Late-Developing Infection in Instrumented Idiopathic Scoliosis

Clark, Cynthia E.; Shufflebarger, Harry L.

doi:10.1097/00007632-199909150-00008

Cited by 174 publications

(124 citation statements)

References 8 publications

Supporting

Mentioning

113

Contrasting

Unclassified

Order By: Relevance

“…Late suppuration is one of the most frequent causes of repeat surgery. Our rate of 7.5% is somewhat higher than those reported in other series using CD instrumentation, which range from 2 to 5.7% [2,6,7,12], but our follow-up was longer. Regarding other types of multisegmental instrumentation, Cook et al [7] reported a late suppuration rate of 2.9% with Isola instrumentation and Richards [18] a rate of 6.7% with TSRH.…”

Section: Discussioncontrasting

confidence: 77%

“…These facts have made CD instrumentation standard for the treatment of idiopathic scoliosis. Nevertheless, there are few series that have been investigated for the long-term results of this method [16], particularly regarding complications [6]. Long-term analysis of an implant should include data on the incidence of reoperations in order to determine the patient's satisfaction with the technique used.…”

Section: Discussionmentioning

confidence: 99%

“…Guidera et al [12], in a series of 52 patients with CD instrumentation and 23 months' follow-up, reported a reoperation rate of 13.4%. Over a total of 1247 instrumentations (917 CD, 330 Moss-Miami) during a 10-year study period, Clark and Shufflebarger [6] had to reoperate 2.2% of patients.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

Bagó¹,

Valencia²,

Pellisé³

et al. 2003

European Spine Journal

View full text Add to dashboard Cite

IntroductionThe outcome of treatment for idiopathic scoliosis is usually assessed by radiologic study, to determine the angular correction obtained, and by analysis of the clinical results. Another datum of interest, particularly regarding vertebral implants, is the incidence of reoperations. From the patient's viewpoint, an implant that achieves excellent correction but is very likely to require a second operation may not be considered satisfactory. The appropriate statistical method for evaluating this event is survivorship analysis, which allows one to determine the true reoperation rate and to predict the probability of reoperation in the long Abstract This study presents a survivorship analysis of Cotrel-Dubousset instrumentation in the surgical treatment of idiopathic scoliosis. Between 1987 and 1995, a total of 133 patients with idiopathic scoliosis received posterior spine fusion and instrumentation with the CD system at our center. The patients' mean age at surgery was 16.5 years (range 11-43 years). The magnitude of the thoracic scoliosis averaged 62.7°(range 40°-125°) and that of the lumbar curve was 58.8°(range 40°-100°). On average, 12.2 segments were fused (range 8-17) and, excluding the rods, 14.1 implants were set for each patient (range 10-21). Survivorship analysis was carried out using the Kaplan-Meier method. Implant removal was considered the terminal event, or "death". The effect of several variables on survival rate was determined with the Cox regression method. The patients remained in the study for 56.7 months (range 2-120 months). One-hundred and ten patients were withdrawn ("censored"): 90 "alive" (did not require repeat surgery and attended followup control in 1997) and 20 "lost" (did not attend control in 1997). Twenty-three patients attained the terminal event of implant removal for a variety of reasons: acute infection (three cases), late infection (ten cases), implant failure requiring revision (six cases) and local pain (four cases). The survival rate was 95.5% at 3 months, 94.7% at 6 months, 93.9% at 1 year, 91.5% at 2 years, 82.2% at 5 years and 76.5% at 10 years. The magnitude of the curves, total number of implants and number of fused segments did not correlate with survival probability. A positive correlation was found between survival rate and correction loss between surgery and last control. A survival rate of 76.5% at 10 years is unexpectedly low. Current data suggest that the incapacity to maintain correction after initial surgery plays a major roll in the long-term evolution of CotrelDubousset instrumentation.

show abstract

Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

Bagó¹,

Valencia²,

Pellisé³

et al. 2003

European Spine Journal

View full text Add to dashboard Cite

show abstract

“…Some published studies on delayed infections in spinal instrumentation have described "delayed infections" as occurring as early as 10 days after the index procedure, although most authors usually describe delayed infections after 9 months from posterior spinal fusion and instrumentation. 3,8,24,28 For the purposes of this study, we defined late infections as those that occurred more than 6 months after the index procedure, after an asymptomatic period.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Shen

Liang

et al. 2014

SPI

View full text Add to dashboard Cite

Object There are limited published data about the risk factors for the development of delayed infections after spinal fusion and instrumentation in the population with scoliosis. The objective of this study was to evaluate the predictive factors of development of delayed infections in patients with scoliosis who underwent surgical treatment. Methods A total of 17 patients with scoliosis and delayed infections were identified from 3463 patients with scoliosis who received surgical treatment. The control group was composed of 85 patients with scoliosis without infections, matched for sex, age, approximate date of surgery, and diagnosis. These 2 groups were compared for demographic distribution and clinical data to investigate the predictive factors of delayed infections. Results The overall incidence rate of delayed infections was 0.49%. The variables of age, body mass index, and number of levels fused were similar between the 2 groups. The average primary curve magnitude for the delayed infection and control (uninfected) groups was 80.4° ± 27.0° (range 47°–135°) and 66.3° ± 11.6° (range 42°–95°), respectively (p = 0.001). Operation time in the group with delayed infections was 384.7 ± 115.9 minutes versus 254.4 ± 79.2 minutes in the control group (p = 0.000), and estimated blood loss was 1342.2 ± 707.2 ml versus 833.9 ± 235.6 ml (p = 0.000) in these 2 groups, respectively. The perioperative mean red blood cell transfusion requirement in the delayed infection group was significantly higher than that found in patients without infections (2.8 ± 2.3 units/patient versus 1.1 ± 1.6 units/patient, respectively; p = 0.000). Logistic regression analysis showed that operation time and allogenic blood transfusion were the 2 independent predictors of delayed infections (odds ratio [OR] 1.021, 95% confidence interval [CI] 1.010–1.033, and OR 1.546, 95% CI 1.048–2.278, respectively). Conclusions The occurrence of a delayed infection in patients with scoliosis who undergo surgical treatment is most likely multifactorial and is related to surgical time and the use of allogenic blood transfusion.

show abstract

“…To cite examples, Clark and Shufflebarger treated delayed infections with surgery and 48-72 hours of parenteral antibiotics followed by ten days of targeted oral antibiotics. All infections were eradicated (16,30). Likewise, Richards and Emara administered antimicrobials only for three weeks, of which 2-5 days intravenously, followed by a 7 to 14 day-course of oral treatment (16,31).…”

Section: Discussionmentioning

confidence: 99%

Variables associated with remission in spinal surgical site infections

Billières¹,

Uçkay²,

Faúndez³

et al. 2016

J. Spine Surg.

View full text Add to dashboard Cite

Background: There is few medical literature regarding factors associated with remission after surgical and medical treatment of postoperative spine infections.Methods: Single-centre case-control study [2007][2008][2009][2010][2011][2012][2013][2014]. Cluster-controlled Cox regression model with emphasis on surgical and antibiotic-related parameters.Results: Overall, we found 66 episodes in 48 patients (49 episodes with metalwork) who had a median follow-up of 2.6 years (range, 0.5 to 6.8 years). The patients had a median of two surgical debridements.The median duration of antibiotic therapy was 8 weeks, of which 2 weeks parenteral. Clinical recurrence after treatment was noted in 13 episodes (20%), after a median interval of 2 months. In 53 cases (80%), the episodes were considered as in remission. By multivariate analyses, no variable was associated with remission. Conclusions:In patients with post-operative spine infections, remission is achieved in 80%. The number of surgical debridement or duration of antibiotic therapy shows no association with recurrence, suggesting that individual risk factors might be more important than the duration of antibiotic administration.

show abstract

Late-Developing Infection in Instrumented Idiopathic Scoliosis

Abstract: Late-appearing infection with spinal instrumentation can be treated with device removal, primary skin closure, and short-term oral antibiotics. The infections affect soft tissue, not the bone.

Cited by 174 publications

References 8 publications

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis

Variables associated with remission in spinal surgical site infections

Contact Info

Product

Resources

About