To evaluate the prevalence of infection after elective spinal surgery, a prospective study of patients was carried out over 10 years to 2002. Demographic details, diagnosis and indications for surgery, duration of surgery, time delay before surgery and concomitant diseases were recorded. The management and outcome of patients who developed infection postoperatively were noted. During the period, 1050 elective cases were done for scoliosis, tuberculous spine, tumours, trauma, biopsy and degenerative disorders. There were four deep and six superficial infections. Deep infections were treated by debridement and implant removal, with good outcomes. Superficial sepsis settled with local therapy. The rate of sepsis following elective spinal surgery was 0.95% and infections responded well to treatment.
This paper retrospectively reviews 40 quadriplegics treated from 1997 to 2000. Hospital records, spinal unit records and telephonic interviews were used to obtain data on age, sex, mechanism of injury, levels involved, delay in admission, associated injuries, treatment, morbidity, mortality, rehabilitation time and placement on discharge. The mean age of the 36 men (89%) and four women (11%) was 36 years (18 to 66). The mechanism of injury in 34 of the patients (85%) was motor vehicle accidents. Five patients (13%) had sustained gunshot wounds and one patient had hit a wall (2%). The mean delay to admission was 5 days (0 to 42). Injuries were at C5/6 in 40% of the patients. Twenty-five patients (62.5%) were treated conservatively and 15 (37.5%) surgically. The 37.5% mortality rate was related to admission delay, associated injuries and patient age. Placement after discharge was problematic in 36% of the patients.
Tuberculosis of the spine is very common and it is important to do confirmatory testing. This retrospective study involved 40 patients in whom tuberculosis of the spine was diagnosed after clinical examination and investigations. All underwent decompression of the spine for neurological fallout. Intra-operatively, histological tissue, MCS and polymerase chain reaction (PCR) were assessed. PCR was positive in only 50% of the patients, but was complementary to histology and MCS.
Sciwora lesions are common in children but rare in adults. In adults, they are often associated with spondylosis, and minor trauma may result in paralysis of varying degrees. In our unit we conducted a retrospective analysis of adult patients with spinal cord injuries. Only two had Sciwora lesions. One lesion was in the thoracic spine and the other in the lumbar spine. The thoracic lesion led to complete paraplegia, with intrinsic cord damage. It was treated conservatively and the patient did not recover. The lumbar lesion was incomplete, with traumatic disc prolapse that recovered after discectomy. Management of Sciwora lesions of the thoracic and lumbar spine depends on MRI findings.
Fractures of the thoracolumbar spine are now so common that most orthopaedic surgeons are likely to have to handle one. It is important that we have common terms of reference when we assess, manage and discuss outcomes of these injuries. The authors plan to assess the intra-observer and inter-observer interpretation of six plain radiographs of thoraco-lumbar fractures. Volunteer orthopaedic surgeons attending the SAOA Congress will be asked to classify the six radiographs twice, on different days, and the radiographic labelling will be changed. Participants will be given the Margel and Dennis classifications for reference. Participants’ names will not be required, only their year of qualification and exposure to spinal surgery. The results will be analysed statistically and communicated to the orthopaedic community in due course.
