Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs. Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations. Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infec...

/pdf/burden-of-surgical-site-infections-associated-with-select-4p63bvy7gy.pdf

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement of Staphylococcus aureus.

Both posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are accepted surgical techniques for the treatment of degenerative lumbar spondylolisthesis (DLS). However, it is still unclear one technique offers distinct advantages over the other. A retrospective study was performed to compare perioperative complications and functional outcomes of patients undergoing TLIF versus PLIF for DLS. A total of 226 consecutive patients who underwent surgery for treatment of DLS at three institutions were evaluated from January 2012 to December 2014. In this series, 125 patients underwent PLIF and 101 received TLIF. The operative time, blood loss, allogeneic blood transfusion rate and perioperative complications (including re-operative rate, nerve root injury, dural tear, wound infection) were compared between the two groups. Pain (VAS) and functional outcomes of patients (Kirkaldy-Willis criteria) were quantified before surgery and 1 week after surgery. Patients involved in the two groups had similar baseline demographic, clinical and radiographic characteristics. The PLIF group was associated with a higher incidence of post-operative iatrogenic nerve root dysfunction [12 cases (9.6 %) versus 2 cases (1.9 %), P = 0.018] and dural tears [15 cases (12 %) versus 4 cases (3.9 %), P = 0.030]. The re-operation rate was significantly higher in patients undergoing PLIF [13 cases (10.4 %) versus 2 cases (1.9 %), P = 0.011]. In addition, intra-operative blood loss, operative times, and allogeneic blood transfusion rates were higher in the PLIF group when compared to the TLIF group (P < 0.05). The wound infection rate of the PLIF group was similar to that of the TLIF group (7.2 versus 5.0 %, P = 0.486). VAS scores were decreased from 7.08 ± 1.13 to 2.84 ± 0.89 in the PLIF group, and from 7.18 ± 1.09 to 2.84 ± 0.91 in the TLIF group, respectively (P = 0.32). 85.6 % of patients in the TLIF group had good or excellent functional outcomes within the first post-operative week compared to 83.2 % in the PLIF group (P = 0.64). Both PLIF and TLIF were equally beneficial in improving short-term functional outcomes for patients with DLS. However, PLIFs were associated with statistically significant higher incidences of nerve root injury, dural tears, allogeneic blood transfusion, increased intra-operative times, blood loss and re-operations. Therefore, caution should be exercised when considering PLIFs.

A comparative study of perioperative complications between transforaminal versus posterior lumbar interbody fusion in degenerative lumbar spondylolisthesis

Is the Use of a Unilateral Biportal Endoscopic Approach Associated with Rapid Recovery After Lumbar Decompressive Laminectomy? A Preliminary Analysis of a Prospective Randomized Controlled Trial.

Study Design:Systematic review.Objectives:(1) What are the surgical indications? Have they changed over time since the year 2000? (2) What is the current surgical approaches of choice? Have they ch...

/pdf/trends-in-spinal-surgery-for-pott-s-disease-2000-2016-an-qsq7e4um8l.pdf

Trends in Spinal Surgery for Pott's Disease (2000-2016): An Overview and Bibliometric Study.

Titanium mesh cages have been used widely for spinal reconstruction since 1986 when they first were introduced. Despite their popularity, relatively few studies have been published on their use in the cervical spine. These cages can be used as structural devices containing autologous local bone or iliac crest bone graft, obviating the need to harvest large structural bone grafts. The main disadvantages of their use are the increased costs and the difficulty of assessing fusion status. The authors review surgical techniques that can be used using titanium mesh cages in cervical spine applications and discuss some of their advantages and disadvantages.

The use of titanium mesh cages in the cervical spine : Anterior column support for the spine

Study Design.A retrospective study.Objective.The purpose of this study was to identify the independent risk factors for postoperative surgical site infection (SSI) after posterior lumbar spinal surgery based on the perioperative factors analysis.Summary of Background Data.SSI is one of the most comm

Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery

Spinal tuberculosis is still prevalent in some developing countries. The purpose of this study is to investigate the efficacy and safety of one-stage posterior debridement, autogenous bone grafting, and transpedicular screw fixation in treating monosegmental thoracic and lumbar tuberculosis in adults. 37 patients were retrospectively reviewed in this study. The data of images, operative time and blood loss volume, perioperative complications, time to achieve bony fusion, VAS score, and neurologic function preoperatively and postoperatively were collected. The mean follow-up period was 21.5 ± 3.5 months. The tuberculosis was cured after surgery in all patients, and no recurrence was observed. Bony fusion was achieved in all patients with a mean time of 5.6 ± 2.5 months. Neurological outcome did not change in one case with grade A, and increased by 1-3 grades in the other patients with nerve deficit. The average preoperative and postoperative VAS scores were 5.5 ± 2.23 and 1.5 ± 1.22, respectively; the difference was significant (P < 0.05). There were three perioperative complications (8.1%, 3/37) observed in this study. In conclusion, the procedure of one-stage posterior debridement, interbody fusion with autogenous bone grafting, and posterior fixation with pedicle screw is effective and safe for treating monosegmental thoracic and lumbar spinal tuberculosis in adults.

/pdf/one-stage-posterior-debridement-and-transpedicular-screw-4gegq1dv1n.pdf

One-Stage Posterior Debridement and Transpedicular Screw Fixation for Treating Monosegmental Thoracic and Lumbar Spinal Tuberculosis in Adults

Spinal epidural haematoma (SEH) is a common complication after lumbar spinal decompression surgery, and symptomatic SEH usually causes devastating neurological deficits. Although different risk factors for post-operative SEH have been reported, few studies focused on patients’ laboratory tests. The purpose of this study was to analyze the incidence of symptomatic SEH following lumbar spinal surgery, as well as identify the risk factors for it. Patients who underwent posterior lumbar spinal decompression surgery between January 2010 and August 2016 were included in this study and their medical records were retrospectively reviewed. Those who developed post-operative symptomatic SEH after the surgery were identified. The risk factors for SEH were analyzed by univariate and multivariate regression analysis. In total, 2715 patients were included in this study and 31 (1.14%) were identified with post-operative symptomatic SEH. Of these patients, 19 were males and 12 were females, with an average age of 59.39 ± 11.66 years. After multivariate logistic regression analysis, low serum calcium level (P = 0.025), blood type A (P = 0.04), increased estimated blood loss (P = 0.032), prolonged surgical duration (P = 0.018), and decreased post-operative globulin (P = 0.016) were identified as the independent risk factors for post-operative SEH following lumbar spinal surgery. Furthermore, prolonged surgical duration (odds ratio = 3.105) was the strongest risk factor for SEH. Based on a large population investigation, the incidence of symptomatic SEH following lumbar spinal decompression surgery was 1.14%. Blood type A, increased estimated blood loss, and prolonged surgical duration were identified as the independent risk factors for post-operative SEH while two new risk factors, including low serum calcium level and decreased post-operative globulin, were firstly identified in this study.

Incidence and risk factors for symptomatic spinal epidural haematoma following lumbar spinal surgery

A retrospective study was performed to compare the clinical and radiological results between local bone graft with a cage and without using a cage in patients treated with posterior lumbar interbody fusion surgery. A total of 115 consecutive patients who underwent PLIF in three institutions were evaluated from December 2005 to December 2010. 53 patients received PLIF with local bone graft combined with using one PEEK cage, and 62 patients received the PLIF with local bone graft without using a cage. The clinical data and perioperative complications of the patients in the two groups were recorded. Preoperative and postoperative radiographs were taken to calculate the disc height and the interbody bony fusion rate. Functional outcome was assessed using the Kirkaldy-Willis criteria at the follow-up time. The results between the cage group and no cage group were compared. The mean follow-up time was 19 months in no cage group and 18.5 months in cage group (P = 0.716). 20.9 % of patients (13 cases) in no cage group and 20.7 % of patients (11 cases) in cage group developed surgical complications perioperatively (P = 0.978). 51.6 % patients in no cage group got excellent functional outcome at the final follow-up while 54.7 % patients in cage group (P = 0.944). The mean interbody bony fusion time was 7.5 ± 4.5 months in no cage group and 8 ± 3.5 months in cage group (P = 0.841). According to the radiographs measurement, no significant difference was found for the disc height at each level between the two groups at the final follow-up. Local bone graft without a cage is as beneficial as that with a cage for PLIF. Comparing with local bone graft using a single cage, we believe that the purely local bone graft is a more ideal way in single PLIF.

A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study

Purpose: In the present study, we examined both FOXM1 mRNA and protein expression by Real-time quantitative PCR (qRT-PCR) and Western blot and investigate the expression of the human FOXM1 by Immunohistochemistry (IHC), and identify their potential roles in prognosis for patients with osteosarcoma. Methods: FOXM1 mRNA and protein expression levels were detected by RT-PCR and Western blot assays, respectively. Then, IHC was performed to analyze the association of FOXM1 expression in 83 osteosarcoma tissues with clinicopathological factors and survival of patients. Results: The expression levels of FOXM1 mRNA were found to be significantly increased in osteosarcoma tissues compared to noncancerous bone tissues (P = 0.0313). Simultaneously, western blot analysis showed that the protein level of FOXM1 in osteosarcoma tissues was significantly higher than that in noncancerous bone tissues. Kaplan-Meier analysis with the log-rank test indicated that high FOXM1 expression had a significant impact on overall survival (P = 0.0001). Conclusions: Our data showed that FoxM1 was upregulated in osteosarcoma tissues, and high expression of FoxM1 was correlated with a poor prognosis of patients with osteosarcoma. FoxM1 may function as a valuable prognostic biomarker for osteosarcoma.

Dong Yang

Papers

Risk Factors for Surgical Site Infection After Posterior Lumbar Spinal Surgery

One-Stage Posterior Debridement and Transpedicular Screw Fixation for Treating Monosegmental Thoracic and Lumbar Spinal Tuberculosis in Adults

Incidence and risk factors for symptomatic spinal epidural haematoma following lumbar spinal surgery

A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study

Forkhead box protein M1 predicts outcome in human osteosarcoma