Journal of Clinical Orthopaedics

Authors: Vishal Kumar [1], Manuj Jain [4], Aditya Gupta [1], Arvind Vatkar [2], Deepshikha [3], Sarvdeep Singh Dhatt [1], Sachin Kale [5]

[1] Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India,

[2] Department of Orthopaedics, Base Hospital, Bagdogra, West Bengal, Department of Orthopaedics,

[3] MGM Medical College, Mumbai, Maharashtra, India,

[4] Department of Physical Medicine and Rehabilitation, Postgraduate Institute of Medical Education and Research, Chandigarh, India,

[5] Department of Orthopaedics, Dr D Y Patil School of Medicine, Mumbai, Maharashtra, India.

Address of Correspondence:
Dr. Vishal Kumar, Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India, E-mail: drkumarvishal@gmail.com

Article Received : 2025-10-02,

Article Accepted : 2025-11-23

This meta-analysis aims to evaluate the incidence, risk factors, and clinical outcomes of late infections in scoliosis patients following spinal instrumentation. A systematic review of studies indexed in PubMed, Embase, and Scopus databases was conducted. Studies that focused on scoliosis patients with late-developing infections, particularly after surgical treatment involving spinal instrumentation, were included. Data on infection rates, risk factors such as patient age and comorbidities, surgical techniques, and clinical outcomes were extracted and analyzed. Statistical methods, including pooled incidence rates and subgroup analysis, were used to assess the significance of the findings. The incidence of late infections varied significantly across different scoliosis types, with idiopathic scoliosis showing lower infection rates compared to neuromuscular scoliosis. Key risk factors identified included the duration of surgery, the use of prophylactic antibiotics, and patient comorbidities, particularly obesity. Late infections were often associated with a higher rate of reoperations, hardware removal, and prolonged antibiotic therapy. Late infections following spinal instrumentation in scoliosis patients remain a significant concern, with certain patient populations at higher risk. Early detection and preventive strategies are essential to mitigate these risks and improve clinical outcomes. Future research should focus on standardizing infection prevention protocols and long-term monitoring of scoliosis patients post-surgery.

Keywords: Late infection, scoliosis, spinal instrumentation, meta-analysis, risk factors, post-operative complications, neuromuscular scoliosis, idiopathic scoliosis.

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References

1.
Kumar V, Gupta A, Deepshikha. Late infection in scoliosis: A meta-analysis. Spine J 2024;1:11-4. [Google Scholar]
2.
Clark CE, Shufflebarger HL. Late-developing infection in instrumented idiopathic scoliosis. Spine (Phila Pa 1976) 1999;24:1909-12. [Google Scholar]
3.
Di Silvestre M, Bakaloudis G, Lolli F, Giacomini S. Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. Eur Spine J 2011;20 Suppl 1:S121-7. [Google Scholar]
4.
Soultanis K, Mantelos G, Pagiatakis A, Soucacos PN. Late infection in patients with scoliosis treated with spinal instrumentation. Clin Orthop Relat Res 2003;411:116-23. [Google Scholar]
5.
Hahn F, Zbinden R, Min K. Late implant infections caused by Propionibacterium acnes in scoliosis surgery. Eur Spine J 2005;14:783-8. [Google Scholar]
6.
Richards BR, Emara KM. Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: Revisited. Spine (Phila Pa 1976) 2001;26:1990-6. [Google Scholar]
7.
Viola RW, King HA, Adler SM, Wilson CB. Delayed infection after elective spinal instrumentation and fusion. A retrospective analysis of eight cases. Spine (Phila Pa 1976) 1997;22:2444-50; discussion 2450-1. [Google Scholar]
8.
Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG. Deep wound infections after neuromuscular scoliosis surgery: A multicenter study of risk factors and treatment outcomes. Spine (Phila Pa 1976) 2000;25:2461-6. [Google Scholar]
9.
Rihn JA, Lee JY, Ward WT. Infection after the surgical treatment of adolescent idiopathic scoliosis: Evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine (Phila Pa 1976) 2008;33:289-94. [Google Scholar]
10.
Shen J, Liang J, Yu H, Qiu G, Xue X, Li Z. Risk factors for delayed infections after spinal fusion and instrumentation in patients with scoliosis. J Neurosurg Spine 2014;21:648-52. [Google Scholar]
11.
Mackay DC, Gibson MJ. Late Wound Infection Following Posterior Scoliosis Surgery. In: Orthopaedic Proceedings. Vol. 85. The British Editorial Society of Bone & Joint Surgery; 2003. p. 198. [Google Scholar]
12.
Kabirian N, Akbarnia BA, Pawelek JB, Alam M, Mundis GM Jr., Acacio R, et al. Deep surgical site infection following 2344 growing-rod procedures for early-onset scoliosis: Risk factors and clinical consequences. J Bone Joint Surg Am 2014;96:e128. [Google Scholar]
13.
Aleissa S, Parsons D, Grant J, Harder J, Howard J. Deep wound infection following pediatric scoliosis surgery: Incidence and analysis of risk factors. Can J Surg 2011;54:263-9. [Google Scholar]
14.
Marks MC, Newton PO, Bastrom TP, Betz RR, Sponseller PD, Lonner B, et al. Surgical site infection in adolescent idiopathic scoliosis surgery. Spine Deform 2013;1:352-8. [Google Scholar]
15.
Mueller FJ, Gluch H. Adolescent idiopathic scoliosis (AIS) treated with arthrodesis and posterior titanium instrumentation: 8 to 12 years follow up without late infection. Scoliosis 2009;4:16. [Google Scholar]
16.
Garg S, LaGreca J, Hotchkiss M, Erickson M. Management of late (>1 y) deep infection after spinal fusion: A retrospective cohort study. J Pediatr Orthop 2015;35:266-70. [Google Scholar]
17.
Cook S, Asher M, Lai SM, Shobe J. Reoperation after primary posterior instrumentation and fusion for idiopathic scoliosis. Toward defining late operative site pain of unknown cause. Spine (Phila Pa 1976) 2000;25:463-8. [Google Scholar]
18.
Beguiristain J, Del Rio J, Duart J, Barroso J, Silva A, Villas C. Corrosion and late infection causing delayed paraparesis after spinal instrumentation. J Pediatr Orthop B 2006;15:320-3. [Google Scholar]
19.
Pizones J, Sanchez-Perez-Grueso FJ, Thompson GH. Postoperative infection in early-onset scoliosis. In: The Growing Spine Management of Spinal Disorders in Young Children. Germany: Springer; 2022. p. 569-78. [Google Scholar]
20.
Myung KS, Glassman DM, Tolo VT, Skaggs DL. Simple steps to minimize spine infections in adolescent idiopathic scoliosis. J Pediatr Orthop 2014;34:29-33. [Google Scholar]
21.
Katyal C, Grossman S, Dworkin A, Singer L, Amaral T, Sugarman E, et al. Increased risk of infection in obese adolescents after pedicle screw instrumentation for idiopathic scoliosis. Spine Deform 2015;3:166-71. [Google Scholar]
22.
Ramo BA, Roberts DW, Tuason D, McClung A, Paraison LE, Moore HG 4th, et al. Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: A thirty-year experience at a single institution. J Bone Joint Surg Am 2014;96:2038-48. [Google Scholar]
23.
Kamath VH, Cheung JP, Mak KC, Wong YW, Cheung WY, Luk KD, et al. Antimicrobial prophylaxis to prevent surgical site infection in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion: 2 doses versus antibiotics till drain removal. Eur Spine J 2016;25:3242-8. [Google Scholar]

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How to Cite This Article: Kumar V, Jain M, Gupta A, Vatkar A, Deepshikha, Dhatt SS, Kale S. Late Infection in Scoliosis: A Meta-Analysis. Journal of Clinical Orthopaedics 2025 December, 10(12): 61-69.

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