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Late spinal infections are more common after pediatric than after adult spinal deformity surgery
Ijezie Ikwuezunma1, Graham J Beutler1, Adam Margalit1
1Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA.
Insights
Late spinal infections are significantly more common in pediatric patients than adults following spinal fusion surgery. The most frequent culprits are skin and indolent microorganisms, such as Propionibacterium.
Area of Science:
- Spine surgery
- Infectious disease
- Orthopedics
Background:
- Late spinal infections, occurring ≥6 months post-operation, pose a challenge in spinal deformity correction.
- Understanding the differences in incidence and microbiology between pediatric and adult patients is crucial for effective management.
Purpose of the Study:
- To compare the incidence, timing, and microbiologic factors of late spinal infections in pediatric versus adult patients undergoing instrumented posterior spinal fusion (PSF).
Main Methods:
- Retrospective review of 1260 patients (755 pediatric, 505 adult) who underwent instrumented PSF for spinal deformity (2000-2015).
- Inclusion criteria: >12-month follow-up, ≥4 levels fused, idiopathic or degenerative deformity.
- Statistical comparison of infection rates, timing, and causative agents using chi-squared and Fisher exact tests.
Main Results:
- Late spinal infection incidence was higher in pediatric (3.7%) versus adult (0.39%) patients (p=0.009).
- Mean onset was similar (pediatric: 4.2 years, adult: 4.0 years).
- Pediatric patients had more levels fused (10 vs. 8.4), while adults had greater blood loss (2085 vs. 796 mL). Propionibacterium and coagulase-negative staphylococci were common in both groups.
Conclusions:
- Late spinal infections are significantly more prevalent in pediatric patients after instrumented PSF for spinal deformity compared to adults.
- Indolent microorganisms, particularly skin-related bacteria, are the primary identified pathogens in both pediatric and adult late spinal infections.
Purpose:
To compare the incidence, timing, and microbiologic factors associated with late spinal infection (onset ≥ 6 months after index operation) in pediatric versus adult spinal deformity patients who underwent instrumented posterior spinal fusion (PSF).
Methods:
We retrospectively queried our institutional database for pediatric (aged ≤ 21 years) and adult patients who underwent instrumented PSF from 2000 to 2015. Inclusion criteria were > 12-month follow-up, spinal arthrodesis spanning 4 or more levels, and idiopathic or degenerative spinal deformity. We included 1260 patients (755 pediatric, 505 adult). Incidence, timing, and microbiologic and operative parameters of late spinal infections were compared using chi-squared and Fisher exact tests. Alpha = 0.05.
Results:
Late spinal infection occurred in 28 (3.7%) pediatric and 2 (0.39%) adult patients (p = 0.009). Mean onset of infection was 4.2 years (range 0.7-12) in pediatric patients and 4.0 years (range 0.7-7.3) in adults (p = 0.93). Pediatric patients underwent arthrodesis spanning more levels (mean ± standard deviation, 10 ± 2.0) compared with adults (8.4 ± 3.3) (p < 0.001). Adults experienced greater intraoperative blood loss (2085 ± 1491 mL) compared with pediatric patients (796 ± 452 mL) (p < 0.001). Culture samples yielded positive growth in 11 pediatric and 2 adult cases. Propionibacterium and coagulase-negative staphylococci were the most commonly detected microorganisms in both cohorts.
Conclusion:
Late spinal infections were significantly more common in pediatric patients than in adults after instrumented PSF for spinal deformity. Skin and indolent microorganisms were the primary identifiable causative bacteria in both cohorts.
Level Of Evidence:
III.
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