|
Year |
2002 |
|---|---|
|
Question Number |
54 |
|
Category |
Pediatric Orthopaedics |
Question
A 15-year-old boy has evidence of a solid fusion mass following posterior spinal instrumentation for idiopathic scoliosis. The patient was asymptomatic until 13 months postoperatively, at which time he noted mild back pain with a 1-week history of an enlarging fluctuant mass in the caudal midline scar. He has no fever or headache and is neurologically intact. Aspiration of the mass reveals purulent fluid with a negative Gram stain. Management should consist of administration of antibiotics and
1- serial aspirations of the fluctuant mass.
2- Injection of corticosteroids into the fluctuant mass.
3- Removal of the caudal portion of the spinal hardware.
4- Incision and debridement with retention of spinal hardware.
5- Incision and debridement with removal of all hardware.
Figures
Answer (click for answer)
Preferred Answer 5.
In a 1995 study of delayed infection in scoliosis patients, the authors state that, in patients with a solid fusion mass, the removal of all components of the instrumentation is felt to be the most important step in the effective treatment of delayed deep wound infections. Of note, this study noted that 2 of 10 patients had a pseudoarthrosis found intra-operatively that had not been noted on the pre-operative radiographs. Therefore, the authors recommend a time period of twelve months post-surgery should be considered necessary before hardware is removed; before that time the authors recommended leaving the hardware in place and treating with suppressive antibiotics until evidence of fusion.
Reference: Richards BS: Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 1995; 77:524-529.