Implant-related postoperative spondylodiscitis (IPOS) is a severe complication in spine surgery and is associated with high morbidity and mortality. With growing knowledge in the field of periprosthetic joint infection (PJI), equivalent investigations towards the management of implant-related infections of the spine are indispensable. To our knowledge, this study provides the largest description of cases of IPOS to date. Patients treated for IPOS from January 2006 to December 2020 were included. Patient demographics, parameters upon admission and discharge, radiological imaging, and microbiological results were retrieved from medical records. CT and MRI were analyzed for epidural, paravertebral, and intervertebral abscess formation, vertebral destruction, and endplate involvement. Pathogens were identified by CT-guided or intraoperative biopsy, intraoperative tissue sampling, or implant sonication.Aims
Methods
The aim of the present study was to answer the question whether curve morphology and location have an influence on rigid conservative treatment in patients with adolescent idiopathic scoliosis (AIS). We retrospectively analyzed AIS in 127 patients with single and double curves who had been treated with a Chêneau brace and physiotherapeutic specific exercises (B-PSE). The inclusion criteria were the presence of structural major curves ≥ 20° and < 50° (Risser stage 0 to 2) at the time when B-PSE was initiated. The patients were divided into two groups according to the outcome of treatment: failure (curve progression to ≥ 45° or surgery) and success (curve progression < 45° and no surgery). The main curve type (MCT), curve magnitude, and length (overall, above and below the apex), apical rotation, initial curve correction, flexibility, and derotation by the brace were compared between the two groups.Aims
Methods
To evaluate the histopathological examination of peri-implant tissue samples as a technique in the diagnosis of postoperative spinal implant infection (PSII). This was a retrospective analysis. Patients who underwent revision spinal surgery at our institution were recruited for this study. PSII was diagnosed by clinical signs, histopathology, and microbiological examination of intraoperatively collected samples. Histopathology was defined as the gold standard. The sensitivity for histopathology was calculated. A total of 47 patients with PSII and at least one microbiological and histopathological sample were included in the study.Aims
Methods
During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients. All patients who underwent a revision surgery after instrumented spinal surgery at our institution between July 2014 and August 2016 with spinal implants submitted for sonication were retrospectively analyzed. Only revisions presumed as aseptic are included in the study. During the study period, 204 spinal revisions were performed for diagnoses other than infection. In 38 cases, sonication cultures were not obtained, leaving a study cohort of 166 cases. The mean age of the cohort was 61.5 years (Aims
Patients and Methods
The purpose of this study was to investigate
the clinical predictors of surgical outcome in patients with cervical spondylotic
myelopathy (CSM). We reviewed a consecutive series of 248 patients
(71 women and 177 men) with CSM who had undergone surgery at our
institution between January 2000 and October 2010. Their mean age
was 59.0 years (16 to 86). Medical records, office notes, and operative
reports were reviewed for data collection. Special attention was
focused on pre-operative duration and severity as well as post-operative
persistence of myelopathic symptoms. Disease severity was graded
according to the Nurick classification. Our multivariate logistic regression model indicated that Nurick
grade 2 CSM patients have the highest chance of complete symptom
resolution (p <
0.001) and improvement to normal gait (p = 0.004)
following surgery. Patients who did not improve after surgery had
longer duration of myelopathic symptoms than those who did improve
post-operatively (17.85 months (1 to 101) vs 11.21 months (1 to
69); p = 0.002). More advanced Nurick grades were not associated
with a longer duration of symptoms (p = 0.906). Our data suggest that patients with Nurick grade 2 CSM are most
likely to improve from surgery. The duration of myelopathic symptoms
does not have an association with disease severity but is an independent
prognostic indicator of surgical outcome. Cite this article:
Increasing numbers of posterior lumbar fusions
are being performed. The purpose of this study was to identify trends
in demographics, mortality and major complications in patients undergoing
primary posterior lumbar fusion. We accessed data collected for
the Nationwide Inpatient Sample for each year between 1998 and 2008
and analysed trends in the number of lumbar fusions, mean patient
age, comorbidity burden, length of hospital stay, discharge status,
major peri-operative complications and mortality. An estimated 1 288 496
primary posterior lumbar fusion operations were performed between
1998 and 2008 in the United States. The total number of procedures,
mean patient age and comorbidity burden increased over time. Hospital
length of stay decreased, although the in-hospital mortality (adjusted
and unadjusted for changes in length of hospital stay) remained
stable. However, a significant increase was observed in peri-operative
septic, pulmonary and cardiac complications. Although in-hospital mortality
rates did not change over time in the setting of increases in mean
patient age and comorbidity burden, some major peri-operative complications
increased. These trends highlight the need for appropriate peri-operative services
to optimise outcomes in an increasingly morbid and older population
of patients undergoing lumbar fusion.
