Orthoracle › Forums › Spine › AIS posterior instrumented scoliosis correction and fusion › Reply To: AIS posterior instrumented scoliosis correction and fusion
A difficult situation, and surprisingly common. The published rates of late deep infection following posterior scoliosis surgery ranges from 2.7-7%.
I do not think there is much role for trying to suppress with antibiotics and it may be more effective to treat aggressively as soon as the infection is identified.
Performing wound debridement will allow sampling for MC+S. It is worth considering that the implants may have a biofilm on. They need to be removed or exchanged. In a young patient with remaining growth potential and fusion not complete on CT, removing the implants is likely to result in recurrence of the curve.
Therefore, I would exchange the implants. I would assess whether the wound is clean enough to allow the at the time of the debridement, or whether it should be staged over a few weeks to minimise risk of new implants becoming infected. She would require IV antibiotics post-operatively, then convert to oral once microbiology advice is available. She may require antibiotics for at least 3 months, and potentially more if the CRP is slow to normalise.
Would you consider anterior fusion if it looks particularly contaminated at time of washout, or multiple staged posterior procedures?