Complications of infection in pediatric spine surgery

Abstract

Pediatric spinal surgery postoperative infections are highly variable, ranging from acute postoperative infections necessitating urgent, and probably repeated, irrigation and debridement with retention of spinal implants to delayed, insidious-appearing infections that smolder. Appreciation of the pathophysiology, bacterial organisms, risk factors and preventative measures are paramount in minimizing not only potentially devastating individual patient outcomes but also in recognizing the tremendous economic burden placed on our healthcare system. The history, physical examination, laboratory values and radiographic imaging of these delayed infections can be underwhelming. Awareness and heightened clinical suspicion must be maintained in order to accurately diagnose these surgical site infections. Experience and keen clinical intuition effectively preserve the ultimate goals of pediatric spinal surgery, mainly halting the progression of deformity and safely correcting existing deformity, allowing physiologic musculoskeletal and other visceral functions to occur. With timely diagnosis, surgical debridement, hardware removal with or without reinstrumentation and fusion, and guided antimicrobial therapy can affect good outcomes.