Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Sponseller, Paul D.; Shah, Suken A.; Abel, Mark F.; Newton, Peter O.; Letko, Lynn; Marks, Michelle

doi:10.1007/s11999-009-0933-4

Cited by 103 publications

(51 citation statements)

References 11 publications

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“…Our studies also observed that prolonged preoperative hospitalization, extended surgery duration, high blood loss [53,54], cognitive impairment, severity of deformity, use of allograft [11,51,55], urinary tract infection and [54,56] and malnutrition [57][58][59] are some of the complexities affiliated with surgical treatment of NMS patients and are also proven risk factors for infections. Szoke et al [36] elaborate that the infected cases in their series had spastic quadriplegia with severe mental retardation, seizures and speech inability; these patients had also received allogenic transfusion subsequent to high blood loss.…”

Section: Infectionmentioning

confidence: 53%

“…Our sensitivity analysis suggests that a larger cohort exhibits lower implant complication rates (6.5 %). Sponseller et al [56], whose main objective was to study infection rates after surgery, mention two cases of implant removal due to infection. Since their main objective was to report infections, other non-infection related implant complications, even if present, were not likely to be mentioned.…”

Section: Implant-related Complicationsmentioning

confidence: 99%

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Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

et al. 2012

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Purpose Our objectives were primarily to review the published literature on complications in neuromuscular scoliosis (NMS) surgery and secondarily, by means of a meta-analysis, to determine the overall pooled rates (PR) of various complications associated with NMS surgery. Methods PubMed and Embase databases were searched for studies reporting the outcomes and complications of NMS surgery, published from 1997 to May 2011. We focused on NMS as defined by the Scoliosis Research Society's classification. We measured the pooled estimate of the overall complication rates (PR) using a random effects meta-analytic model. This model considers both intra-and inter-study variation in calculating PR. Results Systematic review and meta-analysis were performed for 68 cohort and case-control studies with a total of 15,218 NMS patients. Pulmonary complications were the most reported (PR = 22.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability. In regard to surgical complications affiliated with various surgical techniques in NMS, the level of evidence of published literature ranges between 2? to 2-; the subsequent recommendations are level C. Conclusion NMS patients have diverse and high complication rates after scoliosis surgery. High PRs of complications warrant more attention from the surgical community. Although the PR of all complications are affected by heterogeneity, they nevertheless provide valuable insights into the impact of methodological settings (sample size), patient characteristics (age at surgery), and continual advances in patient care on complication rates.

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Section: Infectionmentioning

confidence: 53%

Section: Implant-related Complicationsmentioning

confidence: 99%

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

et al. 2012

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“…2 In certain specific populations, such as patients with multiple injuries or neuromuscular disease, this can rise to 10%. 3,4 Due to its relatively low incidence, the consequences of SSI and its potential influence on patient outcome are still poorly defined, which limits the amount of useful advice that can be given to patients pre-operatively.…”

mentioning

confidence: 99%

Implant survival after deep infection of an instrumented spinal fusion

Núñez-Pereira

Pellisé

Rodríguez-Pardo

et al. 2013

The Bone & Joint Journal

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“…Similar rates were reported in other studies. 5,6,8 In a recent multicenter review, Sponseller et al 62 identified significant wound infection rates of 6% deep and 4% superficial. The use of unit rods was associated with significantly higher rates of infection than custom bent rods, although a clear reason for this finding was unknown.…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Surgical management of spinal deformities in cerebral palsy

Jones-Quaidoo¹,

Yang²,

Arlet³

2010

SPI

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Cerebral palsy is a nonprogressive encephalopathy caused by a brain dysfunction that occurs during the pre-, peri-, or postnatal phase of development. Cerebral palsy can be characterized by a lack of muscle control with increased spasticity or decreased tone, seizure disorder, and variable mental retardation. The overall incidence of CP is estimated to range from 1 to 5 children per 1000 live births. 49 The overall incidence of scoliosis in the CP population is estimated to range from 21% to 76% depending on the series and whether the patient is a walker or is relegated to sitting due to extensive CP. The incidence and severity of the spinal curve appears to be related to the degree of CP involvement. 39,40 Males are more commonly affected, which is in contrast to idiopathic scoliosis with a female predominance. 49 Scoliotic Curve CharacteristicsPatients with neuromuscular scoliosis may have a variety of scoliotic curve types depending on the severity of CP involvement. Lonstein and Akbarnia 37 characterized the deformity into 2 groups that were most common: 1) Group 1 curves are single thoracic or double thoracic and lumbar curves with a level pelvis, commonly noted in ambulatory patients with CP; and 2) Group 2 curves are long thoracolumbar or C-shaped curves with associated pelvic obliquity, often noted in more involved and dependent patients with CP. Hyperlordosis of the lumbar spine or kyphoscoliosis of the thoracic spine is also a common Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VirginiaCerebral palsy (CP) spinal deformities encompass a spectrum of deformities that are often initially treated nonoperatively, only to result in progression of scoliotic curves and further morbidity. Various surgical interventions have been devised to address the progressive curvature of the spine. This endeavor cannot be taken lightly and at times can be encumbered by prior treatments such as the use of baclofen pumps or dorsal rhizotomies. Care of these patients requires a multidisciplinary approach and comprehensive preoperative and postoperative management, including nutritional status, orthopedic assessment of functional level with specific emphasis on the hips and pelvic obliquity, and wheelchair modifications. The surgical techniques in CP scoliosis have progressively evolved from the classic LuqueGalveston fixation methods, the use of unit rods, and lately the use of pedicle screws, to modern sacropelvic fixation. With the latter method, the spinal deformity in patients with CP can usually be almost completely corrected.

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Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Cited by 103 publications

References 11 publications

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

Implant survival after deep infection of an instrumented spinal fusion

Surgical management of spinal deformities in cerebral palsy

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