A narrative review of infection prevention techniques in adult and pediatric spinal deformity surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

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Seromas Following Pediatric Spinal Deformity Surgery

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000001496 ◽

2020 ◽

Vol 40 (4) ◽

pp. e277-e282

Author(s):

James Yu ◽

Anne M. Dumaine ◽

Connie Poe-Kochert ◽

George H. Thompson ◽

R. Justin Mistovich

Keyword(s):

Spinal Deformity ◽

Spinal Deformity Surgery

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Validity of the global alignment proportion (GAP) score in predicting mechanical complications after adult spinal deformity surgery in elderly patients

European Spine Journal ◽

10.1007/s00586-021-06734-2 ◽

2021 ◽

Author(s):

Dae-Woong Ham ◽

Ho-Joong Kim ◽

Jae Heouk Choi ◽

Jiwon Park ◽

Junpyo Lee ◽

...

Keyword(s):

Elderly Patients ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Global Alignment ◽

Mechanical Complications ◽

Spinal Deformity Surgery ◽

Surgery In Elderly

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Pre-existing vertebral fracture is a risk factor for postoperative proximal junctional fracture after adult spinal deformity surgery: A propensity score-matched analysis

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.01.003 ◽

2021 ◽

Author(s):

Junya Katayanagi ◽

Takahiro Iida ◽

Atsuki Hayamizu ◽

Kazuyuki Matsumoto ◽

Hirokazu Furukawa ◽

...

Keyword(s):

Risk Factor ◽

Vertebral Fracture ◽

Propensity Score ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Spinal Deformity Surgery

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Incidence, Management and Outcome of Delayed Deep Surgical Site Infection Following Spinal Deformity Surgery: 20-Year Experience at a Single Institution

Global Spine Journal ◽

10.1177/2192568220978225 ◽

2020 ◽

pp. 219256822097822

Author(s):

Muyi Wang ◽

Liang Xu ◽

Bo Yang ◽

Changzhi Du ◽

Zezhang Zhu ◽

...

Keyword(s):

Surgical Site Infection ◽

Spinal Deformity ◽

Recurrent Infection ◽

Implant Removal ◽

Site Infection ◽

Initial Surgery ◽

Spinal Deformity Surgery ◽

Solid Fusion ◽

Deep Surgical Site Infection

Study Design: A retrospective study. Objectives: To investigate the incidence, management and outcome of delayed deep surgical site infection (SSI) after the spinal deformity surgery. Methods: This study reviewed 5044 consecutive patients who underwent spinal deformity corrective surgery and had been followed over 2 years. Delayed deep SSI were defined as infection involving fascia and muscle and occurring >3 months after the initial procedure. An attempt to retain the implant were initially made for all patients. If the infection failed to be eradicated, the implant removal should be put off until solid fusion was confirmed, usually more than 2 years after the initial surgery. Radiographic data at latest follow-up were compared versus that before implant removal. Results: With an average follow-up of 5.3 years, 56 (1.1%) patients were diagnosed as delayed deep SSI. Seven (12.5%) patients successfully retained instrumentation and there were no signs of recurrence during follow-up (average 3.4 years). The remaining patients, because of persistent or recurrent infection, underwent implant removal 2 years or beyond after the primary surgery, and solid fusion was detected in any case. However, at a minimum 1-year follow-up (average 3.9 years), an average loss of 9° in the thoracic curve and 8° in the thoracolumbar/lumbar curves was still observed. Conclusions: Delayed deep SSI was rare after spinal deformity surgery. To eradicate infection, complete removal of implant may be required in the majority of delayed SSI. Surgeons must be aware of high likelihood of deformity progression after implant removal, despite radiographic solid fusion.

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