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Simple Steps to Minimize Spine Infections in Adolescent Idiopathic Scoliosis

Myung, Karen S. MD, PhD*; Glassman, David M. MD; Tolo, Vernon T. MD*; Skaggs, David L. MD, MMM*

Journal of Pediatric Orthopaedics: January 2014 - Volume 34 - Issue 1 - p 29–33
doi: 10.1097/BPO.0b013e31829b2d75

Background: To examine the surgical site infection (SSI) rates in patients undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) after implementation of a change in antibiotic prophylaxis and intraoperative irrigation.

Methods: A retrospective review of all consecutive spinal fusions for AIS from 1996 to 2008 was performed. In 2003, 2 changes in our protocol were implemented: (1) routine antibiotic prophylaxis was changed from cefazolin alone to vancomycin and ceftazidime; (2) intraoperative irrigation technique was changed from bulb syringe to pulse lavage irrigation. We compared the rates of deep SSI requiring irrigation and debridement before institution of these changes (1996 to 2002) to the rates after these changes (2003 to 2008).

Results: Before the change in the antibiotic and lavage regimen, 261 spinal fusions were performed. Of these, 28/261 (11%) patients underwent irrigation and debridement for SSI. The most common infecting pathogen was coagulase-negative Staphylococcus aureus (47%). Between the years 2003 and 2008, 263 spinal fusions were performed. Only 2/263 (0.7%) patients underwent irrigation and debridement for SSI. This decrease in infection rate is highly significant (P<0.001).

Conclusions: Routine use of vancomycin and ceftazidime and pulsatile lavage for posterior spinal fusion in AIS patients decreased the rates of postoperative infection by 10 fold. As 2 variables were changed, it is impossible to know the relative effect of each. However, as spine infections can be so devastating, and the potential risks of these changes are small, we recommend both the new antibiotic and irrigation protocol.

Level of Evidence: Level III.

*Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, CA

Naval Medical Center Portsmouth, Portsmouth, VA

None of the authors received financial support for this study.

This study has been carried out with the approval from the Committee on Clinical Investigations at Children’s Hospital of Los Angeles.

The authors declare no conflict of interest.

Reprints: David L. Skaggs, MD, MMM, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop #69, Los Angeles, CA 90027. E-mail:

© 2014 by Lippincott Williams & Wilkins