The Journal of Bone and Joint Surgery, Vol 77, Issue 4 524-529, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis
BS Richards
Texas Scottish Rite Hospital for Children, Dallas 75219, USA.
Ten patients who had been managed with posterior spinal arthrodesis and
Texas Scottish Rite Hospital instrumentation because of idiopathic
scoliosis had a delayed deep wound infection at an average of twenty-five
months after the operation. The signs of infection included spontaneous
drainage in eight patients and fluctuance in two patients. In addition, six
patients--including five of the eight who had drainage--had mild pain in
the back. The average erythrocyte sedimentation rate was thirty-nine
millimeters per hour (range, nineteen to eighty-one millimeters per hour).
The instrumentation was removed from all of the patients. In two patients,
a pseudarthrosis that had not been noted on preoperative radiographs was
noted intraoperatively; in both patients, the pseudarthrosis occurred at a
level at which two hooks had been placed in one intervertebral space.
Primary closure was performed in seven patients, and delayed primary
closure was performed on the third postoperative day in three patients. All
wounds healed uneventfully. Cultures of specimens taken from deep within
the wound were positive for Propionibacterium acnes (five patients),
Staphylococcus epidermidis (two patients), a rare coagulase-negative
Staphylococcus species (one patient), or Micrococcus varians (one patient).
No organisms grew on culture of the specimen obtained from the remaining
patient. Propionibacterium acnes required an extended period of incubation
before identification. Antibiotics were administered parenterally to all of
the patients after the removal of the hardware, and this treatment was
followed by oral administration of antibiotics for nine of the patients. We
suspect--but can not prove--that several of the delayed infections resulted
from intraoperative seeding and remained subclinical for an extended period
of time.
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
