Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis

Janjua, M. Burhan; Ghandi, Shashank; Sebert, Michael; Swift, Dale M.; Pahys, Joshua M.; Samdani, Amer F.; Hwang, Steven W.

doi:10.1159/000496693

Cited by 10 publications

(16 citation statements)

References 21 publications

(34 reference statements)

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“…PSSPs rates in patients experiencing long segment instrumented thoracolumbar fusion surgery in general are 0.7% to 4.4% in different studies. Of note, most studies did not differentiate between superficial surgical site problems, deep surgical site infections, wound dehiscence or death space infections (5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Section: Incidence and Causative Microorganismsmentioning

confidence: 99%

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Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

Daldal

Şenköylü

2020

Ann Transl Med

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Postoperative surgical site problems (PSSPs) following spinal surgery may lead to patient mortality, increased treatment costs and possible recurrent medical interventions. Despite efforts to reduce spinal surgery-related infection rates, complications are common and significantly increased by patient comorbidities. Since PSSPs occur regardless of deterrent measures, it is essential to distinguish the related risk factors. Different treatment conventions for PSSPs, for example, antibiotic treatment, debridement, soft tissue care and removal of implants have been prescribed with blended outcomes. The utilization of the wound vacuum-assisted closure (VAC) system has gained increasing popularity in the management of deep wound infections after deformity surgery.

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Section: Incidence and Causative Microorganismsmentioning

confidence: 99%

“…Risk factors for postoperative infection after instrumented spinal surgery in pediatric and adult population(5)(6)(7)(8)(9)(10) …”

mentioning

confidence: 99%

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

Daldal

Şenköylü

2020

Ann Transl Med

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“…There is debate as to whether pelvic fixation is necessary to correct pelvic obliquity with some authors advocating that those with pelvic obliquity less than 10˚-15˚ do not require fixation to the pelvis[ 6 - 8 ]. The majority of authors, however, advocate for fusion to the pelvis to not only correct the pelvic obliquity but also decrease the risk of distal curve progression and revision surgery[ 9 - 11 ].…”

Section: Introductionmentioning

confidence: 99%

Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?

Strom¹,

Hess²,

Jardaly³

et al. 2022

WJO

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BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic obliquity. Scoliosis in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and fusion. While consensus is reached regarding the proximal starting point of fusion, controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic obliquity. AIM To assess the role of pelvic fusion in posterior spinal instrumentation and fusion, particularly it impact on pelvic obliquity correction, and to assess if the rate of complications differed as a function of pelvic fusion. METHODS This was a retrospective, cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single institution. Minimum follow-up was six months. Patients were stratified into two groups: Those who were fused to the pelvis and those fused to L4/L5. The major outcomes were complications and radiographic parameters. The former were stratified into major and minor complications, and the latter consisted of preoperative and final Cobb angles, L5-S1 tilt and pelvic obliquity. RESULTS The study included 47 patients. The correction of the L5 tilt was 60% in patients fused to the pelvis and 67% in patients fused to L4/L5 ( P = 0.22). The pelvic obliquity was corrected by 43% and 36% in each group, respectively ( P = 0.12). Regarding complications, patients fused to the pelvis had more total complications as compared to the other group (63.0% vs 30%, respectively, P = 0.025). After adjusting for differences in radiographic parameters (lumbar curve, L5 tilt, and pelvic obliquity), these patients had a 79% increased chance of developing complications (Relative risk = 1.79; 95%CI: 1.011-3.41). CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative complications. The added value that pelvic fusion offers in terms of correcting pelvic obliquity is not clear, as these patients had similar percent correction of their pelvic obliquity and L5 tilt compared to children whose fusion was stopped at L4/L5. Therefore, in a select patient population, spinal fusion can be stopped at the distal lumbar levels without adversely affecting the surgical outcomes.

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“…Многие авторы считают, что одним из факторов риска осложнений после хирургической коррекции сколиоза вследствие ДЦП является масса тела, ее изменения, индекс массы тела (ИМТ) [14,[17][18][19][20]. Однако единого подхода к анализу данного показателя у пациентов с ДЦП не разработано.…”

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The current view on the body mass and body mass index of children with spine deformity due to cerebral palsy: a systematic review

Щурова

Николаевна²,

Рябых

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Background. Currently, several authors believe that one of the main risk factors for the development of postoperative complications after surgical correction of scoliosis due to cerebral palsy (CP) is the body weight, changes in it, and the body mass index (BMI). However, a unified approach for the analysis of these indicators in children with CP remains unclear. Aim. Analysis of the available data in the modern literature on the issues of body mass and BMI in children with spine deformity due to CP. Materials and methods. A systematic search of the literature was conducted in open electronic databases of the scientific literature PubMed, Web of Science, Scopus, MEDLINE, eLIBRARY, Russian Index of Scientific Citation (RISC), and bibliography of key articles. The criteria of inclusion were systematic reviews, meta-analyses, multicenter studies, controlled cohort studies, uncontrolled cohort studies of children with spine deformities due to CP, and age of the CP patient 20 years. The criteria of exclusion were clinical cases, observations, materials of conferences, the patients age 20 years, and neuromuscular scoliosis of another etiology. Results. The review primarily included 156 articles with the publication date of 19902020. Among them, 25 publications met the following criteria of inclusion: 3 systematic reviews and meta-analysis, 3 population studies, 1 multicenter study, 11 controlled cohort studies, 6 uncontrolled cohort studies, and 1 case-control study. Conclusion. Body mass and BMI correlate with the functional activities of children with scoliosis due to CP. GMFCS stratified growth graphs of children with CP are the most appropriate reference indicators for assessing body mass and BMI of children with CP. Underweight body and low BMI (below the 10th percentile) are important factors that contribute to high risk of complications after scoliosis surgical correction. In the future, it will be necessary to develop national special centile tables for the optimal assessment of the anthropometric indicators in children with CP.

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Risk Factors for Wound Infections after Deformity Correction Surgery in Neuromuscular Scoliosis

Cited by 10 publications

References 21 publications

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy?

The current view on the body mass and body mass index of children with spine deformity due to cerebral palsy: a systematic review

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