Does surgical technique affect the incidence of spondylodiscitis post-lumbar microdiscectomy? A retrospective analysis of 3063 patients.

STUDY DESIGN: Retrospective audit in a single center during a period of 7 years operated by 3 groups of surgeons after 3 different surgical techniques. OBJECTIVE: Our study aimed to determine whether surgical technique had any influence on the incidence of spondylodiscitis in patients undergoing lumbar microdiscectomy and to compare this with published rate of incidence of spondylodiscitis. SUMMARY OF BACKGROUND DATA: The incidence of spondylodiscitis post-lumbar microdiscectomy ranges from 0.2% to 15%. There is limited evidence to compare different techniques and the incidence of spondylodiscitis. METHODS: A total of 3063 patients were analyzed from 2005 to 2011 for discitis postoperatively. The first group followed a standard microdiscectomy technique, the second group used antiseptic (Savlon; Novartis Consumer Health UK Limited, Surrey, UK) irrigation at the end of the procedure to irrigate the disc space, and the third group followed standard microdiscectomy along with usage of a separate disc instruments when discectomy was performed. The number of patients operated in the individual groups was 559, 1122, and 1382. RESULTS: The total number of patients who had postoperative discitis was 3 (0.10%), with a range of 0.07% to 0.18%. There was 1 case of discitis in each group. The incidence of spondylodiscitis in groups A, B, and C were 0.18%, 0.09%, and 0.07%, respectively. CONCLUSION: This study concluded that different techniques used for lumbar microdiscectomy revealed that standard microsurgical technique with usage of antiseptic irrigation for the disc space and usage of separate disc instruments had lesser incidence of spondylodiscitis in comparison with standard microdiscectomy. The overall incidence of postoperative discitis remains less in our series. So far, to our knowledge, this report involves the largest number of patients studied to determine the incidence of discitis in patients undergoing lumbar microdiscectomy. LEVEL OF EVIDENCE: 3.

Aneurysmal subarachnoid haemorrhage in Parry-Rhomberg syndrome.

Parry-Romberg syndrome (PRS) or progressive hemi facial atrophy syndrome is a rare condition of unknown aetiology that is characterised by progressive unilateral facial and cranial atrophic changes of skin, subcutaneous tissues and bone. The authors describe a 37-year-old female with a history of PRS, who presented with a subarachnoid haemorrhage secondary to rupture of a 9 mm fusiform aneurysm of the posterior cerebral artery. There was an associated external carotid arterio-venous fistula noted with this aneurysm. The aneurysm was treated by endovascular route and was successfully coiled. Follow-up angiogram revealed spontaneous resolution of the fistula with good occlusion of the aneurysm. The aetio-pathogenesis of this rare occurrence, literature review and its management is discussed.

The surgical management of rectal cancer: a comparison of treatment methods and outcomes over 2 time periods in the same geographic region.

BACKGROUND: Preoperative radiotherapy combined with total mesorectal excision (TME) has provided excellent local control in the treatment of rectal cancer. This study is a review of patients treated at our regional cancer center from 1998 to 2004. The results were compared with a similar study carried out in our region from 1988 to 1998 to determine any changes in treatment methods, recurrence rates, and survival. METHODS: A retrospective review of 448 patients treated with definitive surgery for rectal cancer was conducted. Patient factors analyzed included sex, age, type of surgery, and adjuvant strategy. Tumor factors analyzed included level, stage, and grade. The presence of local recurrence was recorded and overall survival was determined. RESULTS: The local recurrence rate was 8.3% compared with 12.7% in the previous study. Patients treated with preoperative radiotherapy had a recurrence rate of 3.7%. The type of surgical therapy had no significant effect on local recurrence. There was no significant change in overall survival between the present study and the previous one. CONCLUSION: Preoperative radiotherapy is used more frequently in our region and has resulted in a decrease in the local recurrence rate compared to our previous retrospective review. There was no change in local recurrence seen in those patients treated with operative management alone. This study supports the use of preoperative radiotherapy in the management of rectal cancer.