Management of spinal infection

This review of spinal infections was conducted to better define the population at risk, the affected levels, presentation, causative organisms, duration of antibiotic treatment and indications for surgery. A retrospective analysis of 70 consecutive patients with primary spinal infection [epidural abscess and/or vertebral osteomyelitis] that presented between January 2001 and August 2004 was performed. These patients had not undergone immediate prior spinal surgery. We analyzed patient demographics, co-morbidities, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] and white blood cell count [WBC], management and outcomes. The mean age at presentation was 56.4 years [range 8 to 85], with 69% over the age of 50. Over half [56%] were male and 44% were female. Over a quarter [27%] presented with vertebral osteomyelitis, 40% with spinal epidural abscess, and 33% with both. Pain was the most common symptom, occurring in 77% at presentation. Co-morbid diseases included hypertension [41%], diabetes [33%], heart disease [27%] and pulmonary disease [20%]. Forty-one percent were treated with antibiotics alone while 59% underwent a surgical procedure. Ten percent failed initial medical management and required surgery. Time from diagnosis to surgery ranged from 3 to 10 weeks. Surgery was undertaken for decompression or stabilization. All but one patient improved at last follow-up. Declines in ESR and CRP correlated strongly with treatment success while WBC had less correlation. Parenteral antibiotic therapy averaged 8 weeks. This retrospective study further defines the population at risk for spinal infection, outlines current strategies of medical and surgical management, demonstrates the usefulness of laboratory values and conveys outcomes

Retrospective case study of post-traumatic syringomyelia

this is a retrospective review of patients with symptomatic post-traumatic syringomyelia. We examine initial symptoms, surgical treatment and outcome using clinical and magnetic resonance imaging [MRI] data. Surgical treatments included shunting or duraplasty, with or without lysis of adhesions. Method: twenty patients post-traumatic syringomyelia were identified, and had sufficient clinical and radiological data for inclusion in this study. All data was collected in a retrospective manner using available documentation and radiological images. Deficits in pain sensation, weakness, or pain and paraesthesias were each present in 70% of all presenting signs and symptoms. Shunting alone often required revision with subsequent operations in 56% of cases, while duraplasty required revision in only one of five patients. Lysis of adhesions appears to be most effective when performed with duraplasty. Increase in syrinx size on follow-up MRI examination correlates with clinical regression, while decrease in syrinx size correlates with clinical stability or improvement. we conclude that shunting alone is an ineffective method for treatment of symptomatic post-traumatic syringomyelia. Duraplasty provides more definitive treatment when compared to shunting alone. MRI study of syrinx at follow-up is an accurate predictor or clinical outcome

Optimal Sagittal position of a 20 mm interbody fusion cage

The current study was undertaken to investigate the biomechanical properties of a 20 mm long BAK cage [Spine Tech Inc., Minneapolis, MN] when implanted sequentially in one of three position: anteriorly within the disc space flush with the ventral margin of vertebral bodies, posteriorly with the cage flush with the floor of the spinal canal, and midway between the above 2 positions. eight human cadaveric spines L2-S1 were load tested with 0, 1.5, 3.0, 4.5 and 6.0 Nm in flexion and extension, lateral bending and axial rotation. Testing was first performed in the intact state, after anterior L4-L5 discectomy, and following instrumentation with a 20 mm long BAK cage in either the anterior, mid-, or posterior positions selected at random. when compared to the discectomy state, 20 mm BAK fusion cages reduced spinal motion in all 6 directions of motion. This reduction achieved significance [p < 0.05] in extension with the cages in all 3 positions. Also in extension, the anterior cage position was significantly more rigid than the posterior cage construct. In left axial rotation a significant reduction in motion from the discectomy state was encountered with the cages in the anterior and midposition. the results suggest that when short 20 mm cages are inserted through a ventral approach, anterior location within the disc space may be biomechanically advantageous