ABSTRACT
STUDY DESIGN: Retrospective study. PURPOSE: Missing cottonoids during and after spinal surgery is a persistent problem and account for the most commonly retained surgical instruments (RSIs) noticed during a final cottonoid count. The aim of this study was to enumerate risk factors and describe the sequence to look out for misplaced cottonoids during spinal surgery and provide an algorithm for resolving the problem. OVERVIEW OF LITERATURE: There are only a few case reports on RSIs among various surgical branches. The data is inconclusive and there is little evidence in the literature that relates to spinal surgery. METHODS: This retrospective study was conducted at Indian Spinal Injuries Centre. The data was collected from hospital records ranging from January 2013 to December 2017. The surgical cases in which cottonoid counts were inconsistent during or after the procedure were included in the study. The case files along with operating theater records were thoroughly screened for selecting those in which there was confirmed evidence of such an event. RESULTS: There were 7,059 spinal surgeries performed during the study period. Fifteen cases of miscounts were recorded with an incidence of one in every 471 cases. Cottonoids were most commonly lost under the shoes of the surgeon or assistants. In two instances, cottonoids were found in the surgical field and trapped in the interbody cage site. Based on these locations, a systematic search algorithm was created. CONCLUSIONS: This study enumerates RSI risk factors in spinal surgical procedures and describes steps that can be followed to account for any missing cottonoids. The incidence of missing cottonoids can be decreased using a goal-oriented approach and ensuring that surgical teams work in collaboration.
ABSTRACT
STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the results of posterior pedicle-screw fixation with transpedicular decompression in 21 cases of thoracic and thoracolumbar spinal tuberculosis (TB) in terms of functional, neurological, and radiologic outcomes. SUMMARY OF BACKGROUND DATA: Spinal TB is predominantly an anterior disease that can lead to kyphotic deformity. Hence, anterior debridement and fusion was considered as the gold standard. However, with remarkable improvements in chemotherapy regimens and diagnostic tools, it is possible to detect the disease process early and treat them with less radical approaches. In the present study, authors have shown the results of posterior pedicle-screw fixation with transpedicular decompression in thoracic and thoracolumbar spinal TB. MATERIALS AND METHODS: The study reviewed 21 patients with thoracic or thoracolumbar TB with kyphotic deformity who were operated with posterior pedicle-screw fixation and transpedicular decompression (pus aspiration through a Jamshidi needle) with kyphosis correction for either neurological deficits (11) or intractable pain (10), not responding to at least 4-6 weeks of chemotherapy. Patients with <3 spinal segment involvement, <30 degrees kyphosis, and <50% vertebral body destruction were included in the study. RESULTS: The mean age of patients was 43.9 years and the mean kyphosis angle at the level of involvement was 21.61±3.72 degrees. Kyphosis improved postoperatively to 5.79±3.48 degrees. The mean follow-up period was 24.09 months, and final kyphosis correction was maintained at 8.74±3.65 degrees. Bony fusion was achieved in 80.5% cases. Eleven patients had neurological deficits, and all of them recovered. All patients had a Visual Analog score improvement from 9.52 to 2.57 postoperatively. CONCLUSIONS: Posterior stabilization with transpedicular decompression can be considered as a good treatment option for the management of thoracic and thoracolumbar TB in patients with <50% vertebral body destruction and <30-degree kyphosis. It provides rapid relief of instability pain, improvement of neurological deficit, and prevents progression of deformity.
