A narrative review of infection prevention techniques in adult and pediatric spinal deformity surgery

Spinal infections associated with pediatric and adult spinal deformity surgery are associated with postoperative morbidity and mortality along with elevated health-care costs. Prevention requires meticulous technique by the spine surgeon throughout the perioperative period. There is significant variability in the current practices of spinal deformity surgeons with regard to infection prevention, stemming from the lack of reliable evidence available in the literature. There has also been a lack of literature detailing the difference in infection rates and risk factors between pediatric and adult patients undergoing deformity correction surgery. In this narrative review we looked at 60 studies in the adult population and 9 studies in the pediatric population. Most of these studies of surgical site infections (SSI) in spinal deformity surgery have been performed in adult patients, however it is clear that the pediatric neuromuscular patient requires particular attention that we discuss in detail. This narrative review of the literature outlines evidence and compares and contrasts data for preventive strategies and modifiable risk factors to decrease rates of SSI in the pediatric and adult spinal deformity patient populations. In this review we discuss techniques relating to preoperative cleansing protocols, antibiotic administration, gentle soft tissue handling, appropriate closure, drain usage, and intraoperative technique itself to minimize EBL and operative time.