脊椎ジャーナル

Late Onset Infections after Surgical Treatment of Spinal Deformities in Children

Abstract

Christian Morin, Christophe Delecourt, Amirouche Dahmam and Shrirang Kulkarni

Study design: Retrospective review of monocentric database.

Objective: To determine the rate of late infection (LI) after surgical treatment for spinal deformities in children, to assess the risk factors and to follow them after treatment.

Summary of background data: Late infection is not very well documented. They are described as less frequent than early infection (EI) with a relatively good prognosis after implants removal. Review of a monocentric database with a long follow-up will address the questions.

Methods: We went through our database to look for any septic problem and compared the population with LI, without infection and with EI. Every spine deformity in children or adolescent treated between 1983 and 2010 were included with at least two years of follow up.

Results: During the study period, 1091 surgeries were performed. Nine EI occurred (8-33 days postoperatively) and sixteen LI (8 months-22 years).

If we compare LI surgeries versus no infection the risk factors we found are posterior instrumentation (0.05) especially subcutaneous rod insertion (0.0003), the type of implants we used, with more infection with stainless steel than titanium (0.013) and diamond-shape rod than smooth rod (0.013).

If we compare LI surgeries versus EI surgeries, fever, discharge, raised CRP are not seen frequently.

Cultures were positive in fourteen of the sixteen cases, frequently with low virulence organisms than in EI (0.003).

Removal of the implants and antibiotics were used as treatment. Infection resolved in all the cases after initial surgery more frequently than in EI (0.0002). In six cases we observed a loss of correction after implant removal.

Conclusion: LI are frequent. They may be due to low-virulence organisms. Smooth and titanium rods should be preferred. If removal of implants is the treatment of choice, reinstrumentation must be considered later. LI could be underestimated if the follow up is too short. Risk factor analysis could be done only if data are collected prospectively. This was done in our study.