Surgical Site Infection Following the Correction of Adolescent Idiopathic Scoliosis With ApiFix: A Retrospective Study Analyzing Its Incidence and Recurrence

Konstantinos Zygogiannis; Eleni Pappa; Spyridon I Antonopoulos; Georgios Tsalimas; Konstantinos Manolakos; Ioannis Chatzikomninos; Savvas Moschos; Georgios C Thivaios; Dimitrios Kalatzis; Anastasios Kalampokis

doi:10.7759/cureus.34494

Surgical Site Infection Following the Correction of Adolescent Idiopathic Scoliosis With ApiFix: A Retrospective Study Analyzing Its Incidence and Recurrence

Cureus. 2023 Feb 1;15(2):e34494. doi: 10.7759/cureus.34494. eCollection 2023 Feb.

Affiliations

¹ Trauma and Orthopaedics, Laiko General Hospital of Athens, Athens, GRC.
² 5th Orthopaedic Department, KAT General Hospital, Athens, GRC.
³ Orthopaedics, KAT General Hospital Attica, Κηφισιά, GRC.
⁴ 6th Orthopaedic Department, Kat General Hospital, Athens, GRC.
⁵ Spine and Scoliosis Department, KAT General Hospital, Athens, GRC.
⁶ Spine Department, KAT General Hospital, Athens, GRC.
⁷ Orthopaedics and Traumatology, Laiko General Hospital of Athens, Athens, GRC.
⁸ Spine Department, Kat General Hospital, Athens, GRC.

Abstract

Background and objective ApiFix (OrthoPediatrics, Warsaw, IN) is an internal brace used for the correction of adolescent idiopathic scoliosis (AIS) classified as Lenke 1 or 5 with a Cobb angle of 35-60 degrees that decreases to ≤30 degrees on lateral side-bending radiographs. Since the indications are very specific, it is not a common procedure. Our study aimed to evaluate the incidence of surgical site infection (SSI) and its recurrence following treatment with ApiFix. Materials and methods A retrospective study of 44 cases of AIS treated at our center from 2016 to 2022 with ApifiX was conducted. Two patients who presented with SSI were initially treated with irrigation and debridement (I&D) following antibiotic therapy. Results A total of 44 patients with a mean age of 15.1 years were evaluated. Two of our patients presented with early-onset infection while one of them presented after the end of treatment with a skin ulcer due to septic screw loosening. The removal of the ApiFix implant revealed a pedicle abscess during the screw removal. Conclusions In this study of 44 patients, we observed two cases of infection and one case of reinfection. Given the limited muscle detachment and short operating time needed for Apifix, statistics suggest that the risk of SSI is always present. Further randomized trials are needed to gather more evidence on this subject.

Keywords: adolescent idiopathic scoliosis (ais); early postoperative complication; postoperative wound infection; scoliosis surgery complications; urgent debridement.