The aim of this study was to evaluate whether, after correction of an adolescent idiopathic scoliosis (AIS), leaving out the subfascial drain gives results that are no worse than using a drain in terms of total blood loss, drop in haemoglobin level, and opioid consumption. Adolescents (aged between 10 and 21 years) with an idiopathic scoliosis (major curve ≥ 45°) were eligible for inclusion in this randomized controlled noninferiority trial (n = 125). A total of 90 adolescents who had undergone segmental pedicle screw instrumentation were randomized into no-drain or drain groups at the time of wound closure using the sealed envelope technique (1:1). The primary outcome was a drop in the haemoglobin level during first three postoperative days. Secondary outcomes were 48-hour postoperative oxycodone consumption and surgical complications.Aims
Methods
During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients. All patients who underwent a revision surgery after instrumented spinal surgery at our institution between July 2014 and August 2016 with spinal implants submitted for sonication were retrospectively analyzed. Only revisions presumed as aseptic are included in the study. During the study period, 204 spinal revisions were performed for diagnoses other than infection. In 38 cases, sonication cultures were not obtained, leaving a study cohort of 166 cases. The mean age of the cohort was 61.5 years (Aims
Patients and Methods
The demand for spinal surgery and its costs have
both risen over the past decade. In 2008 the aggregate hospital
bill for surgical care of all spinal procedures was reported to
be $33.9 billion. One key driver of rising costs is spinal implants.
In 2011 our institution implemented a cost containment programme
for spinal implants which was designed to reduce the prices of individual
spinal implants and to reduce the inter-surgeon variation in implant costs.
Between February 2012 and January 2013, our spinal surgeons performed
1493 spinal procedures using implants from eight different vendors.
By applying market analysis and implant cost data from the previous
year, we established references prices for each individual type
of spinal implant, regardless of vendor, who were required to meet
these unit prices. We found that despite the complexity of spinal
surgery and the initial reluctance of vendors to reduce prices,
significant savings were made to the medical centre. Cite this article: 2015; 97-B:1102–5.
Minimal clinically important differences (MCID)
in the scores of patient-reported outcome measures allow clinicians to
assess the outcome of intervention from the perspective of the patient.
There has been significant variation in their absolute values in
previous publications and a lack of consistency in their calculation. The purpose of this study was first, to establish whether these
values, following spinal surgery, vary depending on the surgical
intervention and their method of calculation and secondly, to assess
whether there is any correlation between the two external anchors
most frequently used to calculate the MCID. We carried out a retrospective analysis of prospectively gathered
data of adult patients who underwent elective spinal surgery between
1994 and 2009. A total of 244 patients were included. There were
125 men and 119 women with a mean age of 54 years (16 to 84); the
mean follow-up was 62 months (6 to 199) The MCID was calculated
using three previously published methods. Our results show that the value of the MCID varies considerably
with the operation and its method of calculation. There was good
correlation between the two external anchors. The global outcome
tool correlated significantly better. We conclude that consensus needs to be reached on the best method
of calculating the MCID. This then needs to be defined for each
spinal procedure. Using a blanket value for the MCID for all spinal
procedures should be avoided. Cite this article:
A combination of hemivertebrae and diastematomyelia is rare. We have identified 12 such patients seen during a period of 11 years in the orthopaedic, spinal and neurosurgical units in Nottingham and analysed their treatment and outcome.
