Journal of spine surgery最新文献

{"title":"Instrumented lumbar fusion in patients over 75 years of age: is it worthwhile?-a comparative study of the improvement in quality of life between elderly and young patients.","authors":"Félix Tomé-Bermejo,&nbsp;Fernando Moreno-Mateo,&nbsp;Ángel Piñera-Parrilla,&nbsp;Javier Cervera-Irimia,&nbsp;Charles Louis Mengis-Palleck,&nbsp;Jesús Gallego-Bustos,&nbsp;Francisco Garzón-Márquez,&nbsp;María G Rodríguez-Arguisjuela,&nbsp;Sylvia Sanz-Aguilera,&nbsp;Kelman Luis de la Rosa-Zabala,&nbsp;Carmen Avilés-Morente,&nbsp;Beatriz Oliveros-Escudero,&nbsp;Alexa Anaís Núñez-Torrealba,&nbsp;Luis Alvarez-Galovich","doi":"10.21037/jss-22-115","DOIUrl":"10.21037/jss-22-115","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of degenerative lumbar disease in the elderly is controversial. Elderly patients have an increased risk for medical and surgical complications commensurate with their comorbidities, and concerns over complications have led to frequent cases of insufficient decompression to avoid the need for instrumentation. The purpose of this study was to evaluate clinical outcome between older and younger patients undergoing lumbar instrumented arthrodesis.</p><p><strong>Methods: </strong>This is a retrospective, comparative study of prospectively collected outcomes. One hundred and fifty-four patients underwent 1- or 2-level posterolateral lumbar fusion. Patients were divided into two groups. Group 1: 87 patients ≤65 years of age who underwent decompression and posterolateral instrumented fusion; Group 2: 67 patients ≥75 years of age who underwent the same procedures with polymethylmethacrylate (PMMA) pedicle-screw augmentation. Mean follow-up 27.47 months (range, 76-24 months).</p><p><strong>Results: </strong>Mean age was 49.1 years old (range, 24-65) for the younger group and 77.8 (range, 75-86) in the elderly group. Patients ≥75 years of age showed higher preoperative comorbidity (American Society of Anesthesiology, ASA: 1.7 <i>vs</i>. 2.4), and ≥2 systemic diseases with greater frequency (12.5% <i>vs</i>. 44.7%). No significant differences were found between the two groups in terms of postoperative complications, fusion, or revision rate. During follow-up, adjacent disc disease and adjacent fracture occurred significantly more in Group 2 (P<0.05). At the end of follow-up, there were no significant differences between the two groups in any of the clinical and health-related quality of life scores or satisfaction with treatment received.</p><p><strong>Conclusions: </strong>Osteoporosis represents a major consideration before performing spine surgery. Despite an obvious increased risk of complications in elderly patients, PMMA-augmented fenestrated pedicle screw instrumentation in spine fusion represents a safe and effective surgical treatment option to elderly patients with poor bone quality. Age itself should not be considered a contraindication in otherwise appropriately selected patients.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"247-258"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1a/e9/jss-09-03-247.PMC10570654.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal orthoses in osteoporotic vertebral fractures of the elderly.","authors":"Boyuan Khoo,&nbsp;Augusto Gonzalvo,&nbsp;Barry Ting Sheen Kweh","doi":"10.21037/jss-23-76","DOIUrl":"10.21037/jss-23-76","url":null,"abstract":"","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"224-228"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7f/18/jss-09-03-224.PMC10570645.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allergic reactions from tissue adhesives in spine surgery: a sticky situation.","authors":"Ian J Wellington,&nbsp;Christopher L Antonacci,&nbsp;Michael R Mancini,&nbsp;Isaac L Moss","doi":"10.21037/jss-23-82","DOIUrl":"10.21037/jss-23-82","url":null,"abstract":"J Spine Surg 2023;9(3):233-235 | https://dx.doi.org/10.21037/jss-23-82 The article “Allergic contact dermatitis to Dermabond Prineo after abdominal wound closure for anterior lumbar interbody fusion: case report” by Coppola, Tobin, and Lawrence describes a rarely reported complication of a commonly used surgical tissue adhesive (1). Dermabond (Ethicon, Somerville, NJ, USA) is a popular skin adhesive for surgical wounds, owing to its ease of use, quick curing time, and antimicrobial properties (2). Additionally, it has shown an excellent safety profile in spine surgery, with a majority of complications that do occur being mild dermatitis reactions (3-5). Coppola et al. discuss a case of a type IV hypersensitivity reaction to Dermabond Prineo following its use for an anterior lumbar interbody fusion incision, and importantly noted that the patient had previously been exposed to tissue adhesives for prior surgical wound closure without issue. While infrequent, similar cases have been reported. A recent article by Zhang et al. discusses a similar pruritic dermatitis reaction following the use of Dermabond Prineo for an anterior cervical surgical wound (6). Similar to Coppola et al., the patient was treated by removal of the adhesive coated mesh followed by topical corticosteroids and oral diphenhydramine. Additionally, they utilized oral corticosteroids and an oral antibiotic regimen with good effect. Two additional cases of similar dermatitis following tissue adhesive applications were reported in a 2014 correspondence in patients previously exposed to Dermabond (7). A dermatologic study by Asai et al. in 2021 investigated rates of allergic contact dermatitis following exposure to Dermabond in 577 patients using patch testing (8). They found 9 patients (1.5% prevalence) who experienced dermatitis from Dermabond, all of whom had prior asymptomatic exposure, with an average time from application to onset of reaction of 34 days. While the literature surrounding these reactions in spine surgery is sparse, it demonstrates effective methods for managing the symptoms following adhesive induced dermatitis. Remaining adhesive should be removed from the skin, antihistamines such as diphenhydramine can be administered, as well as oral or topical corticosteroids. Consideration should be given to the possibility of an increased risk for surgical site infection from application of a topic corticosteroid on a recent surgical wound, and while this has not been previously investigated, prior literature has shown efficacy in the healing of topical corticosteroids for chronic wounds and burn wounds (9,10). One of the biggest considerations for surgeons facing similar reactions to tissue adhesives is differentiation between contact dermatitis and a surgical site infection. While both are likely to present with erythema, contact dermatitis is expected to be more pruritic and may have associated vesicles, while a surgical site infection would be expected to present with ","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"233-235"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/7e/jss-09-03-233.PMC10570652.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prone thoracic endovascular aortic repair via the popliteal artery for inadvertent vascular injury during spondylectomy: a case report.","authors":"Yang Xia,&nbsp;Arjun Suresh Chandran,&nbsp;Joseph Hockley,&nbsp;Shirley Jansen,&nbsp;Mark Lam","doi":"10.21037/jss-23-17","DOIUrl":"10.21037/jss-23-17","url":null,"abstract":"<p><strong>Background: </strong>Vascular injury during spinal surgery is a dreaded complication associated with high morbidity and mortality. Repositioning the patient following such an injury could result in significant time delays and haemorrhage. Endovascular repair via popliteal access has never previously been described in the literature. A novel prone thoracic endovascular aortic repair (TEVAR) technique is described here as a safe alternative to manage vascular injury during posterior spinal surgery.</p><p><strong>Case description: </strong>Here we describe a 63-year-old male where endovascular repair of vascular injury to the aorta by intercostal artery avulsion was performed via popliteal artery access in the prone position during T11 <i>en bloc</i> spondylectomy and posterior fusion. The patient remained haemodynamically unstable following the vascular injury precluding immediate transfer to the angiography suite. Identification of vascular injury to deployment of TEVAR graft was 90 minutes. The spondylectomy was able to be completed without repositioning the patient. Radiological and clinical follow-up revealed no complications at 1 and 2 months respectively following surgery.</p><p><strong>Conclusions: </strong>TEVAR placement via this novel popliteal access route was able to halt the haemorrhage allowing stabilisation of the patient and completion of the spinal procedure. Clinical teams should be made aware this is a viable technique to address vascular injuries during spinal surgery.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"342-347"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/2c/jss-09-03-342.PMC10570636.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radical decompression without fusion for L5 radiculopathy due to foraminal stenosis.","authors":"Kohei Takahashi, Ajay Yadav, Takumi Tsubakino, Takeshi Hoshikawa, Tomowaki Nakagawa, Ko Hashimoto, Manabu Suzuki, Toshimi Aizawa, Yasuhisa Tanaka","doi":"10.21037/jss-23-62","DOIUrl":"10.21037/jss-23-62","url":null,"abstract":"<p><strong>Background: </strong>The highest incidence of lumbar foraminal stenosis (LFS) occurs in the L5-S1 segment and its anatomical features differ from those of other segments. Few previous reports have exhaustively assessed surgical outcomes after decompression surgery, limiting the materials to patients with LFS at the L5-S1 segment. We aimed to prospectively investigate instability and neurological improvement following our novel surgical technique for LFS at L5-S1, named \"radical decompression\" of the nerve root.</p><p><strong>Methods: </strong>Patients with foraminal stenosis at L5-S1 who underwent surgery using our technique were prospectively evaluated two years postoperatively. The Japanese Orthopaedic Association (JOA) score and the JOA Back Pain Evaluation Questionnaire (JOABPEQ) were evaluated preoperatively and two years postoperatively. The following radiological parameters at L5-S1 were measured: lateral translation, sagittal translation, the difference in sagittal translation (DST) between flexion and extension, disc wedging angle, lordotic angle, the difference in lordotic angle (DLA) between flexion and extension, and disc height. Pre- and postoperative data were compared using paired <i>t</i>-tests. In addition, the patients were classified into a disc group (Group D) and a non-disc group (Group ND) according to whether a discectomy was performed intraoperatively. Changes in each parameter before and after surgery were compared between the groups.</p><p><strong>Results: </strong>Twenty-eight patients were included in this analysis. The JOA scores improved in all patients. The mean preoperative and two-year postoperative JOA scores were 14.5±3.2 (range, 8-21) and 24.3±3.3 (range, 18-29), respectively (P<0.01). All JOABPEQ categories improved two years postoperatively (P<0.05). None of the patients underwent revision surgery. No significant changes were observed in any of the radiological parameters. No significant differences in the changes in each parameter before and after surgery were found between groups D and ND.</p><p><strong>Conclusions: </strong>Our surgical technique resulted in good neurological recovery and was associated with a low risk of postoperative segmental instability, regardless of additional discectomy.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"278-287"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/18/jss-09-03-278.PMC10570647.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Air-gun pellet at C1: a case report and literature review.","authors":"Norah Ibrahim Alromaih,&nbsp;Hani Nouran Alharbi,&nbsp;Nouf Abdulaziz Altwaijri,&nbsp;Saad Radi Surur","doi":"10.21037/jss-23-42","DOIUrl":"10.21037/jss-23-42","url":null,"abstract":"<p><strong>Background: </strong>Air-gun pellet injuries commonly occur in children between the age of 1-18 years old. These injuries could be fetal because it linked to injury to vital organs such as brain, heart, and eyes. In the literature, there are few studies that reported spine injury by air-gun pellet. Our case is a C1 foreign body in a pediatric patient without any neurological deficits after an air-gun injury.</p><p><strong>Case description: </strong>A 6-year-old boy, known case of Hirschsprung disease presented to the emergency department after an air-gun injury in June 2021. On examination, the patient was hemodynamically stable, and asymptomatic. Neurological exam was intact with power 5/5 in C5-S1 and sensation 2/2 in C5-S1. Computed tomography (CT) of the cervical spine showed a foreign body at C1. After discussing the treatment options with his parents, we treat the patient conservatively by close follow-up and analgesia only. After 1 week, the patient presented to the clinic and the patient was still asymptomatic. A cervical X-ray at that time done and showed no changes in the position from the initial CT. Weekly follow-up was difficult for the family to adhere to due to their socioeconomic status. Therefore, the patient was followed up over the phone call through telemedicine at 6 months and 1 year after the injury.</p><p><strong>Conclusions: </strong>The treatment of these types on injuries is highly controversial. The treatment options could be surgical or non-surgical (conservative) such as antibiotic use. Also, there is always a debate about the choice of the treatment options.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"375-379"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c8/68/jss-09-03-375.PMC10570641.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding indications of full endoscopic spine surgery.","authors":"Pravesh S Gadjradj,&nbsp;Brian Fiani,&nbsp;Fabian Sommer,&nbsp;Rodrigo Navarro Ramirez,&nbsp;Biswadjiet S Harhangi","doi":"10.21037/jss-23-65","DOIUrl":"10.21037/jss-23-65","url":null,"abstract":"performing surgery for herniated lumbar discs (6). Until then, surgery was highly invasive and went alongside a high incidence of complications such as dural tears and instability of the spine. As during the coming decades, new surgical instruments were developed and existing instruments were improved, the invasiveness of lumbar discectomy could be reduced. With the development of microsurgery","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"229-232"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/05/3d/jss-09-03-229.PMC10570651.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinopelvic sagittal realignment and incidence of adjacent segment disease after single-segment posterior lumbar inter-body fusion using 12° lordotic cages-a 2-year prospective cohort study.","authors":"Tomiya Matsumoto,&nbsp;Shinya Okuda,&nbsp;Yukitaka Nagamoto,&nbsp;Yoshifumi Takahashi,&nbsp;Masayuki Furuya,&nbsp;Motoki Iwasaki","doi":"10.21037/jss-23-78","DOIUrl":"10.21037/jss-23-78","url":null,"abstract":"<p><strong>Background: </strong>The importance of spinopelvic sagittal alignment for adjacent segment disease (ASD) after lumbar fusion surgery has been reported. However, no longitudinal cohort studies have determined the extent to which segmental alignment and spinopelvic global alignment can be achieved using 12° lordotic cages in posterior lumbar inter-body fusion (PLIF) and the extent to which the development of ASD can be prevented. The purpose of this study was to analyze changes in segmental and spinopelvic sagittal alignment after single-segment PLIF with 12° lordotic cages, to clarify the relationship between changes in segmental and spinopelvic sagittal alignment, and to report the incidence of ASD at 2 years postoperatively.</p><p><strong>Methods: </strong>Subjects in this 2-year prospective longitudinal cohort study were 28 patients who had undergone L4/5 PLIF using 12° lordotic cages. Incidence of operative ASD (O-ASD) was evaluated as clinical outcomes. Radiological measurements were examined preoperatively and at 3 months, 1 year and 2 years postoperatively. The following radiographic spinopelvic parameters were measured: segmental lordosis (SL) at L4/5; sagittal vertical axis (SVA); T1 pelvic angle (TPA); thoracic kyphosis (TK); lumbar lordosis (LL); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI). With respect to radiological outcomes, changes in SL (ΔSL) and spinopelvic parameters and the incidence of radiological ASD (R-ASD) were evaluated. Correlations of ΔSL and changes in other spinopelvic parameters (ΔSVA, ΔTPA, ΔTK, ΔLL, ΔSS, ΔPT, and ΔPI-LL) between preoperatively and 3 months postoperatively were examined.</p><p><strong>Results: </strong>The follow-up rate was 100% (n=28) at 1 year postoperatively and 96.4% (n=27) at 2 years postoperatively. No cases of O-ASD were seen during 2 years of follow-up. Significant realignment was observed and maintained at 2 years postoperatively in almost all spinopelvic sagittal parameters (SL, SVA, TPA, LL, PT, PI-LL). Regarding the correlation between ΔSL and other parameters, significant correlations were detected with ΔSVA (r=-0.37, P<0.05) and ΔLL (r=0.538, P<0.01). Three cases (11.1%) showed R-ASD at 2 years postoperatively.</p><p><strong>Conclusions: </strong>PLIF with 12° lordotic cages for L4 degenerative spondylolisthesis improved SL and global sagittal realignment, and achieved satisfactory clinical outcomes with a low incidence of ASD during 2 years of follow-up.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"269-277"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/69/c1/jss-09-03-269.PMC10570649.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal alignment in operative degenerative lumbar spondylolisthesis: a scoping review.","authors":"Patrick Thornley, Matthew H Meade, Colby Oitment, Renan Rodrigues Fernandes, Jennifer C Urquhart, Supriya Singh, Fawaz Siddiqi, Parham Rasoulinejad, Christopher S Bailey","doi":"10.21037/jss-23-26","DOIUrl":"10.21037/jss-23-26","url":null,"abstract":"<p><strong>Background: </strong>The benefit of surgical intervention over conservative treatment for degenerative lumbar spondylolisthesis (DLS) patients with neurologic symptoms is well-established. However, it is currently unclear what breadth of available evidence exists on regional and global sagittal alignment in DLS surgery. As such, the purpose of the current study is to conduct a scoping review to map and synthesize the DLS literature regarding the current radiographic assessment of sagittal spinal alignment in DLS surgery.</p><p><strong>Methods: </strong>A comprehensive search of the MEDLINE, EMBASE and Cochrane databases from January 1971 to January 2023 was performed for all DLS studies examining sagittal spinal alignment parameters with DLS surgery according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) protocol.</p><p><strong>Results: </strong>From 2,222 studies, a total of 109 studies were included, representing 10,730 patients with an average age of 63.0 years old and average follow-up of 35.1 months postoperatively. Among included studies, 93 (85%), were largely published in the last decade and predominantly represented retrospective cohorts 70 (64%) or case series 22 (20%). A common theme among the reporting of radiographic parameters in the included investigations was the assessment of the magnitude and/or maintenance of a radiographic change postoperatively, with 92 (84%) studies reporting these findings. The majority of studies focused on index DLS level [33 (30%) studies] or lumbar spine radiographic imaging [33 (30%) studies] only. Thirty-seven (34%) studies reported spinopelvic parameters, with only 13 (12%) of included studies assessing 36-inch standing lateral radiographs and overall alignment.</p><p><strong>Conclusions: </strong>There is increasing prevalence of investigations assessing sagittal spinal alignment parameters in DLS surgery. Although, there is an increasing prevalence of studies investigating sagittal spinal alignment parameters in DLS surgery the quality of the currently available literature on this topic is of overall low evidence and largely retrospective in nature. Additionally, there is limited analysis of global sagittal spinal alignment in DLS suggesting that future investigational emphasis should prioritize longitudinally followed large prospective cohorts or multi-centre randomized controlled trials. Attempts at standardizing the radiographic and functional outcome reporting techniques across multi-centre investigations and prospective cohorts will allow for more robust, reproducible analyses of significance to be conducted on DLS patients.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"314-322"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/43/jss-09-03-314.PMC10570642.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drain blockage by topical vancomycin powder-a case report of a potentially catastrophic complication in spine surgery.","authors":"Graham Ka-Hon Shea","doi":"10.21037/jss-23-46","DOIUrl":"10.21037/jss-23-46","url":null,"abstract":"<p><strong>Background: </strong>There is evidence that application of vancomycin powder reduces the incidence of surgical site infection (SSI) and is also effective for the treatment of infections requiring surgical debridement. The use of intrawound vancomycin powder is therefore becoming prevalent. Surgical drain occlusion by antibiotic powder is a potentially serious complication that has yet to be reported in the literature.</p><p><strong>Case description: </strong>We describe a 62-year-old female with L4/5 spondylodiscitis as well as an L1-S1 epidural abscess who presented with back pain, lower limb numbness and weakness. Urgent surgical drainage was performed via a hemilaminectomy and L4/5 diskectomy. Drain output was absent for the first 36 hours post-op, and upon inspection and disconnection of the distal drain tubing, vancomycin powder residue was noted to be deposited within the lumen and connection point to cause complete obstruction. Following tubing exchange, drainage output resumed. The patient experienced relief of her back and leg symptoms after surgery as well as a normalization of her inflammatory markers upon receiving a course of intravenous (IV) antibiotics.</p><p><strong>Conclusions: </strong>Drain occlusion from antibiotic powder may be catastrophic following spine surgery due to the risk of epidural hematoma formation followed by compression of neural elements. We review the physicochemical properties of vancomycin powder and discuss ways to prevent this complication from occurring.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"9 3","pages":"369-374"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/5b/jss-09-03-369.PMC10570648.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}