Infections after spinal correction and fusion for spinal deformities in childhood and adolescence

Abstract

Deep wound infection after instrumented fusion of the spine remains a difficult and challenging clinical problem and entails substantial morbidity, cost, and recovery time for the patient. An aggressive approach to deep wound infection emphasising early irrigation and debridement allowed preservation of instrumentation and successful fusion in most cases. At the conclusion of treatment, patients can expect a medium-term clinical outcome similar to patients in whom infectious complication did not occur.

Normal behavior of plasma procalcitonin in adolescents undergoing surgery for scoliosis

“…retention of spinal instrumentation with irrigation and debridement only, and patients can expect similar clinical outcome compared to patients without infection (5,6). Major spine surgery induces a systemic inflammatory response as evidenced by fever and highly elevated acute phase proteins such as CrP and PCT.…”

“…The clinical signs of acute deep wound infections (within 6 weeks) after spinal instrumentation include fever, pain, swelling, erythema, and wound drainage or discharge (4). It is important to detect deep wound infections as soon as possible because early, aggressive debridement and irrigation with appropriate antibiotics may allow preservation of instrumentation and successful fusion in most of the cases when the delay from the initial surgery is less than 90 days (5,6). Biomarkers, such as elevated serum C-reactive protein (CrP), white blood cell (WBC) counts, and erythrocyte sedimentation rate (ESr) can assist in diagnosing deep subfascial infection, but often are not diagnostic.…”

Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement

“…The reported incidence rate of delayed infection after spinal instrumentation ranges from 1.7 to 6.9 % [2,3]. Although uncommon, late infection may result in serious consequences, such as back pain, additional surgical intervention [4], spinal pseudoarthrosis [5], and even loss of deformity correction [6].…”

Orthopädische Behandlung bei Myelomeningozele

“…Über die Notwendigkeit eines operativen Untetherings vor Skolioseaufrichtung wird insbesondere bei fehlender Symptomatik kontrovers diskutiert[26]. Die Infektionsrate nach Spondylodesen ist bei MMC um ein Vielfaches höher als bei idiopathischer Skoliose[50,51]. Als mögliche Ursachen dafür werden von Hatlen et al[51] ein präoperativ niedriger Hämatokrit und ein asymptomatischer Harnwegsinfekt mit positiver Urinkultur beschrieben.…”