Surgical Site Infection as a Risk Factor for Long-Term Instrumentation Failure in Patients with Spinal Deformity: A Retrospective Cohort Study

Andrew A. Fanous, John Paul G. Kolcun, G. Damian Brusko, Michael Paci, George M. Ghobrial, Jonathan Nakhla, Ananth Eleswarapu, Nathan H. Lebwohl, Barth A. Green, Joseph P. Gjolaj

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Surgical site infection (SSI) remains a complication of spine deformity surgery. Although fusion/instrumentation failure in the setting of SSI has been reported, few studies have investigated the relationship between these entities. We examine the relationship between early SSI and fusion/instrumentation failure after instrumented fusion in patients with thoracolumbar scoliosis. Methods: A retrospective review of a prospectively maintained case series for patients undergoing spine surgery between January 1, 2006, and October 3, 2017. Inclusion criteria included age ≥18 years and surgery performed for correction of thoracolumbar scoliosis. Data collected included various demographic, clinical, and operative variables. Results: 532 patients met inclusion criteria, with 20 (4%) experiencing SSI. Diabetes mellitus was the only demographic risk factor for increased SSI (P = 0.026). Number of fused levels, blood volume loss, and operative time were similar between groups. Fusion/instrumentation failure occurred in 68 (13%) patients, 10 of whom (15%) had SSI, whereas of the 464 patients with no fusion/instrumentation failure, only 10 (2%) had SSI (P < 0.001). Of the 20 patients with SSI, 10 (50%) had fusion/instrumentation failure, whereas in the 512 patients with no infection, only 58 (11%) had fusion/instrumentation failure (P < 0.001). Patients with infection also experienced significantly shorter time to fusion/instrumentation failure (P = 0.025), higher need for revision surgery (P < 0.001), and shorter time to revision surgery (P = 0.012). Conclusions: Early SSI significantly increases the risk of fusion/instrumentation failure in patients with thoracolumbar scoliotic deformity, and it significantly shortens the time to failure. Patients with early SSI have a significantly higher likelihood of requiring revision surgery and after a significantly shorter time interval.

Original languageEnglish (US)
Pages (from-to)e514-e519
JournalWorld Neurosurgery
StatePublished - Dec 2019
Externally publishedYes


  • Instrumentation failure
  • Scoliosis
  • Spinal deformity
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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