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Recurrence of Deep Surgical Site Infection in Cerebral Palsy After Spinal Fusion Is Rare

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Abstract

Study Design

Retrospective review of prospective registry.

Objectives

To assess the following in children with cerebral palsy (CP) who develop deep surgical site infection (DSSI) after spinal fusion: (1) rate of infection recurrence after treatment; (2) treatments used; (3) radiographic outcomes; and (4) differences in Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) scores versus those of children with no infection (NI).

Summary of Background Data

Studies show high rates of surgical site infection in patients with CP but do not address late recurrence or quality-of-life effects.

Methods

One hundred fifty-one children with CP underwent spinal fusion surgery from 2008 through 2011 and had ⩾2-year follow-up. Patients who developed DSSI were compared with patients with NI. Student t tests were used to analyze deformity; analysis of variance was used to analyze CPCHILD scores in both groups preoperatively and at final follow-up.

Results

Eleven patients developed DSSI. Causative organisms were polymicrobial infection (5 cases), Escherichia coli (2 cases), and Proteus mirabilis, Staphylococcus aureus, Enterococcus faecalis, and Peptostreptococcus (1 case each). All patients underwent irrigation and debridement and received at least 6 weeks of antibiotics. Six had negative-pressure-dressing-assisted wound closure; 5 had primary closure. At mean 4-year follow-up (range, 3–5 years) no patient had recurrent infection. From immediate postoperative to final follow-up, no patient had significant loss of coronal curve (p = .77) or pelvic obliquity (p = .71) correction. However, at final follow-up, comfort and emotions, overall quality-of-life, and total CPCHILD scores in the DSSI group were significantly lower compared with the NI group (p = .005, .022, and .026, respectively).

Conclusions

In children with CP who developed DSSI after spinal fusion, there was no recurrence of infection or deformity after infection treatment. CPCHILD scores in patients with DSSI were lower compared with the NI group.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, Baltimore, MD, 21287, USA

    Amit Jain MD, Urvij M. Modhia MD, Dolores B. Njoku MD & Paul D. Sponseller MD

  2. Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  3. Department of Orthopedics, Rady Children’s Hospital of San Diego, 3020 Children’s Way, San Diego, CA, 92123, USA

    Peter O. Newton MD & Tracey P. Bastrom MS

  4. Setting Scoliosis Straight Foundation, 2535 Camino Del Rio S., San Diego, CA, 92108, USA

    Michelle C. Marks PT, MA

  5. British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada

    Firoz Miyanji MD

Authors
  1. Amit Jain MD
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  2. Urvij M. Modhia MD
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  3. Dolores B. Njoku MD
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  4. Suken A. Shah MD
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  5. Peter O. Newton MD
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  6. Michelle C. Marks PT, MA
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  7. Tracey P. Bastrom MS
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  8. Firoz Miyanji MD
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  9. Paul D. Sponseller MD
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Corresponding author

Correspondence to Paul D. Sponseller MD.

Additional information

Author disclosures

AJ (grants from Setting Scoliosis Straight Foundation, during the conduct of the study); UMM (none); DBN (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; other from McGraw-Hill Education, outside the submitted work); SAS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and personal fees from DePuy Synthes Spine, outside the submitted work); PON (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, personal fees from Law firm of Smith, Haughey, Rice & Roegge, grants from NIH, grants from OREF, grants and other from SRS, grants from EOS imaging, personal fees from Thieme Publishing, other from NuVasive, personal fees from Ethicon Endosurgery, other from Electrocore, personal fees from Cubist, other from International Orthopedic Think Tank, other from Orthopediatrics Institutional Support, personal fees from K2M, outside the submitted work; in addition, PON has a patent Anchoring systems and methods for correcting spinal deformities [8540754] with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems [8123749] issued to DePuy Spine, Inc., a patent Screw placement guide [7981117] issued to DePuy Spine, Inc., and a patent Compressor for use in minimally invasive surgery [7189244] issued to DePuy Spine, Inc.); MCM (grants from DePuy Synthes Spine, grants from K2M, during the conduct of the study; grants from EOS Imaging, grants from OREF, grants from SRS, grants from DePuy Synthes Spine Canada, outside the submitted work); TPB (grants from Setting Scoliosis Straight Foundation, during the conduct of the study); FM (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from Depuy Synthes Spine, outside the submitted work); PDS (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from JBJS, personal fees from DePuy Synthes SPine, personal fees from Globus, outside the submitted work).

Institutional review board approval was received for this study. The Harms Study Group receives funding from the Setting Scoliosis Straight Foundation (no grant number available).

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Jain, A., Modhia, U.M., Njoku, D.B. et al. Recurrence of Deep Surgical Site Infection in Cerebral Palsy After Spinal Fusion Is Rare. Spine Deform 5, 208–212 (2017). https://doi.org/10.1016/j.jspd.2016.12.004

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  • DOI: https://doi.org/10.1016/j.jspd.2016.12.004

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