ABSTRACT
OBJECTIVE: Surgical site infection (SSI) results in high morbidity and mortality in patients undergoing spinal fusion. Using intravenous antibiotics in anesthesia induction reduces the rate of postoperative infection, but it is not common practice to use them topically, despite recent reports that this procedure helps reduce infection. The objective of this study was to determine whether the topical use of vancomycin reduces the rate of postoperative SSI in patients undergoing thoracolumbar fusion. METHODS: A randomized, double-blind clinical trial in a single hospital was performed comparing vancomycin and placebo in thoracolumbar fusion patients. RESULTS: A total of 96 patients were randomized to placebo or vancomycin treatment. The mean patient age was 43 ± 14.88 years, 74% were male, and the most common etiology was fall from height (46.9%). The overall rate of postoperative SSI was 8.3%, and no difference was found between the groups: postoperative infection rates in the vancomycin and placebo groups were 8.2% and 8.5% (relative risk [RR] of SSI not using vancomycin 1.04, 95% confidence interval [CI] 0.28-3.93, p = 0.951), respectively. Patients with diabetes mellitus had higher SSI rates (RR 8.98, 95% CI 1.81-44.61, p = 0.007). CONCLUSIONS: This is the first double-blind randomized clinical trial to evaluate the effects of topical vancomycin on postoperative infection rates in thoracolumbar fusion patients, and the results did not differ significantly from placebo.Clinical trial registration no.: RBR-57wppt (ReBEC; http://www.ensaiosclinicos.gov.br/).
ABSTRACT
BACKGROUND: Spinal metastatic disease compromises the quality of life and prognosis of the patients. Prognosis is an important factor for the decision-making process and needs to be precise in order to adjust the intensity of therapy. The Tokuhashi score is a universal instrument to determine the prognosis. The objective was to analyze the effectiveness of the Tokuhashi score in determining the prognosis of the patients with spine metastasis by comparing the expected survival time from the Tokuhashi score with the survival time observed among surgical patients. METHODS: This retrospective study was performed from October 2008 to October 2015. The inclusion criteria were symptomatic patients with spinal metastasis who underwent spinal cord decompression and had a minimum of 1-year follow-up. The exclusion criteria were patients without histologic confirmation and were lost to follow-up. The Tokuhashi score was applied, and once the expected survival was defined, it was compared with the survival time observed in the follow-up. RESULTS: The sample studied was 117 patients. The commonly female (58%) and breast spinal metastasis was often observed (25.6%). The patients were followed for a minimum period of 12 months. The actual survival was beyond that estimated by the Tokuhashi score (P < 0.05). CONCLUSION: The Tokuhashi score was not reliable to predict the prognosis. Patients with lower scores that surgical treatment was not recommended by the Tokuhashi score had better quality of life and longer survival after surgery. Tokuhashi score is not a precise tool to establish the best therapy and survival in patients with spinal metastasis.
