Sealing the Deal: Incisional Vacuum Assisted Closure Following Neuromuscular Posterior Spinal Fusion is Associated...

Surgical site infection (SSI) after posterior spinal fusion (PSF) to correct neuromuscular scoliosis is a devastating complication in pediatric patients. Incisional Vacuum-Assisted Closure (iVAC) is a method used for wound management, especially in high-risk surgical wounds. Pediatric neuromuscular patients are at high risk for infection or wound complications following spinal deformity correction. The goal of this study was to evaluate the effectiveness of iVAC therapy after PSF in pediatric neuromuscular scoliosis in preventing wound dehiscence and SSI as measured by the metric of unplanned return to the OR for infection in <90 days from the date of surgery.

We reviewed all nonambulatory patients with neuromuscular scoliosis who underwent PSF at a single, large tertiary care pediatric hospital from 2019 to 2024. Ambulatory patients with neuromuscular disease were excluded. During this period of time, a consistent SSI prevention protocol was active and remained similar for all spine surgeons at our institution. Patients were placed into 1 of 2 groups based on whether they had an iVAC placed at the index procedure, and postoperative outcomes were examined.

A total of 134 patients [71 (53%) male and 63 (47%) female] with a mean age of 13.5±3.1 years at the time of surgery were included. Unplanned return to the operating room (UPROR) for suspected infection (<90 d) occurred among 7 (7.3%) patients with iVAC versus 8 (21.0%) without. UPROR was 2.9 times higher without iVAC ( P =0.023). Only one (2.2%) patient faced infection among those sent home with the iVAC [ P =0.020 (vs. either iVAC in the hospital or no iVAC)]. The number needed to treat with iVAC treatment to prevent one UPROR was 7.3.

iVAC is a clinically useful, low-cost, low-morbidity tool in the fight against NM infection. Any duration of use of the iVAC following neuromuscular PSF appears to be associated with a lower incidence of infection.

Level III.