Delayed Infections After Posterior TSRH Spinal Instrumentation for Idiopathic Scoliosis

Abstract

Low-virulent skin organisms are primarily responsible for delayed infections. Intraoperative seeding followed by subclinical quiescent periods appears to be the method by which infection occurs. The increased bulk and modularity of modern instrumentation systems can lead to inflammation and bursa formation, thus contributing significantly to the activation of these infections. Primary wound closure results in successful wound healing. Delayed closure after 48 hours is unnecessary. Short-term postoperative parenteral antibiotics (2-5 days) followed by short-term oral antibiotics (7-14 days) is recommended.

Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management

“…[25585962120146] Furthermore, patients with delayed infections accompanied by spinal instrumentation typically present several months to years later with chronic pain, implant failure, or lack of adequate spinal fusion. [1627114146148] Although constitutional symptoms may be the only indication of infection, local findings such as increased pain at the incision site and tenderness to palpation of the soft tissue under the incision are usually present. Wound drainage can also occur in delayed spinal infections.…”

“…[162756114146150] Factors promoting the risk of delayed infections after scoliosis surgery include: Failure to use a drain, the necessity for intraoperative blood transfusion, the use of bone allograft, intraoperative and hematogenous seeding, and metal fretting (leading to a sterile inflammatory response). [94695129146] Of interest, the incidence of delayed infections does not appear to directly correlate with the number of levels fused.…”

“…[16275694114115146150] For some time Propionibacterium was considered a culture contaminant but now it is clear that this organism is responsible for a significant number of late infections following implantation of spinal instrumentation. [14] It has been suggested that postoperative sterile inflammatory processes may create a favorable environment for the growth of low virulence organisms such as Propionibacterium.…”

“…[57] It is a facultative anaerobe and a fastidious organism that can be hard to detect unless the cultures are evaluated for a prolonged period of time. [121627114146150] A list of organisms responsible for early and late SSIs are summarized in Table 2.…”

“…[92078114117141151] Late-onset infections are caused primarily by organisms known to produce biofilm (e.g., coagulase-negative Staphylococci and Propionibacter acnes). Similar to the management of other bone and joint infections involving prostheses, this makes the eradication of infection difficult without foreign body removal.…”