Post-operative infection in early-onset scoliosis

Abstract

Spinal surgery in children under 10 years of age is mainly used to treat deformities that require early short fusion or more commonly to treat deformities that affect a large part of the spine with distraction or growing-based techniques. There is almost no information on the incidence of post-operative infections in children subjected to short arthrodesis. Information on post-operative infections in distraction systems is more abundant but only in relation to its incidence and less in its management and medium- and long-term results. The prevalence of deep postoperative surgical site infection associated with growing-based techniques is higher than that associated with standard spine fusion in adolescents. The reported post-operative infection rate is 5.3–30 % in patients treated with distraction-based rowing systems. Significant risk factors are repeated surgeries and neuromuscular diagnoses such as myelodysplasia and cerebral palsy. Increased risk of post-operative deep infection is also shown to be associated with stainless-steel implants. Treatment for post-operative surgical site infection in children subject to definitive fusion should follow the same guidelines prescribed for adolescents. The treatment of post-operative surgical site infections in children treated with distraction-based systems is more controversial. For deep infections, early debridement and cleansing accompanied by specific antibiotic treatment is the usual treatment. It appears that no deep infection could be permanently controlled without the removal of the instrumentation, but this may interfere with the very nature of growth-friendly surgery. Neuromuscular aetiology and non-ambulatory status increase the likelihood of implant removal to treat the infection. Preventing the infection is the best method of treatment. Best practice guidelines have been established in an attempt to prevent infection in high-risk paediatric spinal surgery.