Implant-Associated Spinal Infections in Children: How Can We Improve Diagnosis and Management?

Implant-associated spinal infection affects up to 10% of all pediatric instrumented spinal fixation surgeries and is associated with patient morbidity and significant impact on the health care system. Children with neuromuscular scoliosis are at increased risk compared with those with idiopathic scoliosis. Early infections (≤90 days from index surgery) are caused by virulent pathogens such as Staphylococcus aureus; more indolent pathogens cause late infections. Early infections are treated with debridement and implant retention with prolonged antibiotics, but implant removal is often needed to treat late infections. Antibiofilm agents and pathogen-specific imaging may improve future outcomes.