Late Implant Removal After Posterior Correction of AIS With Pedicle Screw Instrumentation—A Matched Case Control Study With 10-Year Follow-up

Farshad, Mazda; Sdzuy, Christoph; Min, Kan

doi:10.1016/j.jspd.2012.10.001

Cited by 18 publications

(23 citation statements)

References 12 publications

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“…In particular, there were no complications related to thoracic pedicle screws. The phenomenon of late infections in association with the use of stainless steel implants has been reported elsewhere [12,13,19]. Since we changed from stainless steel to titanium implants we did not see this complication up to now.…”

Section: Discussionsupporting

confidence: 51%

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Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up

2012

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Purpose Since early 1990s pedicle screws in thoracic spine have been used in posterior correction of adolescent idiopathic scoliosis (AIS). Long-term results are scarce. We report clinical, radiological and pulmonary function results of 48 consecutive patients with 10-year minimal follow-up. Methods Forty-eight consecutive patients (42 females, 6 males) with 41 Lenke 1 (lumbar modifier A = 19, B = 8, C = 14), 7 Lenke 2 (lumbar modifier A = 2, B = 4, C = 1) were operated for AIS from posterior with pedicle screw alone instrumentation. Risser stage at the time of operation was 0-3 in 24, more than 3 in 24 patients. Mean age was 15.3 years. The data were prospectively collected preoperatively, at 6 weeks, 2 years and 10 years postoperatively. Cobb angle, sagittal and coronal balance, distal adjacent disc angle and lowest fused vertebral tilt were documented at all time-points. Choice of fusion levels is described. Not every vertebra was instrumented with pedicle screws. The implant density was average one pedicle screw per vertebra or 50 %. Derotation and translation of apical vertebrae on the concave side were performed for correction. The overall outcome and the outcome of different curve types were analyzed statistically. Results Lowest instrumented vertebra (LIV) was distal end vertebra in two-thirds of the patients and was one below distal end vertebra in one-third of the patients. The main thoracic curve correction was 63 %, from 58°± 12°p reoperative to 21°± 9°at 6 weeks. The Cobb angle was 23°± 10°at 2 years and 26°± 10°at 10 years. The apical vertebral rotation improved 35 %, the non-instrumented lumbar curves improved 47 %, the distal adjacent disc angle decreased from 6°± 3°preoperatively to -2°± 4°p ostoperatively and the last instrumented vertebral tilt decreased from 23°± 8°preoperatively to 5°± 5°post-operatively. All these parameters remained stable up to 10-year follow-up. The scoliosis correction was not associated with any change in the preoperative thoracic kyphosis and lumbar lordosis. The % FVC remained unchanged with 74 ± 21 % preoperatively to 74 ± 11 % at 2 years and 75 ± 10 % at 10 years. The SRS-24 score was 93 ± 18 points at 2 years and 95 ± 22 points at 10 years. There were no neurological complications, no pedicle screw-related complications. Conclusion Posterior correction of thoracic AIS with pedicle screw instrumentation is safe and produces a longterm stable correction and high patient satisfaction. An implant density of 50 % is sufficient to achieve these results. LIV can be the distal end vertebra or one below the distal end vertebra depending on the position of the distal end vertebra to the centre sacral line. The preoperative pulmonary function does not change on long term.Keywords Adolescent idiopathic scoliosis Á Selective posterior correction with pedicle screw instrumentation Á Choice of fusion levels Á Long-term operative results Á Long-term pulmonary function

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Section: Discussionsupporting

confidence: 51%

“…This phenomenon was presumably due to gradual bending of the immature fusion mass in the coronal plane. The aetiology and modalities of treatment in patients with late implant-associated infection with P. acnes have already been reported and thoroughly discussed [12,13].…”

Section: Different Lumbar Curvesmentioning

confidence: 99%

Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up

2012

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“…The subsequent studies proposed stable fusion mass and absence of pseudarthrosis as the indications for implant removal. 16 , 18 , 29 According to the experience in our center, the existence of infection seems not to disturb the process of spinal fusion, and with the support of instrumentation, good quality of fusion can normally be achieved beyond 2 years after the initial surgery. For patients who developed refractory infection within 2 years after surgery, debridement without implant removal followed by dress change and antibiotic administration were employed until solid fusion was evidenced.…”

Section: Discussionmentioning

confidence: 92%

Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Wang

Yang

et al. 2020

Global Spine Journal

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Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

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“…These variables include infection rates according to underlying condition, microbiology, risk factors, progression rate of the deformity in case the implant is removed, and need for reimplantation, among others. 3,4,[13][14][15] Nevertheless, we identified few studies assessing the long-term effectiveness of cure of acute SSI treated with I&D and antibiogram-based antibiotics with retention of the implant. 11,16 Lamberet et al did not find infection recurrence in a study of 26 pediatric patients after a follow-up of 24 months.…”

Section: Discussionmentioning

confidence: 99%

Infection Recurrence in Instrumented Spinal Fusion in Children

Moyano

Tello

Piantoni

et al. 2020

Global Spine Journal

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Study Design: Level 4 retrospective case series. Objectives: Surgical site infection (SSI) is one of the main complications of instrumented spinal fusion. The aim of our study was to evaluate infection recurrence (same bacteria) or reinfection (different bacteria) in posterior spinal fusion in children. Methods: A retrospective study was conducted to evaluate patients who were successfully treated for SSI after instrumented spinal fusion due to deformity, with irrigation and debridement (I&D) procedures, followed by antibiotic therapy, with a follow-up of at least 2 years. Results: Overall, 29 patients with a mean age of 14 + 3 years were evaluated. Preoperative diagnosis was nonidiopathic scoliosis in 23, idiopathic scoliosis in 5, and Scheuermann’s disease in 1 patient. The etiology was Gram-positive cocci (40.9%), Gram-negative bacilli (27.2%), and polymicrobial infection (31.8%). A mean of 1.5 (1-3) I&D procedures were performed. Intravenous antibiotic treatment was given for a mean of 15.8 (4-86) days, followed by oral treatment for a mean of 335.1 (0-1095) days. Mean follow-up was 5 + 2 years (2 to 14 + 7 years) during which 28 patients were cured (96.6%) and 1 patient developed reinfection (3.4%). This reinfection was treated with oral clindamycin for 6 months. After the infection persisted, the decision was to remove the implants. Conclusions: In this series of 29 pediatric patients who underwent instrumented spinal fusion due to deformity, we reported one case of reinfection (3.4%). Given that 96.6% of infections were resolved, we suggest treatment with I&D procedures with retention of implants to treat acute SSI.

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Late Implant Removal After Posterior Correction of AIS With Pedicle Screw Instrumentation—A Matched Case Control Study With 10-Year Follow-up

Cited by 18 publications

References 12 publications

Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up

Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation: results of 48 patients with minimal 10-year follow-up

Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Infection Recurrence in Instrumented Spinal Fusion in Children

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