Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines

Stephen R. Stephan, MD; Kenneth D. Illingworth, MD; Kavish Gupta, MD; Lindsay M. Andras, MD; David L. Skaggs, MD, MMM


Spine. 2021;46(17):1147-1153. 

In This Article


Study Design

IRB approval was obtained for this study. We conducted a single-site, retrospective review of primary PSF procedures on patients with NMS from January 2008 to December 2012 (Group 1) and January 2014 to December 2018 (Group 2). The BPG was published in July 2013 and we chose to exclude all of 2013 as a transition time and compare the 4 years prior to and after the implementation of the strategies.

Strategies that were adopted are listed in Table 1. A more detailed explanation of these strategies may be found in the original article.[21]

The records for all patients who underwent primary PSF from 2008 to 2012 and 2014 to 2018 were reviewed. Patients were included if they had a diagnosis of NMS, undergone primary and definitive PSF, and undergone at least 1-year of postoperative follow-up. Patients who underwent an anterior approach alone, or in conjunction with a posterior approach, and who underwent revision arthrodesis were excluded. Patients were also excluded if they were undergoing a growing construct procedure. NMS was defined as cerebral palsy (CP), muscular dystrophy, spina bifida, syndromic conditions, spinal muscular atrophy, and other neuromuscular diagnoses. Patient demographics collected are listed in Table 2 and Table 3.

Deep surgical site infections were diagnosed by the criteria provided by the United States Center for Disease Control.[22] They were defined as an infection involving deep soft tissues along with one of the following: purulent drainage from deep tissues, a dehiscence or opening with positive identification of microorganisms or abscess. All were treated with surgical debridement with possible removal of instrumentation and reoperation for continued infection.

All surgeons were fellowship trained. Junior attendings were defined as those who had less than 5 years in practice following fellowship at the beginning of data collection for each group.

Statistical Methods

Data were compared between groups based on year of procedure (Pre ≤ 2012, Post ≥ 2014). Continuous data are shown as mean ± sd and compared with Student t test and categorical shown as n (%) and compared with the chi-square test. Statistical significance was defined as P < 0.05. All analysis was done with SAS 9.4 (Cary, NC).