scholarly journals Delayed Adjacent Level Spondylodiscitis after Initial Surgery with Instrumented Spinal Fusion: A Report of Three Cases and Review of the Literature

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Narihito Nagoshi ◽  
Masanobu Shioda ◽  
Etsuro Yorimitsu ◽  
Mitsuru Yagi
Keyword(s):  
Spinal Fusion ◽  
Surveillance System ◽  
Spinal Instability ◽  
Adjacent Segment ◽  
Review Of The Literature ◽  
Adjacent Level ◽  
Bony Fusion ◽  
Initial Surgery ◽  
Deep Wound ◽  
Progressive Neurological Deficit

To date, 2 cases of adjacent level spondylodiscitis occurring a few months after initial spinal fusion were reported. However, the development of delayed adjacent level spondylodiscitis is very rare. The authors report 3 cases of spondylodiscitis that occurred at the proximal adjacent level of the fused spine more than 1 year after the initial surgery. Antibiotic treatment was initially chosen in all three cases. In two of the cases, progressive neurological deficit occurred at the level of the infection due to compression of neural elements and spinal instability. For these patients, additional spinal fusion was performed. In each of the three cases, the selected treatment resulted in successful bony fusion at the level of the spondylodiscitis. According to the National Nosocomial Infections Surveillance System, deep wound infection is defined as occurring within 1 year after surgery with instrumentation. The spondylodiscitis in the present cases occurred more than 1 year after the initial surgery, suggesting that these cases may be considered as adjacent segment disease rather than surgical site infection.

Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis

2006 ◽  
Vol 5 (4) ◽  
pp. 313-319 ◽  
Author(s):  
Hideki Sudo ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Yoshihisa Kotani ◽  
Tatsuto Takeuchi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spinal Fusion ◽  
Posterior Instrumentation ◽  
Survival Rates ◽  
Spinal Instability ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Spine Disorders

Object As increasing numbers of patients receive long-term hemodialysis, the number of reports regarding hemodialysis-related cervical spine disorders has also increased. However, there have been few reports summarizing the surgical results in patients with these disorders. The objective of this study was to evaluate the long-term follow up and clinical results after surgical treatment of cervical disorders in patients undergoing hemodialysis. Methods Seventeen patients in whom surgery was performed for cervical spine disorders while they received long-term hemodialysis therapy were enrolled in this study. Of these, 15 underwent follow-up review for more than 3 years after surgery, and these represent the study population. The remaining two patients died of postoperative sepsis. The average follow-up period was 120 months. Five patients without spinal instability underwent spinal cord decompression in which bilateral open-door laminoplasty was performed. Ten patients with destructive spondyloarthropathy (DSA) underwent reconstructive surgery involving pedicle screw (PS) fixation. In eight patients in whom posterior instrumentation was placed, anterior strut bone grafting was performed with autologous iliac bone to treat anterior-column destruction. Marked neurological recovery was obtained in all patients after the initial surgery. In the mobile segments adjacent to the site of previous spinal fusion, the authors observed progressive destructive changes with significant instability in four patients (40%) who underwent circumferential spinal fusion. No patients required a second surgery after laminoplasty for spinal canal stenosis without DSA changes. Conclusions Cervical PS-assisted reconstruction provided an excellent fusion rate and good spinal alignment. During the long-term follow-up period, however, some cases required extension of the spinal fusion due to the destructive changes in the adjacent vertebral levels. Guidelines or recommendations to overcome these problems should be produced to further increase the survival rates of patients undergoing hemodialysis.

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

2021 ◽  
Author(s):  
Marcus Rickert ◽  
Michael Rauschmann ◽  
Nizar Latif-Richter ◽  
Mohammad Arabmotlagh ◽  
Tamin Rahim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Wound Infection ◽  
Spinal Fusion ◽  
Negative Pressure Wound Therapy ◽  
Wound Infections ◽  
Wound Therapy ◽  
Postoperative Wound ◽  
Deep Wound ◽  
The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

scholarly journals Paraspinal gossybipoma: A case report and review of the literature

2010 ◽  
Vol 01 (02) ◽  
pp. 102-104 ◽  
Author(s):  
Baris Kucukyuruk ◽  
Huseyin Biceroglu ◽  
Bashar Abuzayed ◽  
Mustafa O Ulu ◽  
Ali M Kafadar
Keyword(s):  
Clinical Presentation ◽  
Review Of The Literature ◽  
Disk Herniation ◽  
Serous Fluid ◽  
Lumbar Disk Herniation ◽  
Radiologic Findings ◽  
Initial Surgery ◽  
History Of ◽  
Retained Surgical Sponges ◽  
Operation Wound

ABSTRACTSpinal or paraspinal retained surgical sponges (gossybipoma or textiloma) are rare incidents and mostly asymptomatic in chronic cases, but can be confused with other masses such as a hematoma, an abscess or a tumor. In chronic cases, the presentation can be as late as decades after the initial surgery; however, some gossybipomas cause infection or abscess formation in the early stages. The authors report a 40-year-old woman with a history of operation for lumbar disk herniation before 8 months, and got admitted with a complaint of serous fluid leakage from the operation wound. In this report, the authors discuss the clinical presentation, the radiologic findings and the differential diagnosis of gossybipoma.

scholarly journals Technical outcome of atlantoaxial transarticular screw fixation without supplementary posterior construct for rheumatoid arthritis

2020 ◽  
Vol 11 ◽  
pp. 188
Author(s):  
Philip Thomas ◽  
Michael Amoo ◽  
Jack Horan ◽  
Mohammed Ben Husien ◽  
Derek Cawley ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Results ◽  
Posterior Fusion ◽  
Adjacent Segment ◽  
Transarticular Screw ◽  
Bony Fusion ◽  
Pull Out ◽  
Screw Breakage ◽  
The Mean ◽  
Anterior Subluxation

Background: transarticular screw (TAS) fixation without a supplementary posterior construct, even in rheumatoid arthritis (RA) patients, provides sufficient stability with acceptable clinical results. Here, we present our experience with 15 RA patients who underwent atlantoaxial (AA) TAS fixation without utilizing a supplementary posterior fusion. Methods: To treat AA instability, all 15 RA patients underwent C1–C2 TAS fixation without a supplementary posterior construct. Patients were followed for at least 24 months. Pre- and postoperative sagittal measures of C1– C2, C2–C7, and C1–C7 angles, atlanto-dens interval (ADI), posterior atlanto-dens interval (PADI), and adjacent segment (i.e., C2–C3) anterior disc height (ADH) were retrospectively recorded from lateral X-ray imaging. The presence or absence of superior migration of the odontoid (SMO), cervical subaxial subluxation, C1–C2 bony fusion, screw pull-out, and screw breakage were also noted. Results: There was little difference between the pre- and postoperative studies regarding angles measured. Following TAS fixation, the mean ADI shortened, and mean PADI lengthened. There was no difference in the mean measures of C2–C3 ADH. There was no evidence of SMO pre- or postoperatively. Two patients developed anterior subluxation at C5–C6; one of the two also developed anterior subluxation at C2–C3. All patients subsequently showed C1–C2 bony fusion without screw pull-out or breakage. Conclusion: In RA patients who have undergone C1–C2 TAS fixation, eliminating a supplementary posterior fusion resulted in adequate stability.

Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability

2017 ◽  
Vol 78 (06) ◽  
pp. 556-560 ◽  
Author(s):  
Christof Wrangel ◽  
Ali Karakoyun ◽  
Kaye-Marie Buchholz ◽  
Olaf Süss ◽  
Theodoros Kombos ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Implant Failure ◽  
Adjacent Segment ◽  
Adjacent Level ◽  
Lumbar Instability ◽  
Titanium Cages

Background Posterior lumbar interbody fusion (PLIF) surgery is a commonly used procedure for degenerative lumbar instability. Locally harvested bone is usually inserted into intervertebral cages to increase fusion rate. The fusion rate without bone application remains unknown. Our aim was to analyze retrospectively the fusion rates of intervertebral polyetheretherketone (PEEK) and titanium cages in PLIF surgery that were implanted without bone grafting using three-dimensional computed tomography (CT) scanning. Material and Methods Forty patients (age 43–83 years) with mono- or bisegmental degenerative instability were included. PEEK cages were used in 28 segments (25 patients), and titanium cages were used in 17 segments (15 patients) undergoing PLIF surgery plus pedicle screws. The primary outcome parameter was radiologic fusion rate measured by CT at follow-up. Secondary parameters included rate of implant failure and adjacent segment disease. Results No difference in mean age between groups was identified (PEEK: 69 ± 10 years; titanium: 62 ± 13 years). Mean follow-up was 39 ± 13 months in PEEK and 24 ± 12 months in the titanium group. Radiologic fusion rate was 32% of operated segments in PEEK and 53% in the titanium group. Screw loosening/adjacent-level disease was observed in 8% and 8% in the PEEK group and in 0% and 7% in the titanium group, respectively. Conclusion Radiologic fusion rates of PEEK and titanium cages without bone grafting is low in PLIF surgery, and therefore bone grafting should be performed if possible. Rate of implant failure and adjacent-level disease remains low despite reduced osseous fusion in the operated segments.

Effectiveness of Reoperations for Adjacent Segment Disease Following Lumbar Spinal Fusion

Orthopedics ◽  
2017 ◽  
Vol 41 (2) ◽  
pp. e161-e167 ◽  
Author(s):  
Austin Drysch ◽  
Remi M. Ajiboye ◽  
Akshay Sharma ◽  
Jesse Li ◽  
Tara Reza ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Lumbar Spinal Fusion ◽  
Lumbar Spinal

Correlation Between Clinical Result and Adjacent Segment Degeneration After Lumbar Spinal Fusion

2008 ◽  
Vol 15 (1) ◽  
pp. 38 ◽  
Author(s):  
Jun-Young Yang ◽  
June-Kyu Lee ◽  
Ho-Sup Song ◽  
Tae-Hoon Kim ◽  
Kyu-Woong Yeon
Keyword(s):  
Spinal Fusion ◽  
Clinical Result ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Spinal Fusion ◽  
Lumbar Spinal

scholarly journals Unligated vertical vein presenting as a large atrio-portal shunt in adulthood: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Georgia R Layton ◽  
Marinos Koulouroudias ◽  
Eyad Issa ◽  
Steve Jepson ◽  
Antonio F Corno ◽  
...  
Keyword(s):  
Case Report ◽  
Portal Vein ◽  
Adult Patient ◽  
Pulmonary Veins ◽  
Systemic Circulation ◽  
Review Of The Literature ◽  
Right Heart ◽  
Vertical Vein ◽  
Initial Surgery ◽  
Anomalous Pulmonary Venous Connection

Abstract A 28-year-old male with infra-cardiac totally anomalous pulmonary venous connection (TAPVC) repaired as new-born presented in adulthood with right heart strain and very large left atrium to portal vein vessel. Residual connections from pulmonary veins to systemic circulation are believed to represent persistent ‘vertical veins’ (VV) not ligated at the time of the initial surgery. In our patient, since endovascular occlusion was not judged suitable, the anomalous vessel was surgically ligated and resected. A review of the literature failed to find such a procedure reported in an adult patient and analyzed the intra-operative ligation of VV during repair of TAPVC.

scholarly journals Evaluation of Effects on Adjacent Segment after Lumber Spinal Fusion: Comparison between Monosegmental Fusion Group and Multisegmental Fusion Group

2006 ◽  
Vol 55 (4) ◽  
pp. 496-499
Author(s):  
Hirokazu Saiwai ◽  
Isao Saikawa ◽  
Tsutomu Irie ◽  
Tetsuya Tanaka ◽  
Ken-ichi Kawaguchi ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Adjacent Segment
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