Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples

Lenke, Lawrence G.; Lee, Veronica; Hassan, Fthimnir M.

doi:10.3390/jcm13082233

Cited by 1 publication

(1 citation statement)

References 35 publications

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“…Adolescent idiopathic scoliosis (AIS) is a curvature of the spine not caused by a vertebral defect, neurologic disease, or muscular disease. Progression of the curve frequently occurs during the adolescent growth spurt, and skeletal maturity is an important factor affecting treatment approaches [ 1 ]. The severity of the curve is assessed by the Cobb angle in the frontal/coronal plane on a standing spine X-ray.…”

Section: Introductionmentioning

confidence: 99%

Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?—A Pilot Study

Yu,

Dooley,

Woods

et al. 2024

JCM

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Background: Cefazolin may minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence for achieved tissue concentrations. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30 mg/kg every 3 h) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour) during PSF for AIS. Results: Patients were well matched for demographic and perioperative variables. While total drug exposure, measured as area-under-the-curve (AUC), was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent above minimal inhibitory concentration (MIC), both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL, patients in the bolus group spent a median of 1/5 and 1/3 of the typical 6 h operative time below target in subcutaneous and muscle tissue, respectively. Conclusions: We conclude that intraoperative determination of cefazolin tissue concentrations is feasible and both bolus and infusion dosing of cefazolin achieve concentrations in excess of typical MICs. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

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Section: Introductionmentioning

confidence: 99%