Abstract
One hundred and one consecutive adolescent scoliosis patients instrumented from the posterior between 1995 and 2002, with a minimum follow-up of 24 months (maximum 106 months), were reviewed for incidence of infection. Stainless steel implants with pedicle screws were used in the thoracic and lumbar spine of all patients. All were operated on by a single surgeon. There were no early infections. Incidence of late infection was 6.9% (seven patients). Clinical indicators for infection were the sudden onset of local pain and swelling without fever after an initial pain-free interval. There were no reliable laboratory parameters. Normal CRP and ESR did not rule out a late infection. Extended cultures were done from intraoperative swabs. Propionibacterium acnes was found in six patients. There were no other organisms identified. No causative organism could be identified in one patient, despite extended cultures. All patients were successfully treated with implant removal and antibiotic therapy for 4–9 weeks. No pseudarthrosis was seen on implant removal. Despite bony fusion, loss of correction between 10° and 26° was observed in three patients after implant removal.
Similar content being viewed by others
References
Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M (1996) Influence of materials for fixation implants on local infection. An experimental study of steel versus titanium DCP in rabbits. J Bone Joint Surg Br 78:647–651
Barth E, Myrvik QM, Wagner W, Gristina AG (1989) In vitro and in vivo comparative colonization of Staphylococcus aureus and Staphylococcus epidermidis on orthopaedic implant materials. Biomaterials 10:325–328
Bose B (2003) Delayed infection after instrumented spine surgery: case reports and review of the literature. Spine J 3:394–399
Clark CE, Shufflebarger HL (1999) Late-developing infection in instrumented idiopathic scoliosis. Spine 24:1909–1912
Cook S, Asher M, Lai SM, Shobe J (2000) Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause. Spine 25:463–468
Dietz FR, Koontz FP, Found EM, Marsh JL (1991) The importance of positive bacterial cultures of specimens obtained during clean orthopaedic operations. J Bone Joint Surg Am 73:1200–1207
Dubousset J, Shufflebarger HL, Wenger D (1994) Late “infection” with CD instrumentation. Orthop Trans 18:121–128
Eady EA, Ingham E (1994) Propionibacterium acnes—friend or foe? Rev Med Microbiol 5:163–173
Fishbach RS, Rosenblatt JE, Dahlgren JG (1973) Pyogenic vertebral osteomyelitis in heroin addicts. Calif Med 119:1–4
Gaine WJ, Andrew SM, Chadwick P, Cooke E, Williamson JB (2001) Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction? Spine 26:583–587
Genster HG, Andersen MJ (1972) Spinal osteomyelitis complicating urinary tract infection. J Urol 107:109–111
Hatch RS, Sturm PF, Wellborn CC (1998) Late complication after single-rod instrumentation. Spine 23:1503–1505
Heggeness MH, Esses SI, Errico T, Yuan HA (1993) Late infection of spinal instrumentation by hematogenous seeding. Spine 18:492–496
Ido K, Shimizu K, Nakayama Y, Shikata J, Matsushita M, Nakamura T (1996) Suction/irrigation for deep wound infection after spinal instrumentation: a case study. Eur Spine J 5:345–349
Jakab E, Zbinden R, Gubler J, Ruef C, von Graevenitz A, Krause M (1996) Severe infections caused by Propionibacterium acnes: an underestimated pathogen in late postoperative infections. Yale J Biol Med 69:477–482
Johansson A, Lindgren JU, Nord CE, Svensson O (1999) Material and design in haematogenous implant-associated infections in a rabbit model. Injury 30:651–657
Richards BR, Emara KM (2001) Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: revisited. Spine 26:1990–1996
Richards BS (1995) Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 77:524–529
Robertson PA, Taylor TK (1993) Late presentation of infection as a complication of Dwyer anterior spinal instrumentation. J Spinal Disord 6:256–259
Sanfilippo AM, Barrio V, Kulp-Shorten C, Callen JP (2003) Common pediatric and adolescent skin conditions. J Pediatr Adolesc Gynecol 16:269–283
Sanzen L, Linder L (1995) Infection adjacent to titanium and bone cement implants: an experimental study in rabbits. Biomaterials 16:1273–1277
Sheehan E, McKenna J, Mulhall KJ, Marks P, McCormack D (2004) Adhesion of Staphylococcus to orthopaedic metals, an in vivo study. J Orthop Res 22:39–43
Soultanis K, Mantelos G, Pagiatakis A, Soucacos PN (2003) Late infection in patients with scoliosis treated with spinal instrumentation. Clin Orthop 411:116–123
Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG (2000) Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 25:2461–2466
Thomas KA, Cook SD, Harding AF, Haddad RJ Jr (1988) Tissue reaction to implant corrosion in 38 internal fixation devices. Orthopedics 11:441–451
Viola RW, King HA, Adler SM, Wilson CB (1997) Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine 22:2444–2450; discussion 2450–2441
Wiesseman GJ, Wood VE, Kroll LL, Linda L (1973) Pseudomonas vertebral osteomyelitis in heroin addicts. Report of five cases. J Bone Joint Surg Am 55:1416–1424
Wimmer C, Gluch H (1998) Aseptic loosening after CD instrumentation in the treatment of scoliosis: a report about eight cases. J Spinal Disord 11:440–443
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hahn, F., Zbinden, R. & Min, K. Late implant infections caused by Propionibacterium acnes in scoliosis surgery. Eur Spine J 14, 783–788 (2005). https://doi.org/10.1007/s00586-004-0854-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-004-0854-6