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Infection After Spinal Fusion for Pediatric Spinal Deformity: Thirty Years of Experience at a Single Institution

Study Design. A retrospective, consecutive case study of 1571 pediatric patients who underwent spinal deformity surgery and had minimum 2-year follow-up. Objective. To identify (1) the rate of infection after pediatric spinal deformity surgery; (2) the number of surgeries required to treat a postoperative infection after a pediatric spinal deformity surgery; (3) the percentage of patients with a postoperative infection after pediatric spinal deformity surgery who require implant removal to quantify the effect of removal on the deformity; and (4) the microbiology of postoperative infections after pediatric spinal deformity surgery. Summary of Background Data. Several previous reports have discussed the rates of infection after spinal surgery for pediatric spinal deformity. No previous reports have quantified the rate and magnitude of deformity progression after infection in pediatric spinal deformity surgery. Methods. A retrospective review was performed of the medical records and radiographs of all children undergoing surgery for spinal deformity at the Shriners Hospital for Children in Chicago from January 1, 1975, to June 1, 2005. Results. The rate of infection varied based on underlying diagnosis: idiopathic scoliosis 0.5%, myelomeningocele 19.2%, myopathies 4.3%, and cerebral palsy 11.2%. On average, 2 surgeries were required to eradicate the infection. Approximately half of the patients required removal of the instrumentation to treat their infection. Forty-four percent of patients who developed an infection had significant progression of their deformity, with an average increase in deformity magnitude of 27°. Implant removal predisposed patients to progression of deformity. The 3 most common organisms in order were Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa. Conclusion. Infection after spinal deformity in idiopathic scoliosis is rare but is relatively common in neuromuscular conditions. Eradication of infection can be expected, but implant removal is often required. Should implants be totally removed, significant progression of the deformity is possible.