Management of Infection in Pediatric Scoliosis Fusions

Summary: When children with an infection of a posterior spinal fusion with instrumentation undergo I&D, there is a nearly 50% chance that the infection will remain if the spinal hardware is not removed. Patients with idiopathic scoliosis do not appear to clear infection following an I&D any better than patients with other diagnoses. Low virulent skin flora is the most common factor responsible for both early and late wound complications seen in scoliosis surgery.

Background: There is little information on the treatment of infection following posterior instrumentation for scoliosis in children.

Methods: Patients who required a surgical irrigation and debridement (I&D) for infection following posterior spinal fusion and instrumentation for scoliosis at a single institution from 1995 to 2002 were identified retrospectively.

Results: Fifty three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other diagnoses. There were 31 patients (58%) in the early group, and 22 (42%) patients in the late group. Of the 43 patients with hardware retained at the time of the first I&D, 20 patients required a 2nd I&D (47% . Of the 10 patients with complete hardware removal, 2 patients required a 2nd I&D (20%). Coagulase-negative staphylococcus was the most prevalent organism, growing in 25 (47%) and staphylococcus aureus was the 2nd most prevalent. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (p>0.05).

Discussion: When children with an infection of a posterior spinal fusion with instrumentation undergo I&D, there is a nearly 50% chance that the infection will remain if the spinal hardware is not removed. Even with complete hardware removal, 10% of patients still underwent a second I&D for persistent infection. To our surprise, patients with idiopathic scoliosis do not appear to clear infection following an I&D any better than patients with other diagnoses. Low virulent skin flora is the most common factor responsible for both early and late wound complications seen in scoliosis surgery. We speculate that antibiotic coverage for Staph. Epidermidis may be warranted at the time of the initial spinal fusion.