The posterior midline approach used in spinal surgery has been associated with a significant rate of wound dehiscence. This study investigates anatomical study of the arterial supply of the cervical and thoracic spinal muscles and overlying skin at each vertebral level. It aimed to provide possible anatomical basis for such wound complications.

A dissection and angiographic study was undertaken on 8 cadaveric neck and posterior torso from 6 embalmed and 2 fresh human cadavers. Harvested cadavers were warmed and hydrogen peroxide was injected into the major arteries. Lead oxide contrast mixture was injected in stepwise manner into the subclavian and posterior intercostal arteries of each specimen. Specimens were subsequently cross-sectioned at each vertebral level and bones elevated from the soft tissue. Radiographs were taken at each stage of this process and analysed.

The cervical paraspinal muscles were supplied by the deep cervical arteries, transverse cervical arteries and vertebral arteries. The thoracic paraspinal muscles were supplied by the superior intercostal arteries, transverse cervical arteries and posterior intercostal arteries. In the thoracic region, two small vessels provide the longitudinal connection between the segmental arteries and in the cervical region, deep cervical arteries provide such connection from C3 to C6. The arterial vessels supplying the paraspinal muscles on the left and right side anastomose with each other, posterior to the spinous processes in all vertebral levels. At cervical vertebral levels, source arteries travel near the surgical field and are not routinely cauterised; Haematoma is postulated to be the cause of wound complications. At thoracic levels, source arteries travel in the surgical field and tissue ischemia is a contributing factor to wound complications, especially in operations over extensive levels.

Post-operative wound complications is a multi-factorial clinical problem, the anatomical findings in this study provide possible explanations for wound dehiscence in the posterior midline approach. It is postulated that drain tubes may reduce the incidence of haematoma in the cervical level.

To identify factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.

There is a paucity of information on factors that predict poor patient-reported outcomes in patients with traumatic vertebral body fracture(s) of the thoracic and/or lumbar spine without neurological deficit.

Patients were identified from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). VOTOR includes all patients with orthopaedic trauma admitted to the two adult Level 1 trauma centres in Victoria, Australia. Patient-reported outcomes and data on possible predictive factors, including demographic details, injury-related and treatment-based factors, were obtained from the VOTOR database.

Patient-reported outcomes were measured at 12 months post-injury using the 12-Item Short-Form Health Survey (SF-12), a Numerical Rating Scale (NRS) for pain, global outcome questions and data was collected on return to work or study. For the identification of predictive factors, univariate analyses of outcome vs. each predictor were carried out first, followed by logistic multiple regression.

344 patients were eligible for the study and data were obtained for 264 (76.7%) patients at 12 months follow-up. Patients reported ongoing pain at 12 months post-injury (moderate–severe: 33.5%), disability (70.1%) and inability to return to work or study (23.3%). A number of demographic, injury-related and treatment-based factors were identified as being predictive of poor patient-reported outcomes. Patients who had associated radius fracture(s) were more likely to have moderate to severe disability (odds ratio (OR) = 3.85, 95% confidence interval = 1.30–11.39), a poorer physical health status (OR = 3.73, 1.37–10.12) and moderate to severe pain (OR = 3.23, 1.22–8.56) at 12 months post-injury than patients without radius fracture. Patients who did not receive compensation for work-related or road traffic-related injuries were less likely to report moderate to severe pain (OR = 0.45, 0.23–0.90) or have a poorer mental health status (OR = 0.17, 0.04–0.70) at 12 months post-injury than those who received compensation.

The prognostic factors identified in this study may assist clinicians in the identification of patients requiring more intensive follow-up or additional rehabilitation to ultimately improve patient care.

Introduction: The best surgical technique for patients with bacterial spinal infections is still matter of debate. Recent publications suggest that titanium implants can be used safely in infectious sites in combination with debridement and antibiotic therapy. The aim of this study was to provide further evidence in support of debridement and instrumentation as a single-stage procedure for spinal osteomyelitis/discitis.

Methods: We retrospectively review patients with spontaneous spondylodiscitis in whom medical therapy failed, and consequently underwent instrumented fusion by the same surgeon (DD). We defined failed medical treatment as progression of the neurological deficit, lack of improvement of the inflamatory markers after 48 hours of an adequate antibiotic therapy or progression to spinal deformity in the follow-up x-rays. In all cases, the following variables were evaluated: sex, age, relevant medical history, neurological compromise measured by the Frankel scale, level operated and operation performed, source of infection, etiologic agent, antibiotic treatment, postoperative complications, inflammatory markers, length of hospitalization, fusion time. Quality of life was measured after at least 12 months of the operation with the EQ5D questionnaire.

Results: 12 patients (5 men and 7 women), ranging in age from 42 to 85 years, with a Frankel score of D in 10 cases, and of E in 2 cases, underwent a single stage debridement and posterior instrumented fusion with titanium pedicle screws and interbody autogenous bone. Preoperative neurological deficits improved in all cases and solid bone fusion was achieved in all 12 patients (100%) at 6 months. The indication for surgery was progressive neurological deficit in the lower limbs in 9 cases, lack of improvement after 48hrs of antibiotic therapy guided by blood culture results in 2 patients and progression to spinal deformity in the remaining one. The mean follow-up period was 60 months (range 12 to 100). In all patients the infection healed after surgery, not requiring a second operation to remove the metal implants. Quality of life assessed with the EQ5-questionnaire showed the following results: mobility (median 1, range 1 to 2), personal care (median 1, range 1 to 1), usual activities (median 1.5, range 1 to 2), pain/discomfort (median 1.5, range 1 to 2), anxiety/depression (median 1, range 1 to 2), visual analog scale for health state (median 67.5, range 30 to 80).

Discussion: These findings support that debridement and instrumented fusion can be performed as a single-stage procedure without an increase in the recurrence rate or morbidity. The outcome has been satisfactory in our patients in terms of rate of fusion and quality of life in the long term follow up.

We studied prospectively 22 young athletes who had undergone surgical treatment for lumbar spondylolysis. There were 15 men and seven women with a mean age of 20.2 years (15 to 34). Of these, 13 were professional footballers, four professional cricketers, three hockey players, one a tennis player and one a golfer. Preoperative assessment included plain radiography, single positron-emission CT, planar bone scanning and reverse-gantry CT. In all patients the Oswestry disability index (ODI) and in 19 the Short-Form 36 (SF-36) scores were determined preoperatively, and both were measured again after two years in all patients. Three patients had a Scott’s fusion and 19 a Buck’s fusion.

The mean duration of back pain before surgery was 9.4 months (6 to 36). The mean size of the defect as determined by CT was 3.5 mm (1 to 8) and the mean preoperative and postoperative ODIs were 39.5 (sd 8.7) and 10.7 (sd 12.9), respectively. The mean scores for the physical component of the SF-36 improved from 27.1 (sd 5.1) to 47.8 (sd 7.7). The mean scores for the mental health component of the SF-36 improved from 39.0 (sd 3.9) to 55.4 (sd 6.3) with p < 0.001. After rehabilitation for a mean of seven months (4 to 10) 18 patients (82%) returned to their previous sporting activity.

The incidence of symptomatic pars defect varies between 15% and 47% in the young athletic population. We have analysed the outcome of direct repair spondylolysis on young professional athletes.

We have prospectively studied 22 young athletes with lumbar spondylolysis in whom conservative treatment has failed. Fifteen male and 7 female patients with a mean age of 20.2 years (range 15–34 years) were surgically treated for radiographically confirmed spondylolysis between 1994 and 1999. Eleven patients were professional footballers and four were professional cricketers. Pre-operative assessment included plain X rays, SPECT imaging with planar bone scan and reverse gantry CT scans. All patients had the Oswestry disability index (ODI) and 19 patients had Short Form 36 (SF-36) scores recorded pre-operatively and two years post operatively. Nineteen patients underwent Buck’s fusion and 3 underwent Scott’s fusion. At two-year follow-up nineteen patients had ODI and SF36 scores recorded. Return to the sporting activity at the previous level was regarded as a successful outcome.

The average duration of back pain prior to surgery was 8.9 months (range 1-36 months). The mean lysis defect determined by CT was 3.5 mm (range 1–8 mm). The mean pre-operative ODI was 39.5 (SD=8.7) and the mean post-operative ODI was 10.7 (SD=12.9). The mean scores of the physical health component of SF-36 improved from 27.1 (SD=5.1) to 47.8 (SD=7.7). The mean scores of the mental health component of SF-36 improved from 39.0 (SD=3.9) to 55.4 (SD=6.3) [P < 0.001].

The surgical repair of bilateral spondylolysis with modified Buck’s fusion in professional sportsmen and women results in a significant improvement in Oswestry Disability scores (p< 0.001) and in all domains of SF36 health questionnaire (p< 0.001). Ninety five percent of patients in this group return to active sport within seven months of surgery.