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The Management and Outcome of Spinal Implant-related Infections in Pediatric Patients: A Retrospective Review

Messina, Allison F. MD*; Berman, David M. DO*; Ghazarian, Sharon R. PhD; Patel, Ravi*; Neustadt, Jeffrey MD; Hahn, Gregory MD; Sibinga, Erica M. S. MD, MHS

Pediatric Infectious Disease Journal: July 2014 - Volume 33 - Issue 7 - p 720–723
doi: 10.1097/INF.0000000000000264
Original Studies

Background: Infection after implantation of spinal rods is a significant complication of this procedure. Optimal treatment of surgical implants often involves device removal. This approach is problematic when treating spinal implant-related infections, because device removal may cause significant morbidity. Medical management of these infections is therefore necessary, but treatment regimens are not standardized. We conducted a retrospective review of pediatric patients with spinal implant-related infections at a regional spinal center for a 6-year period. We describe clinical course, duration of treatment and outcomes.

Methods: We reviewed records of patients with spinal implant-related infections from 2005 to 2010. Data collection included demographics, underlying diagnosis, surgical hardware, timing to infection after implantation, signs and symptoms of infection, duration of antimicrobials, adverse drug events and long-term outcomes.

Results: We enrolled 23 patients with spinal implant infections, aged 8–20 years. Wound drainage was the most common presenting symptom (82.6%). Median time from surgery to first infection was 16 days (range: 8–1052 days). Median length of antimicrobial therapy was 131 days (range: 42–597 days). Seventy eight percent were cured with antibiotics alone with implanted devices retained. Four patients failed medical therapy and required device removal. A wide range of antibiotic duration was used (42 to >597 days). Seven patients (30.4%) experienced at least 1 adverse drug event.

Conclusions: Infection related to spinal instrumentation procedures can be managed medically with long-term antibiotic therapy. Careful monitoring for not only efficacy but also adverse drug events is advised. Further research is needed to determine the optimal duration of antibiotics for spinal implant-related infections.

From the *Department of Pediatrics, Division of Infectious Diseases, All Children’s Hospital, Saint Petersburg, FL; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; and Department of Surgery, All Children’s Hospital, Saint Petersburg, FL.

Accepted for publication December 23, 2013.

S.R.G. discloses that her institution receives grant money (for grants not related to this study) from the National Institutes of Mental Health. G.H. discloses that he receives payment for his services as a consultant from Stryker Spine and Alphatec Spine and royalties from Alphatec Spine. J.N. reports a past relationship with Styker Spine in which he received payment for lectures and teaching and discloses that he does receive royalties from Alphatec Spine for design of spinal implant devices.

The author have no other funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Allison F Messina, MD, All Children’s Hospital, 601 5th St South, OCC Suite 504, Saint Petersburg, FL 33701. E-mail: allison.messina@allkids.org.

© 2014 by Lippincott Williams & Wilkins, Inc.