Risk factors for surgical site infections among 1,772 patients operated on for lumbar disc herniation: a multicentre observational registry-based study.

BACKGROUND: There are no previous studies evaluating risk factors for surgical site infections (SSIs) and the effectiveness of prophylactic antibiotic treatment (PAT), specifically for patients operated on for lumbar disc herniation. METHOD: This observational multicentre study comprises a cohort of 1,772 consecutive patients operated on for lumbar disc herniation without laminectomy or fusion at 23 different surgical units in Norway. The patients were interviewed about SSIs according to a standardised questionnaire at 3 months' follow-up. RESULTS: Three months after surgery, 2.3% of the patients had an SSI. Only no PAT (OR = 5.3, 95% CI = 2.2-12.7, p< 0.001) and longer duration of surgery than the mean time (68 min) (OR = 2.8, 95% CI = 1.2-6.6, p = 0.02) were identified as independent risk factors for SSI. Numbers needed to have PAT to avoid one SSI was 43. CONCLUSIONS: In summary, this study clearly lends support to the use of PAT in surgery for lumbar disc herniation. Senior surgeons assisting inexperienced colleagues to avoid prolonged duration of surgery could also reduce the occurrence of SSI.

Incidence rates and surgery of primary intraspinal tumors in the era of modern neuroimaging: a national population-based study.

STUDY DESIGN: Prospective national population-based cohort study. OBJECTIVE: To evaluate national population-based data on histopathologically verified intraspinal tumors and explore time trends in incidence and surgery rates and associations with the increased availability of magnetic resonance imaging (MRI) during 1993 and 2011. SUMMARY OF BACKGROUND DATA: There is a relative lack of updated epidemiological data on primary intraspinal tumors and most previous studies do not capture the advances in diagnostics and surgical treatment in the era of modern neuroimaging. The possible effect of the increasing availability of MRI on incidence rates and clinical management of primary intraspinal tumors is not known. METHODS: We included all patients with a histologically verified intraspinal tumor diagnosed between 1993 and 2011 in a population-based cohort based on data from the Cancer Registry of Norway. The incidence and surgery rates were calculated and compared with the number of available MRI scanners in Norway. RESULTS: We identified 1104 patients diagnosed with a primary intraspinal tumor. The incidence rate based on the Norwegian population between 1993 and 2011 was 1.28 per 100,000. In 1993, there were 8 MRI scanners in Norway increasing to 125 in 2011. There seems to be a plateau in the increase in incidence rates after 2002 where the subsequent increase in the number of MRI scanners did not seem to be followed by further increases of intraspinal tumor surgery. CONCLUSION: The incidence rate of primary intraspinal tumors in Norway changed dramatically during the study period, stabilizing around 1.5 per 100,000 per year since 2002. There was an increase in surgery for all major subgroups. This increase in surgical activity seems to correlate with the simultaneous large increase in the availability of diagnostic magnetic resonance imaging.

Prehospital use of cervical collars in trauma patients: a critical review.

The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.