The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation.

Ojetti V, Bruno G, Paolucci V, Triarico S, D'aversa F, Ausili E, Gasbarrini A, Rendeli C. (2013) The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation. Spinal Cord. 2013 Nov 19.

Study design:Prospective study.Objectives:The objective of this study was to assess the prevalence of small intestinal bacterial overgrowth (SIBO), methane (CH₄) production and orocecal transit time (OCTT) in children affected by myelomeningocele.Setting:This study was conducted at the Catholic University in Rome, Italy.Methods:Eighteen (6M/12F; 16.4±7.6 years) children affected by myelomeningocele were enrolled. All subjects underwent H₂/CH₄ lactulose breath tests to assess SIBO and OCTT. All patients performed a visual analog scale to investigate abdominal pain, bloating and flatulence, and maintained a diary of the frequency and consistency of the stool during the previous 7 days. A nephro-urological clinical evaluation of the number of urinary tract infections (UTIs) and neurogenic bowel disease score were also performed.Results:Thirty-nine percent (7/18) of the children showed SIBO and 61% (11/18) presented a delayed OCTT. Moreover 44.4% (8/18) produced high levels of CH₄. Interestingly, all myelomeningocele children who produced CH₄ showed a delayed OCTT and a higher incidence of UTI, with a lower frequency of evacuation, compared with those with a normal or accelerated OCTT.Conclusion:The association between CH₄ and constipation suggests that CH₄ has an active role in the development of constipation. One of the most interesting features of our study is to identify a correlation between myelomeningocele, CH₄, delayed OCTT and UTI. The intestinal decontamination with locally acting drugs in these children may reduce the number of UTIs and improve intestinal motility.

doi: 10.1038/sc.2013.131.

Management of Infection After Instrumented Posterior Spine Fusion in Pediatric Scoliosis

Ho C, Skaggs DL, Weiss JM, Tolo VT. Management of Infection After Instrumented Posterior Spine Fusion in Pediatric Scoliosis. Spine. 2007 Nov 15;32(24):2739-2744.

STUDY DESIGN.: Case series retrospective review.

OBJECTIVE.: To identify what factors predict successful eradication of infection after I&D of an infected posterior spinal fusion with instrumentation.

SUMMARY OF BACKGROUND DATA.: The treatment of infection of instrumented spine fusions in children has few clear guidelines in the literature. METHODS.: The medical records of patients who required a surgical irrigation and debridement (I&D) for infection after posterior spinal fusion and instrumentation for scoliosis from 1995 to 2002 were retrospectively reviewed.

RESULTS.: Fifty-three patients were identified with the following underlying diagnoses: 21 patients (40%) idiopathic scoliosis, 10 patients (23%) cerebral palsy, 3 patients (6%) spina bifida, 1 patient (2%) congenital scoliosis, and 17 patients (32%) other. There were 31 patients (58%) with surgery <6 months from initial fusion, and 22 (42%) patients >6 months. Of the 43 patients with implant retained at the time of the first I&D, 20 patients required a second I&D (47%). Of the 10 patients with complete implant removal, 2 patients required a second I&D (20%). Coagulase-negative Staphylococcus was the most prevalent organism, growing in 25 (47%) of the cultures. Of patients with idiopathic scoliosis, 8 of 21 (38%) required a second I&D; of the patients with other diagnoses, 14 of 32 (44%) required a second I&D, which was not a significant difference (P > 0.05).

CONCLUSION.: To the best of our knowledge, this is the largest reported series of spinal implant infections. When children with an infection after posterior spinal fusion with instrumentation undergo irrigation and debridement, there is a nearly 50% chance that the infection will remain if all spinal implants are not removed. As nearly 50% of the infections were caused by coagulase-negative Staphylococcus, we recommend that prophylactic antibiotic coverage for this organism is used at the time of the initial spinal fusion.

PMID: 18007254