O2535 LATE POSTOPERATIVE INFECTIONS IN PATIENTS WITH SCOLIOSIS

Abstract

Aim: To present our experience concerning late infections in operated scoliosis. Methods: 118 patients were treated surgically using multiple hook and screw instrumentation systems over the last 10 years. 103 patients had idiopathic (mean age 22.1) and 15 had neuromuscular scoliosis (mean age 12.2 years). All patients were instrumented posteriorly. Bovine xenografts were used were used in all cases where fusion was the goal. Additional anterior fusion was necessary in 8 patients. To date 10 patients (7 idiopathic and 3 neuromuscular) presented late deep wound postoperative infections. None of these patients had signs of generalized septic condition. The latent period of the infection varied from 1 to 5 years. Two patients presented rod failure. Initial pus cultures were negative in 5 patients. A common þnding was pus lining on the instrumentation surface with increased concentration under the cross-links. All patients had at least one loose cross-link nut. Local corrosion of the hardware and metal inþltration of the surrounding tissues was also present. The instrumentation was removed in all cases. All patients but one had satisfactory bony fusion. A variety of pathogens were cultured from intra-operative specimens (5 CNS, 2 A. baumannii, 1 peptostreptococcus, 2 St. epidermidis). A continuous irrigation system was used for 5 days in all patients, combined with antibiotics IV for 7 days and po for 45 days. Results: Protocol treatment was successful in all patients. No recurrence of the infection was observed after the removal of the instrumentation. Conclusions: The exact etiology of those infections seems to be an interesting subject for investigation. The extended surface and bulky nature of the construct are a probable predisposing factor, as is instrumentation failure and loosening. No bone involvement was noticed. Removal of instrumentation appears to be effective treatment.