Overview and classification of spinal infections.

Hematogenous spread is the most common cause for vertebral osteomyelitis. S. aureus is the most common organism in pyogenic vertebral osteomyelitis. Hematogenous osteomyelitis is common among diabetics and intravenous drug abusers. Tuberculous spondylitis remains common worldwide. In general, vertebral body infections not responding to antibiotic treatment and those creating unacceptable deformity or neurologic compromise require debridement via an anterior approach with strut grafting. Posterior infections are almost always postsurgical and require posterior irrigation and debridement in addition to antibiotics. Abscesses within the canal require antibiotics and surgical debridement especially when neurologic symptoms are present. Infections within the canal are approached posteriorly unless the pathology involves the anterior spine. Use of metal fixation within the site of an adequately debrided spinal infection is controversial but necessary on rare occasions. Posterior fixation for anterior infections is preferred. Much has been written about spinal infections and their treatment. Landmark articles and additional comprehensive sources on spinal infections have been included in the references.

Cost of medical care for postoperative spinal infections.

The movement towards managed care has raised the awareness of health care costs in today's society. The additional expense involved in treating patients with deep postoperative spinal infections after lower back fusion increases the total cost of care more than four times. Three areas of greatest increase in cost are room and board, pharmacy and laboratory charges. Decreasing the expense of this complication can best be effected through use of home nursing care, choice, and duration of antibiotic treatment and prudent laboratory testing.

Outcome assessment in spinal infections.

The importance of outcome studies in patients undergoing spinal surgery is discussed. There are numerous questionnaires used to assess quality of life results in orthopedic patients. This suggests disagreement and difficulty in the assessing and comparing outcomes. Several of these instruments for assessing outcome are reviewed. Postoperative spinal infection can prolong a patients recovery from spinal surgery and exacerbate symptoms of lower back pain. A review of the authors' patients at 3 years follow-up suggests that outcome with postoperative infections was similar to other patients with low back pain undergoing fusion without postoperative infectious complications.

Perioperative risk factors for wound infections after lower back fusions.

Although reduced by technology, antibiotics and surgical technique, spinal infection from surgery remains a recognizable risk. The rate of infection in spinal surgery is reviewed. Identification of risk factors are important in preoperative planning. Preoperative risk factors for postoperative spinal infection include obesity and smoking. Attention to sterility and efficient technique can reduce potential wound contamination intraoperatively. Excessive wound drainage and seroma formation should warn of a potential wound infection.

Treatment of shoulder dislocation with ipsilateral humeral shaft fracture.

A case presentation of shoulder dislocation with ipsilateral humeral shaft fracture is presented along with a review of the literature regarding nine reported cases. In the current case, closed treatment of the humeral shaft fracture was undertaken with an unsuccessful attempt at closed reduction of the anterior shoulder dislocation, resulting in a radial nerve deficit. Successful treatment required open reduction of the humeral fracture with compression plating followed by closed reduction of the shoulder dislocation. We compare this treatment (with outcome) to other methods of treatment.