Correlation between surgical site infection and classification of early onset scoliosis (C-EOS) in patients managed by rib-based distraction instrumentation

Patrick J. Cahill, Mahmoud A. Mahmoud, Elle M. MacAlpine, Aaron M. Tatad, Robert M. Campbell, John M. Flynn

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: The aim of this study is to determine risk factors for infection among EOS patients treated by rib-based distraction instrumentation, and to further assess the incidence of infection among C-EOS categories and sub-types. Summary of background data: Despite the heterogonous nature of early onset scoliosis, the classification of early onset scoliosis (C-EOS) has proven to have excellent reliability across its major categories. C-EOS’s reliability has been verified; however, little data exist on the utility of this categorization in clinical decision-making and risk assessment. Methods: After institutional review board approval, data for EOS patients treated by rib-based distraction instrumentation were collected between 2013 and 2017 in a single institution. Data collection included: major categories of early onset scoliosis classification (etiology, major curve and kyphosis), BMI, height, weight, procedure type, site of procedure, presence of tracheostomy, and bowel/urinary incontinence. Results: 156 EOS patients underwent 843 rib-based distraction instrumentation procedures. 22.4% of patients (35/156 patients, 42 procedures) developed infections, 30/35 requiring irrigation and debridement. Type of procedure was significantly associated with infection rate, with rib-based distraction instrumentation insertion corresponding with the highest incidence of infection, as compared to instrumentation revisions or expansions (p = 0.006). Infection rates were also more common in shorter and lighter weight children (p = 0.001 and 0.03; respectively). Patients with a neuromuscular etiology had the highest rate of infection in comparison to congenital, syndromic, and idiopathic (5.7% vs, 4.9%, 4.7%, and 2.6%; respectively). Notably, high infection rates occurred neuromuscular hyper-kyphotic subjects (M+), occurring in all major curve C-EOS subgroups and at a rate of 8.3% for all procedures. Conclusion: Neuromuscular, larger magnitude major curve, and larger magnitude kyphotic angle C-EOS categories appear to be at a higher risk of infection. Such information potentiates the usefulness of C-EOS in surgical decision-making and in the informed consent process. Level of evidence: Level III therapeutic.

Original languageEnglish (US)
Pages (from-to)787-792
Number of pages6
JournalSpine Deformity
Issue number4
StatePublished - Aug 1 2020
Externally publishedYes


  • C-EOS
  • Pediatrics
  • Scoliosis
  • Surgical site infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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