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Infection in neuro-muscular scoliosis deformity correction
Shahnawaz Haleem1, John Edwin2, Muhammad A Bashir3
1Division of Spinal Surgery, St. George's University Hospitals NHS Foundation Trust, London, UK.
Insights
Post-operative wound infections are common after neuro-muscular scoliosis (NMS) surgery. A standardized treatment protocol led to a 100% cure rate and successful spinal fusion in all patients.
Area of Science:
- Orthopedics
- Infectious Disease
- Spinal Surgery
Background:
- Post-operative wound infection is a significant complication following spinal deformity correction surgery, particularly in patients with neuro-muscular scoliosis (NMS).
- A standardized treatment protocol is crucial for managing these infections effectively and ensuring favorable patient outcomes.
Purpose of the Study:
- To assess the outcomes of a standardized protocol for treating post-operative wound infections in patients undergoing neuro-muscular scoliosis deformity correction.
- To analyze patient demographics, comorbidities, pathogens, treatment strategies, and outcomes in infected patients.
Main Methods:
- Retrospective review of 443 consecutive patients with neuro-muscular scoliosis (NMS) undergoing primary posterior deformity correction.
- Analysis of 44 patients (9.9%) who developed post-operative wound infections, examining causative pathogens, treatment (antibiotics alone vs. surgical debridement), length of stay, cure rates, and complications.
Main Results:
- Wound infections occurred in 9.9% of patients, with slightly more mono-microbial (23) than poly-microbial (21) infections.
- Staphylococcus species (Coagulase-negative and Staphylococcus aureus) were the most common pathogens.
- Patients treated with antibiotics alone had an average length of stay (LOS) of 12 days, while those requiring surgical debridement had an average LOS of 35 days.
Conclusions:
- Post-operative wound infections are a common challenge in neuro-muscular scoliosis (NMS) deformity correction.
- A defined, standardized treatment strategy, including antibiotics and surgical debridement when necessary, resulted in a 100% cure rate and successful spinal fusion for all patients.
Abstract:
Assess the outcome of a standardised protocol for the treatment of post-operative wound infection in patients undergoing deformity correction for neuro-muscular scoliosis (NMS). Retrospective review of 443 consecutive patients with a minimum 18 months' follow-up, following a primary posterior deformity correction for NMS. In patients who developed a wound complication, the patient demographic and comorbidities, causative pathogen, number of re-operations, length of stay (LOS), rate of cure, and complications were analysed. Forty-four patients (9.9%) developed a wound infection. Marginally more infections were mono-microbial (23) than poly-microbial (21). Coagulase negative staphylococcus and Staphylococcus aureus were the most commonly cultured pathogens. Seventeen patients were treated with antibiotics alone, while 27 patients also required surgical debridement. The average LOS for those treated with antibiotics alone was 12 days (range: 9-15 days), in contrast to those requiring debridement, which was 35 days (range: 35-70 days). All patients were cured from their infection and ultimately achieved fusion. Infection is common in NMS deformity correction. This is marginally more common as a mono-microbial than poly-microbial infection with most pathogens being staphylococcal in origin. Our defined treatment strategy resulted in a cure for all patients and capacity for all patients to achieve fusion.
