Post-operative infection is a serious complication of spine surgery and can contribute to the strain on the healthcare system's resources. The purpose of this study is to determine what factors affect the risk of developing postoperative infection. We hypothesize that female gender, smoking, diabetes, having thoracolumbar procedures, having a neurological deficit, increased age, body mass index (BMI), American Society of Anaesthesiologists (ASA) score, blood loss, number of operative levels, operative time and undergoing non-elective surgery will increase the patients' risk of developing a post-operative infection. A retrospective review of prospectively collected data within the Canadian Spine Outcome and Research Network (CSORN) was conducted. Data was analyzed using IBM-SPSS. Multivariable logistical regression analysis was conducted (odds ratios) to determine any association between the outcome and independent factors. Significance level was p < 0.05. There were 7747 patients identified from the registry that had completed at least 12 weeks of follow up. There were 199 infections recorded representing a 2.6% risk of infection. There were no association found between the risk of developing a post operative infection and gender, smoking, diabetes, having thoracolumbar procedures, having a neurological deficit, ASA score, blood loss, number of operative levels and undergoing non-elective surgery. The following were associated with an increased risk of developing a post operative infection: Older age (adjusted OR=1.021, 95% CI=1.005–1.038, p < 0 .05), having an elevated BMI (adjusted OR=1.042, 95% CI=1.013–1.072, p < 0 .005), longer operative time (adjusted OR=1.002, 95% CI=1.001–1.004, p < 0 .001). There is a 2.6% overall rate of post-operative spine infection across 20 Canadian centres. The factors that were associated with an increased risk of developing a post operative-infection were older age, increased BMI and longer operative time. This study establishes a benchmark against which the effectiveness of future interventions to reduce infection can be compared.
To evaluate risk factors and outcomes of spondylodiscitis in hemodialysis patients. Retrospective case control study of twenty-two spondylodiscitis patients and forty-four control subjects. The incidence of spondylodiscitis was 8.3 cases per 1000 patient-years. Spondylodiscitis patients had been receiving hemodialysis for a significantly longer average duration (median, thirty-seven months) than control subjects (median, thirteen months; P <
0.0008). A greater proportion of spondylodiscitis patients (eighteen [82%] patients) than control subjects (six [14%] subjects; P <
0.0001) had microorganism growth from at least one blood culture within three months before diagnosis of spondylodiscitis. During the months before spondylodiscitis diagnosis, a significantly greater proportion of spondylodiscitis patients than control subjects had received blood products, had an invasive procedure, had any type of vascular access established, or had temporary or permanent internal jugular or temporary femoral central venous catheters placed. All patients with spondylodiscitis received antimicrobial therapy (mean duration, twenty-one ± fourteen weeks). The death rate was significantly greater for spondylodiscitis patients (thirteen [59%] patients) than control subjects (twelve [28%] subjects; P <
0.03; odds ratio, 2.69; 95% confidence interval, 1.03 to 7.04). Risk factors for spondylodiscitis in hemodialysis patients include antecedent bacteremia, receipt of blood products, invasive procedures, or establishment of vascular access. Spondylodiscitis in hemodialysis patients has a poor prognosis and high risk of mortality.
Posterior segmental fixation of the cervical spine facilitates fixation in sub-optimal bone, abnormal anatomy, and complex deformity. Compared to lateral mass plates a screw rod construct provides a stable construct in osteoporotic bone or in cases where the lateral masses are fractured or missing. To investigate whether a posterior cervical screw- rod construct is an effective, stable and safe means of posterior cervical fixation. Retrospective evaluation of consecutive patients undergoing a posterior cervical stabilization with a screw- rod construct with clinical and radiographic evaluation. Clinical variables included age, gender, neurologic status, surgical indication, number of levels stabilized, and number of screws. Note was made as to whether a laminectomy was performed and concomitant anterior surgery. Clinical and radiographic assessments were carried out immediately after surgery and at six weeks, three, six, twelve months and annually after surgery. Eighty-three patients had five hundred and seventy-three screws placed from October 1998 to December 2003. Mean patient age was fifty-seven. Mean follow-up was twenty-three months, (one to sixty months). The underlying diagnoses were inflammatory arthritis thirty-three, spondylotic myelopathy twenty-nine and trauma in twenty-one patients. Forty-four patients (53% had motor deficit, forty-seven patients (57%) had sensory deficit. Fixation was carried out over an average of five levels (range – two to eight). Mean number of screws per construct was seven (range – four to fourteen). The instrumentation was successfully implanted in all despite lateral mass deficiencies (fracture, poor bone) and coronal and sagittal plane deformities. Late occipital fixation failure was encountered in one patient. There was no loss of alignment or surgical correction on follow-up radiographs. A posterior screw-rod system allows for treatment of traumatic and degenerative and inflammatory conditions. Crossing the occipitocervical or cervicothoracic junctions is easily afforded. We have had excellent success without complications from screw placement or pseudoarthrosis.
We report an unusual presentation of a solitary plasma-cell myeloma of the spine in an adolescent patient. Our case indicates the need to consider plasma-cell myeloma as a differential diagnosis even in younger patients.