General Session: Pediatric Spine
Presented by: J. Zavatsky - View Audio/Video Presentation (Members Only)
B. Cook(1), D. Briski(1), A. King(2), J. Zavatsky(3)
(1) Ochsner Medical Center, New Orleans, LA, United States
(2) Childrens Hospital New Orleans, New Orleans, LA, United States
(3) Florida Orthopedic Institute, Tampa Bay, FL, United States
Hypothesis: Plastic surgery multilayered wound closure will decrease rates of wound complications, particularly deep space infections and revision surgery. Design: Multicenter retrospective review.
Introduction: Postoperative deep space infections after posterior spinal fusion can be difficult to manage and potentially devastating. The overall rate of infection after posterior spinal fusion has been reported as high as 23% in patients with neuromuscular scoliosis. A multilayered plastic surgery closure decreases potential dead space, protecting the spinal instrumentation. We compared surgically treated neuromuscular scoliosis patients with and without plastic surgery multilayered wound closure.
Methods: All neuromuscular scoliosis patients treated with posterior spinal fusion from 2008 to 2014 were analyzed. Patients with 2-year follow-up and completed charts were reviewed. Patients were categorized into 2 Groups:
Group 1 [Plastic Closure (PC)] - included patients with a multilayered closure and advancement flaps when necessary;
Group 2 - Standard Closure (SC). Differences in demographic, radiographic, and clinical parameters were analyzed.
Results: 50 patients met inclusion criteria for the database, of which 39 had complete 2-year data.
Group 1 had 11 patients, each having a multilayered plastic surgery wound closure.
Group 2 included 28 patients who had a standard wound closure.
There was no difference in age, male gender, number of levels fused, or postop max coronal Cobb angles between the Groups (Table 1).
There was a significant difference in deep space infections (0 vs 7, p=0.0057), revision surgeries (0 vs 7, p=0.0057), EBL (2425 vs 644cc, p= 1.46E-06), OR time (467 vs 245 min, p=1.97E-08), iliac screw fixation (58% v. 21%, p=0.022), and preop max coronal Cobb angle (58.29 vs 71.99°, p=0.043) in the PC vs SC Groups, respectively.
Conclusion: Plastic surgery closure resulted in a statistically significant decrease in infection and revision surgery rates despite this patient cohort having significant increases in blood loss, operative time, and iliac screw fixation, all of which have been shown to increase the risk of infection. Utilizing a plastic surgery closure can reduce dead space, providing better soft-tissue coverage of the spinal instrumentation reducing infections and revision surgery rates.