Deep wound infections after neuromuscular scoliosis surgery

A multicenter study of risk factors and treatment outcomes

Paul David Sponseller, Dawn Mitzner Laporte, M. W. Hungerford, K. Eck, K. H. Bridwell, L. G. Lenke

Research output: Contribution to journalArticle

Abstract

Study Design. A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. Objectives. To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment. Summary of Background Data. No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients. Methods. After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal. Results. Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative Staphylococcus, Enterobacter, Enterococcus, and Escherichia coli. Debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012). Conclusions. Patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. Patients in whom infection develops are then at increased risk for pseudarthrosis.

Original languageEnglish (US)
Pages (from-to)2461-2466
Number of pages6
JournalSpine
Volume25
Issue number19
DOIs
StatePublished - Oct 1 2000

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Scoliosis
Wound Infection
Multicenter Studies
Debridement
Infection
Meningomyelocele
Cerebral Palsy
Pseudarthrosis
Allografts
Therapeutics
Orthopedic Procedures
Enterobacter
Coagulase
Enterococcus
Wounds and Injuries
Coinfection
Staphylococcus
Case-Control Studies
Drainage
Escherichia coli

Keywords

  • Cerebral palsy
  • Deep infection complications
  • Myelomeningocele
  • Pseudarthrosis
  • Scoliosis surgery

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Deep wound infections after neuromuscular scoliosis surgery : A multicenter study of risk factors and treatment outcomes. / Sponseller, Paul David; Laporte, Dawn Mitzner; Hungerford, M. W.; Eck, K.; Bridwell, K. H.; Lenke, L. G.

In: Spine, Vol. 25, No. 19, 01.10.2000, p. 2461-2466.

Research output: Contribution to journalArticle

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AU - Sponseller, Paul David

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AU - Eck, K.

AU - Bridwell, K. H.

AU - Lenke, L. G.

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