ABSTRACT
<p><b>BACKGROUND</b>Wound infection following spinal instrumented surgery is a frequent complication. The optimal treatment of acute deep wound infection following spinal instrumentation fusion remains controversial because of variability in cohort identification, definition of an infection, and the instrument used to measure outcomes. This retrospective study evaluated the clinical curative effect for postoperative spinal infection after instrumented spine fusion with extensive debridement, or implant removal.</p><p><b>METHODS</b>From January 2004 to October 2009, 851 patients were identified who underwent surgical treatment of spinal diseases. The medical records of patients who developed infections were reviewed in detail.</p><p><b>RESULTS</b>Of 851 patients, 41 (4.9%) developed an infection. Thirty-three were acute, and eight were delayed. Acute infected cases were managed with antibiotic therapy, and aggressive debridement of the wound and soft tissues leaving all instrumentation in situ in all but one patient. The most common symptoms of acute infection included: posterior incisional drainage (26 of 33 patients), back pain (22 of 33 patients) and fever (13 of 33 patients). Among patients with delayed onset infection, five of eight patients had local pain, four of eight patients had incision drainage, and one patient had a prolonged period of intermittent fever. The most frequent causative organism for postoperative spinal infection following spine surgery is Staphylococcus aureus. Pseudarthrosis was noted in long-term follow-up in four of 41 patients.</p><p><b>CONCLUSIONS</b>We recommend irrigation and debridement, no instrumentation removal, and, if necessary, repeat debridement followed by delayed primary closure for the treatment of acute deep infection with instrumentation.</p>
Subject(s)
Female , Humans , Male , Debridement , Retrospective Studies , Surgical Wound Infection , Diagnosis , Drug Therapy , General SurgeryABSTRACT
<p><b>BACKGROUND</b>There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic alignment in adult idiopathic scoliosis patients is poorly defined. This study was conducted to evaluate the sagittal alignment of pelvis and spine in adult idiopathic scoliosis patients.</p><p><b>METHODS</b>The sagittal parameters of the spine and pelvis were analyzed in lateral standing radiographs of 124 patients (mean age 47.4 years) with adult idiopathic scoliosis, including thoracic kyphosis (TK), thoracolumbar junction kyphosis (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT) and C7 plumb line (C7PL). The patients were divided into three groups according to the age: 20 - 40 years, 41 - 64 years, and ≥ 65 years. The parameters were compared with those in normal adults and adolescent idiopathic scoliosis (AIS) patients. The relationship between all parameters as well as age and sagittal parameters were analyzed.</p><p><b>RESULTS</b>The PI in patients with adult idiopathic scoliosis was 58.1° ± 13.0°, which was significantly higher than that in normal adults. The PT (19.9° ± 10.6°) was also higher than that in both normal adults and AIS patients, while the SS (38.1° ± 12.0°) was similar or smaller. As age increased, C7PL, PT and TJL increased while LL decreased. There was no relationship between age and both PI and TK. PT had the strongest statistical association with the C7PL.</p><p><b>CONCLUSIONS</b>PI is higher in adult idiopathic scoliosis than normal subjects. The PT is the most relevant pelvic parameter to the global sagittal alignment of the spine. Age significantly influences sagittal parameters of the spine and pelvis except the PI and TK.</p>