New method for closing scoliosis surgery incision nearly eliminates all infections

129

Patients with scoliosis who undergo surgery may be less likely to develop an infection or other complications after the procedure when a novel wound closure technique pioneered at NYU Langone Medical Center, New York, USA, is utilised, according to new research. The study was published online in the Journal of Pediatric Orthopaedics.

In this new technique, surgeons use a multi-layered flap closure that enables doctors to close several layers of muscle and fascia while maintaining blood supply from the donor site to the recipient site. The researchers believe this new method reduces complication rates by eliminating “dead space”—pockets around spinal hardware and fusion sites where infection can start. The technique also creates a better barrier to separate surgical hardware and bone grafts from the skin’s surface.

“This game-changing method for closing incisions after surgery can benefit all patients with scoliosis, especially those most at risk for complications depending on the cause of their spine problems,” says corresponding study author David S Feldman, professor of orthopaedic surgery and paediatrics at NYU Langone. “All of our patients with scoliosis, from the basic to most complex cases, can feel confident knowing their safety is our top priority.”

A conventional, non-standardised closure method after scoliosis surgery often involves a bulk skin closure performed by an orthopaedic surgeon where no flaps are mobilised.

In this retrospective study, NYU Langone researchers reviewed 76 charts of patients aged 8–25 years, with non-idiopathic scoliosis who had undergone a posterior spinal fusion surgery. Forty-two patients had their incisions closed using conventional techniques, while 34 underwent the new, multi-layered flap technique.

Approximately 19% of patients who underwent the conventional, non-standardised closure methods experienced a wound complication, which was in line with previous estimates of infection rates for people with non-idiopathic scoliosis. However, patients who underwent the novel, multi-layered muscle flap closure method experienced a 0% complication rate.

The new closure method has been increasingly used at NYU Langone since 2009, and is a collaborative effort between the Departments of Orthopaedic Surgery and Plastic Surgery.

“The success of this procedure speaks to our Medical Center’s commitment to collaborate with other medical specialties to ensure our patients receive optimal patient care,” says senior study author Michael S Margiotta, assistant professor of plastic surgery and neurosurgery at NYU Langone.

Infections can be debilitating to patients and their families, and place significant burdens on the health care system through follow-up wound care, additional treatments or possible surgical procedures.

Until now, there has been little published research about the best technique for spinal wound closure after surgery to prevent complications for patients, especially those at highest risk due to scoliosis caused by an underlying condition.

“There was a time when complex scoliosis cases, including revision surgery, had infection rates approaching double digits,” says study co-author Thomas Errico, chief of the Division of Spine Surgery at NYU Langone. “We have now lowered infection rates to less than 1%, a remarkable accomplishment thanks to attention to detail and teamwork of the dedicated surgeons in our Orthopaedic Surgery and Plastic Surgery departments.”