Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?

Wright, Margaret L.; Skaggs, David L.; Matsumoto, Hiroko; Woon, Regina P.; Trocle, Ashley; Flynn, John M.; Vitale, Michael G.

doi:10.1016/j.jspd.2015.11.002

Cited by 19 publications

(9 citation statements)

References 14 publications

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“…7,18 In previous investigations, such infectious complications have consistently been attributed to increased implant density, fusion to the pelvis, residual postoperative curve magnitude, longer operative times, neurogenic bowel/bladder dysfunction, body mass index > 95th percentile, degree of cognitive impairment, use of allograft bone tissue, and presence of gastrostomy/jejunostomy tubes or ventriculoperitoneal shunts. 1,3,5,8,15,17,18,21 Ultimately, nutritional depletion has been additionally linked to slow wound healing and immunological compromise, contributing to heightened risk for infection. 5 In the present cohort, pulmonary comorbidity (p = 0.001), increase in weight from preoperative to follow-up (p < 0.01), and residual lumbar lordosis at follow-up (p = 0.015) were the most reliable and consistent risk factors for SSI.…”

Section: Discussionmentioning

confidence: 99%

Perioperative complications and risk factors in neuromuscular scoliosis surgery

Toll¹,

Samdani²,

Janjua³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEHigh rates of perioperative complications are associated with deformity correction in neuromuscular scoliosis. The current study aimed to evaluate complications associated with surgical correction of neuromuscular scoliosis and to characterize potential risk factors.METHODSData were retrospectively collected from a single-center cohort of 102 consecutive patients who underwent spinal fusions for neuromuscular scoliosis between January 2008 and December 2016 and who had a minimum of 6 months of follow-up. A subgroup analysis was performed on data from patients who had at least 2 years of follow-up. Univariate and multivariate regression analyses, as well as binary correlational models and Student t-tests, were employed for further statistical analysis.RESULTSThe present cohort had 53 boys and 49 girls with a mean age at surgery of 14.0 years (± 2.7 SD, range 7.5–19.5 years). The most prevalent diagnoses were cerebral palsy (26.5%), spinal cord injury (24.5%), and neurofibromatosis (10.8%). Analysis reflected an overall perioperative complication rate of 27% (37 complications in 27 patients), 81.1% of which constituted major complications (n = 30) compared to a rate of 18.9% for minor complications (n = 7). Complications were predicted by nonambulatory status (p = 0.037), increased intraoperative blood loss (p = 0.012), increased intraoperative time (p = 0.046), greater pelvic obliquity at follow-up (p = 0.028), and greater magnitude of sagittal profile at follow-up (p = 0.048). Pulmonary comorbidity (p = 0.001), previous operations (p = 0.013), history of seizures (p = 0.046), diagnosis of myelomeningocele (p = 0.046), increase in weight postoperatively (p < 0.005), and increased lumbar lordosis at follow-up (p = 0.015) were identified as risk factors for perioperative infection.CONCLUSIONSThese results suggest that in neuromuscular scoliosis, patients with preexisting pulmonary compromise and greater intraoperative blood loss have the greatest risk of experiencing a major perioperative complication following surgical deformity correction.

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Section: Discussionmentioning

confidence: 99%

Perioperative complications and risk factors in neuromuscular scoliosis surgery

Toll¹,

Samdani²,

Janjua³

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…12,14,23-25 Soultanis et al found that 5 of 50 stainless steel implants compared with 0 of 40 titanium implants developed infections ≥ 1 year after surgery, postulating that a more stable construct led to greater bone adhesion on the implant resulting in a thinner glycocalyx biofilm reducing the risk of infection. 23 However, Wright et al found that the type of metal instrumentation did not affect the risk of SSI, 26 and that surface imperfections and rougher microtopography may be more important factors in harboring bacteria. 27 Our findings support the use of titanium implant as the material had the lowest late infection rate (0.2%) and in that no patient who underwent IE, of which most implants were titanium, developed a subsequent infection.…”

Section: Discussionmentioning

confidence: 99%

Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal

Benes

Shufflebarger

Shah

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Late infection after posterior spinal arthrodesis for adolescent idiopathic scoliosis (AIS) is the leading cause of late revision. While implant removal and antibiotic therapy are usually curative, patients may experience deformity progression. The goal of this study was to compare outcomes after implant exchange (IE) or removal (IR) to treat late-onset (≥1 y postoperative) deep surgical site infection (SSI) after spinal arthrodesis in patients with AIS. Methods: Using a multicenter AIS registry, patients who underwent posterior spinal fusion between 2005 and 2019 and developed late deep SSI treated with IE or IR were identified. Radiographic, surgical, clinical, and patient-reported outcomes at most recent follow-up were compared. Results: Of 3,705 patients, 47 (1.3%) developed late infection 3.8±2.2 years (range 1 to 9.7 y) after index surgery. Mean follow-up after index surgery was 6.1 years, with 2.8 years (range 25 to 120 mo) of follow-up after revision surgery. Twenty-one patients were treated with IE and 26 with IR. At the latest follow-up, average major-curve loss of correction (1° vs 9°, P<0.001) and increase in kyphosis (1° vs. 8°, P=0.04) were smaller in the IE group than in the IR group. Two IR patients but no IE patients had reoperation. Patients who underwent IE had higher Scoliosis Research Society 22-Item Patient Questionnaire (SRS-22) total scores (4.38 vs. 3.81, P=0.02) as well as better subscores for self-image, function, and satisfaction at the latest follow-up than those who underwent IR only. There were no significant between-group differences in operative duration, estimated blood loss, length of hospital stay, or changes in SRS-22 total scores. No patient had a subsequent infection during the follow-up period. Conclusions: When treating late-onset deep SSI after posterior spinal fusion for AIS, single-stage IE is associated with better maintenance of major curve correction, sagittal profile, and patient-reported outcomes and fewer reoperations compared with IR, with no significant differences in blood loss, operative duration, or length of stay. No time interval from index surgery to IR was observed where the corrected deformity remained stable. Both techniques were curative of infection. Level of Evidence: Level III

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“…Literature toward this topic is controversial. While some studies [22][23][24] emphasized a protective role of TiAl rods compared with stainless steel, others 25,26 showed no difference in infection rate between the various materials.…”

Section: Discussionmentioning

confidence: 99%

5.5-mm Cobalt-Chrome vs 6-mm Titanium Alloy Rods in Surgical Treatment of Lenke 1 Adolescent Idiopathic Scoliosis With High-Density Pedicle Screws and Direct Vertebral Rotation on Differently Shaped Rods: A Retrospective Comparative Cohort Study

et al. 2022

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Background: The gold standard of surgical treatment of adolescent idiopathic scoliosis (AIS) consists of a posterior approach requiring complex 3-dimensional correction with multisegmental pedicle screws and 2 contoured rods. The substantial corrective forces and the ability of the rod to withstand these forces rely on its biomechanical properties. The aim of this study is to compare outcomes of 5.5-mm cobalt-chrome (CoCr) and 6-mm titanium alloy (TiAl) rods in surgical correction in Lenke 1 AIS patients. TiAl has greater elasticity, which may facilitate the correction maneuver, whereas the stiffness of CoCr may result in stronger correction forces. The literature provides no clear indications about which rod may allow better correction and safety.Methods: A total of 64 consecutive patients (30 CoCr vs 34 TiAl) with Lenke 1 AIS <100°, with 2 years minimum followup, requiring correction and posterior fusion at our institution were included. The primary outcome measure was coronal and sagittal correction and loss of correction at 2-year follow-up. Secondary outcome measures compared peri-and postoperative complications.Results: The mean coronal correction was higher in the CoCr group: −73.6% ± 7.4 vs −65.5% ± 11 (P = 0.001). Mean T5-T12 kyphosis did not change significantly after surgery. In patients with hypokyphosis (<10°), an improvement in thoracic kyphosis was observed in both groups, but the improvement was significantly higher in the TiAl group (P = 0.038). In patients with hyperkyphosis (>40°), a similar reduction in thoracic kyphosis was observed in both groups. At follow-up, no coronal correction loss occurred. The sagittal correction loss was slight (0.5° ± 1.5 for the CoCr group, 1.5° ± 3 for the TiAl group) but statistically higher in the TiAl group (P = 0.032). There were no mechanical complications. One revision was required for infection in the CoCr group. Conclusion:In this series of Lenke 1 AIS, with the limitations of the study, 5.5-mm CoCr rods have provided better correction in the coronal plane than 6-mm TiAl rods. However, TiAl rods have been found to be associated with higher increase of thoracic kyphosis in hypokyphotic curves, although the clinical relevance of this finding could be questionable.Clinical Relevance: This article provides surgeons with more information regarding rod material options when correcting Lenke 1 AIS.

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Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?

Abstract: Level II, prognostic.

Cited by 19 publications

References 14 publications

Perioperative complications and risk factors in neuromuscular scoliosis surgery

Perioperative complications and risk factors in neuromuscular scoliosis surgery

Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal

5.5-mm Cobalt-Chrome vs 6-mm Titanium Alloy Rods in Surgical Treatment of Lenke 1 Adolescent Idiopathic Scoliosis With High-Density Pedicle Screws and Direct Vertebral Rotation on Differently Shaped Rods: A Retrospective Comparative Cohort Study

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