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Can magnetically controlled growing rods be successfully salvaged after deep surgical site infection?
Krishna V Suresh1, Majd Marrache1, Jaime Gomez2
1Department of Orthopaedic Surgery, Johns Hopkins University Hospital, 601 North Caroline Street, JHOC 5230, Baltimore, MD, 21287, USA.
Purpose:
The purpose is to compare the rate of recurrent deep wound infection in patients who retained MCGRs versus those who underwent implant removal and exchange following index deep wound infection.
Methods:
Using a multicenter registry, we identified patients with EOS who underwent surgical correction with MCGR. We defined deep SSI as any infection that required subsequent I&D and antibiotic therapy. Recurrent infection was defined as any additional deep SSI following treatment of index deep infection. We considered MCGR to be salvaged if implant exchange or removal was not performed for at least 1 year following date of infection. Bivariate statistical analyses were performed.
Results:
992 EOS patients were identified, of whom 33 (3.3%) developed deep SSI. The mean time between initial surgery and first deep SSI was 13.1 months (Interquartile range [IQR]: 1 to 25 months. Infection rates by EOS diagnosis were as follows: 13/354 patients (3.6%) had neuromuscular scoliosis (NMS), 9/225 (4.0%) syndromic, 6/248 (2.4%) idiopathic, 3/135 congenital (2.2%), and 2/30 (6.6%) unknown etiology. MCGR was salvaged in 69% of NMS patients, 77% of syndromic patients, 100% of congenital patients, and 83% of idiopathic patients (83%). There were only four recurrent infections (2/13 NMS, 2/9 syndromic) and no differences in rates of recurrent infection between salvaged or replaced/exchanged MCGR. (p = 0.97).
Conclusion:
Deep wound infection occurred in 3% of MCGR patients at a mean of 13.1 months. There were no significant differences in rates of recurrent infection between salvaged implants and those removed or exchanged.
Insights
Retained Mehta-Cobb Spinal Instrumentation (MCGR) showed similar recurrent deep wound infection rates compared to removal and exchange after initial deep surgical site infections (SSI). Salvaging MCGR is a viable option with comparable outcomes to revision surgery.
Area of Science:
- Spine Surgery
- Infectious Disease
- Orthopedic Implants
Background:
- Deep surgical site infections (SSI) following spinal instrumentation pose a significant challenge.
- Management options include implant retention (salvage) or removal and exchange.
- Recurrent infection rates and outcomes for retained versus revised implants require further investigation.
Purpose of the Study:
- To compare the rate of recurrent deep wound infection in patients who retained Mehta-Cobb Spinal Instrumentation (MCGR) versus those who underwent implant removal and exchange.
- To evaluate the efficacy of salvaging MCGR following an index deep wound infection.
Main Methods:
- A multicenter registry identified patients with early-onset scoliosis (EOS) who underwent surgical correction with MCGR.
- Deep SSI was defined as infection requiring incision and drainage (I&D) and antibiotic therapy.
- Recurrent infection was defined as an additional deep SSI after treatment of the index infection. MCGR salvage was defined as no removal/exchange for at least one year post-infection.
Main Results:
- Of 992 EOS patients, 33 (3.3%) developed deep SSI.
- MCGR was salvaged in 69-100% of patients across different EOS etiologies.
- There were only four recurrent infections, with no significant difference in recurrent infection rates between salvaged and replaced/exchanged MCGR (p=0.97).
Conclusions:
- Deep wound infection occurred in 3% of MCGR patients, with a mean time to infection of 13.1 months.
- Salvaging MCGR is associated with similar rates of recurrent infection compared to implant removal and exchange.
- These findings suggest that retaining MCGR is a safe and effective management strategy following deep surgical site infections.
