ABSTRACT
STUDY DESIGN: A rabbit model was used to test the efficacy of two commonly used prophylactic antibiotics, cefazolin and vancomycin, in preventing iatrogenically introduced Staphylococcus aureus intervertebral disc infections. OBJECTIVE: This study was performed to assess the efficacy of two prophylactic antibiotics in preventing iatrogenically introduced Staphylococcus aureus intervertebral disc infections. SUMMARY OF BACKGROUND DATA: Previous studies have had conflicting results regarding the penetration of antibiotics into the nucleus pulposus and their ability to eradicate infection. METHODS: In this study, 40 adult New Zealand White rabbits underwent inoculation of 10(1) or 10(3) Staphylococcus aureus/ml into 3-6 lumbar intervertebral discs under direct visualization. Either no antibiotics (control groups) or various preoperative and postoperative dosing schedules of cefazolin or vancomycin were given intravenously. Five days after surgery, the discs were harvested and cultured. RESULTS: All 40 discs inoculated in the control groups became infected. None of the 35 discs inoculated in the cefazolin groups became infected. Infection developed in 23 of 107 discs inoculated in the vancomycin groups. Most notable of these were 17 of 17 positive cultures in animals given vancomycin 8 hours preoperatively only. CONCLUSIONS: Based on these results, it was concluded that intravenous cefazolin or vancomycin given within 1 hour before surgery can effectively prevent postoperative discitis. No advantage was found with additional postoperative antibiotics.
Subject(s)
Cefazolin/therapeutic use , Iatrogenic Disease/prevention & control , Intervertebral Disc/microbiology , Spinal Diseases/prevention & control , Staphylococcal Infections/prevention & control , Vancomycin/therapeutic use , Animals , Disease Models, Animal , Injections, Intravenous , Intervertebral Disc/drug effects , Intervertebral Disc/surgery , Postoperative Complications/prevention & control , Rabbits , Spinal Diseases/microbiology , Spinal Diseases/surgery , Staphylococcal Infections/microbiology , Staphylococcus aureusABSTRACT
A case involving spinal cord compression due to local extension of vertebral chondrosarcoma is described. The malignancy originated in an osteochondroma and spread via the epidural veins. Surgical staging as well as options for the treatment of vertebral chondrosarcoma are discussed.
Subject(s)
Chondrosarcoma/pathology , Neoplasms, Multiple Primary/pathology , Osteochondroma/pathology , Spinal Cord Compression/etiology , Spinal Neoplasms/pathology , Thoracic Vertebrae , Adult , Chondrosarcoma/complications , Chondrosarcoma/radiotherapy , Chondrosarcoma/surgery , Combined Modality Therapy , Epidural Space , Female , Humans , Internal Fixators , Neoplasm Invasiveness , Neoplasm Staging , Osteochondroma/complications , Osteochondroma/surgery , Spinal Neoplasms/complications , Spinal Neoplasms/radiotherapy , Spinal Neoplasms/surgery , Thoracic Vertebrae/pathology , ThoracotomyABSTRACT
Eighteen neurologically intact patients with burst fractures at the thoracolumbar junction were treated with early ambulation in a total contact orthosis. No attempt was made to reduce the associated deformity. Selection criteria excluded patients with posterior column disruption. Hospital stay averaged 10 days. Follow-up averaged 19 months. Mean kyphosis was 19 at time of injury and 20 at follow-up. At follow-up, 15 patients rated their pain as little or none. Seventeen patients had little or no restriction of activity. Follow-up computed tomography (CT) scans obtained in eight patients showed significant resorption of retropulsed bone. No deterioration of neurologic function developed in any patient. In patients with intact posterior elements and thoracolumbar burst fractures, early mobilization in a total contact TLSO can lead to satisfactory functional results. Prolonged bed rest was not required in this series. The authors attribute the good results of nonoperative management to the exclusion of patients with posterior column disruption.
