppl):S46-57. https://doi.org/10.1097/01.brs.0000175190.08134.73

    Article  Google Scholar 

  13. 13.

    Reames DL, Smith JS, Fu KM et al (2011) Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 36(18):1484–1491. https://doi.org/10.1097/BRS.0b013e3181f3a326

    Article  Google Scholar 

  14. 14.

    Hedequist D, Haugen A, Hresko T et al (2009) Failure of attempted implant retention in spinal deformity delayed surgical site infections. Spine (Phila Pa 1976) 34(1):60–64. https://doi.org/10.1097/BRS.0b013e31818ed75e

    Article  Google Scholar 

  15. 15.

    Ho C, Skaggs DL, Weiss JM et al (2007) Management of infection after instrumented posterior spine fusion in pediatric scoliosis. Spine (Phila Pa 1976) 32(24):2739–2744. https://doi.org/10.1097/BRS.0b013e31815a5a86

    Article  Google Scholar 

  16. 16.

    Smith JT, Smith MS (2011) Can infection associated with rib distraction techniques be managed without implant removal? Spine (Phila Pa 1976) 36(25):2176–2179. https://doi.org/10.1097/BRS.0b013e3182045abc

    Article  Google Scholar 

  17. 17.

    Lott C, Qiu C, McNeely LW et al (2020) Can we save the implant: rib-based implant removal rates and risk factors following irrigation and debridement (I&D) surgery? J Pediatr Orthop 40(5):e346–e351. https://doi.org/10.1097/BPO.0000000000001475

    Article  PubMed  Google Scholar 

  18. 18.

    Muschik M, Luck W, Schlenzka D (2004) 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(7):645–651. https://doi.org/10.1007/s00586-004-0694-4

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Kocyigit IA, Olgun ZD, Demirkiran HG et al (2017) Graduation protocol after growing-rod treatment: removal of implants without new instrumentation is not a realistic approach. J Bone Jt Surg Am 99(18):1554–1564. https://doi.org/10.2106/JBJS.17.00031

    Article  Google Scholar 

  20. 20.

    Potter BK, Kirk KL, Shah SA et al (2006) Loss of coronal correction following instrumentation removal in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(1):67–72. https://doi.org/10.1097/01.brs.0000192721.51511.fe

    Article  Google Scholar 

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Contributions

AMD, JY: data collection, Writing—original draft preparation, approval of final version of manuscript, Agree to be accountable for the work. CPK: data collection, approval of final version of manuscript, agree to be accountable for the work. CPK, GHT, RJM: approval of final version of manuscript, agree to be accountable for the work.

Corresponding author

Correspondence to R. Justin Mistovich.

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Conflict of interest

Anne Marie Dumaine, James Yu, Connie Poe-Kochert: No relevant CME disclosures or conflict of interest to report. George H Thompson: Consultant—OrthoPediatrics; Financial support—Broadwater, LLC (course production and management), NuVasive (travel expenses), OrthoPediatrics (royalties), Scoliosis Research Society (travel expenses), Shriners Hospital for Children (salary), Wolters Kluwer (salary). R. Justin Mistovich: Consultant—Philips Healthcare, OrthoPediatrics.

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Dumaine, A.M., Yu, J., Poe-Kochert, C. et al. Surgical site infections in early onset scoliosis: what are long-term outcomes in patients with traditional growing rods?. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00412-5

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Keywords

  • Early-onset scoliosis
  • Spine deformity
  • Surgical site infection
  • Instrumentation