Infections Following Spinal Deformity Surgery: a Twenty-Year Assessment of 2876 Patients

Purpose: To evaluate post-operative infections in adult and pediatric patients undergoing spinal deformity surgery at one institution over a twenty-year period (1985-2005) in order to determine risk factors, examine treatment strategies, and analyze clinical outcome.

Materials and Methods: The medical records of 2876 adult and pediatric patients who underwent spinal deformity surgery (greater than or equal to 5 levels) at one institution were analyzed. Patients who developed a wound infection requiring formal debridement in the operating room were identified.

Results: Of the 2876 patients who were treated surgically for spinal deformity, 69 patients (41 females and 28 males) with an average age of 25.1±18.6 years developed a postoperative wound infection requiring a debridement in the operating room, for an overall infection rate of 2.4%. Sixty-five patients (94.2%) had a posterior wound infection and the remaining four patients (5.8%) had an anterior wound infection. The overall infection rate was 2.1% (39/1897) in pediatric patients (<18 years of age) and 3.1% (30/979) in adult patients (greater than or equal to 18 age). The risk developing a postoperative wound infection was large part determined by the patient's underlying diagnosis as is illustrated table below. average time from surgery until noted 470±859 days (range, 4 11.3 years). Patients were treated with irrigation debridement appropriate antibiotics. Implants not removed unless absolutely necessary. With treatment 39.1% (27/69) achieved solid fusion only 26.1% (18/69) required removal implants.

Conclusion: Post-operative wound infection can be a devastating complication; fortunately, however, the risk of developing a post-operative wound infection following spinal deformity surgery is reasonably low (2.4%) and varies considerably depending on the patient's underlying diagnosis. With appropriate treatment a large percentage of patients can expect to achieve solid fusion and only a minority will require removal of implants.

Diagnosis	Patients w/Infection	Total Patients	Infection Rate (%)
Neuromuscular Scoliosis	18	495	3.6
Congenital Kyphosis/Scoliosis/Kyphoscoliosis	11	372	4.0
Adolescent Idiopathic Scoliosis	9	1031	0.9
Adult Idiopathic Scoliosis	6	369	1.6
Degenerative Scoliosis	5	81	6.2
Fixed Sagittal Imbalance	5	71	7.0
Trauma	3	64	4.7
Charcot Spine	3	9	33.3
Kyphosis	1	126	0.8
Infantile Scoliosis	1	23	4.3
Scheuermann's Disease	1	54	1.9
Other	6	281	2.5
Total	69	2876	2.4