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Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

  • Symposium: Pediatric Spine
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Infection is a serious complication of surgery to correct scoliosis in patients with cerebral palsy (CP). We obtained multicenter representative figures for deep and superficial infection rates, analyzed risk factors and treatment outcomes, and compared deformity correction relative to infection. We retrospectively reviewed 157 patients who had posterior spinal fusion for CP at one of eight centers. Preoperative and intraoperative variables were subjected to multivariate analysis to determine factors predictive of infection. There were 16 wound infections (10%; nine deep, seven superficial). Only two study factors predicted infection: higher preoperative white blood cell count (8.5 versus 6.4 [in those without infection] × 103) and use of a unit rod (15% versus 5% for bent rods). Fourteen patients underwent irrigation and débridement procedures. Five infections required 2 months or longer to resolve. Two had implant removal. Final curve correction was lower for those with deep infections than those without (67% versus 53%, respectively). We noted a trend toward greater percentages of pain at last followup in those with deep infection than in those without infection (50% versus 18%, respectively) but the study was not adequately powered to confirm this point. Our infection rate in scoliosis surgery for CP was higher than that for most elective spinal deformity surgery.

Level of Evidence: Level III, retrospective case-control study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the following additional surgeons for contributing patients to the study: Daniel Sucato, MD, James Guille, MD, Harry Shufflebarger, MD, Lawrence Lenke, MD, Jurgen Harms, MD, Keith Bridwell, MD, Freeman Miller, MD, Kirk W. Dabney, MD, and Randal R. Betz, MD.

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Authors and Affiliations

  1. The Johns Hopkins Medical Institutions, 601 North Caroline St #5212, Baltimore, MD, 21287-0882, USA

    Paul D. Sponseller MD

  2. Alfred I duPont Institute, Wilmington, DE, USA

    Suken A. Shah MD

  3. University of Virginia, Charlottesville, VA, USA

    Mark F. Abel MD

  4. Rady Children’s Hospital, San Diego, CA, USA

    Peter O. Newton MD & Michelle Marks MS, PT

  5. Klinikum Karlsbad, Langensteinbach, Karlsbad, Germany

    Lynn Letko MD

Authors
  1. Paul D. Sponseller MD
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  2. Suken A. Shah MD
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  3. Mark F. Abel MD
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  4. Peter O. Newton MD
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  5. Lynn Letko MD
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  6. Michelle Marks MS, PT
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Corresponding author

Correspondence to Paul D. Sponseller MD.

Additional information

One or more authors (PDS, SAS, MFA, PON, LL, MM) received funding from DePuy Spine, Inc through unrestricted support of the Harms Study Group.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Johns Hopkins Medical Institutions, Baltimore, MD, the Alfred I duPont Institute, Wilmington, DE, the University of Virginia, Charlottesville, VA, the Rady Children’s Hospital, San Diego, CA, and the Klinikum Karlsbad, Langensteinbach, Germany.

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Sponseller, P.D., Shah, S.A., Abel, M.F. et al. Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment. Clin Orthop Relat Res 468, 711–716 (2010). https://doi.org/10.1007/s11999-009-0933-4

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  • DOI: https://doi.org/10.1007/s11999-009-0933-4

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