R S Hatch1, P F Sturm, C C Wellborn. 1. Department of Orthopaedic Surgery, Children's National Medical Center, Washington, DC 20010, USA.
Abstract
STUDY DESIGN: A case report of late complication after single-rod instrumentation. OBJECTIVES: To report a case of symptomatic, perispinal, soft-tissue complication after successful fusion of a scoliotic curve using a unilateral, posterior, multiple hook-rod construct. SUMMARY OF BACKGROUND DATA: Delayed perispinal soft-tissue complications recently have been observed with two-rod, multihook system constructs. The etiology is believed to be low, virulence bacteria causing delayed infection, or metal fretting causing chronic inflammation. This phenomenon has not been linked to single-rod constructs. METHODS: The observation of perispinal soft-tissue inflammation was made during exploratory surgery for progressive pain overlying the rod. The diagnosis was supported by laboratory findings. RESULTS: Complete pain relief was obtained after removal of the hardware and empiric treatment with an oral antibiotic. CONCLUSIONS: Delayed chronic inflammation may occur as a late complication of the use of a unilateral, posterior, multiple hook-rod construct in the spine. This problem can be managed successfully with hardware removal, and, because the etiology of this type of inflammation is unclear, infection with a low virulence organism should be considered.
STUDY DESIGN: A case report of late complication after single-rod instrumentation. OBJECTIVES: To report a case of symptomatic, perispinal, soft-tissue complication after successful fusion of a scoliotic curve using a unilateral, posterior, multiple hook-rod construct. SUMMARY OF BACKGROUND DATA: Delayed perispinal soft-tissue complications recently have been observed with two-rod, multihook system constructs. The etiology is believed to be low, virulence bacteria causing delayed infection, or metal fretting causing chronic inflammation. This phenomenon has not been linked to single-rod constructs. METHODS: The observation of perispinal soft-tissue inflammation was made during exploratory surgery for progressive pain overlying the rod. The diagnosis was supported by laboratory findings. RESULTS: Complete pain relief was obtained after removal of the hardware and empiric treatment with an oral antibiotic. CONCLUSIONS: Delayed chronic inflammation may occur as a late complication of the use of a unilateral, posterior, multiple hook-rod construct in the spine. This problem can be managed successfully with hardware removal, and, because the etiology of this type of inflammation is unclear, infection with a low virulence organism should be considered.