Late spinal infections following posterior spinal fusion in pediatric deformities: treatment using single-stage titanium implant exchange.

PURPOSE: Late infection following posterior spinal fusion (PSF) for deformity is a leading cause of revision. The purpose of this study is to evaluate clinical and radiographic outcomes following a single-stage debridement and exchange of spinal implants with titanium in adolescent patients with late-onset infections following PSF METHODS: A retrospective review of prospectively collected data of adolescent patients with spinal deformity, who were surgically treated with PSF was collected. Patients were included for the study if they developed late arising infection (> 1 year after index posterior fusion for the deformity) from 2006-2019. Treatment consisted of irrigation, debridement, implant exchange with titanium screws and rods, and antibiotics. Parameters evaluated include radiographic Cobb angles, operative data, and clinical data, all at minimum 2-year follow-up.

RESULTS: 31 patients (29 with AIS and 2 with Scheuermann's kyphosis) developed late spinal infections. Mean age was 11.4 ± 2.3 years, 84% female, mean time from index surgery was 52.5 months. 25 had all stainless steel implants and 6 had cobalt chrome during the index procedure. Positive cultures were obtained in 5 patients (2 Staphylococcus Aureus, 1 Staphylococcus epidermidis, 1 Peptostreptococcus, 1 Pseudomonas aeruginosa) with cultures followed till 7 days post-operatively. At 2-years following the exchange, there was no change in coronal and sagittal alignment. Three (9%) patients developed subsequent infection necessitating implant removal.

CONCLUSION: A single-stage procedure consisting of implant removal, irrigation, and debridement, and replacement with all titanium implants is an effective treatment strategy in patients developing late wound infection following PSF with regards to maintenance of curve correction and minimizing recurrent infections.