ABSTRACT
Introduction: Postoperative surgical site infection remains one of the major complications after spinal surgery. IntraSPINE® (intraspine) is a dynamic intralaminar device introduced by Cousin Biotech and is indicated for the surgical treatment of lumbar spine disorders. There are no reports on delayed surgical site infection (SSI) after lumbar surgery using this device. Case Presentation: A 29-year-old male patient was admitted to our department with complaints of moderate pain and chronic subcutaneous abscess with purulent flow from his old surgical scar. Thirty-four months ago, he underwent a traditional open bilateral L4 laminotomy without discectomy and intraspine insertion for the treatment of L4-5 central lumbar spinal stenosis at another hospital. The patient was discharged 4 days after surgery without radiating pain, and the surgical wound was well healed. He gradually returned to his normal activity and work. However, he experienced moderate pain, redness and swelling of his old surgical scar approximately one month before coming to our hospital, but he did not receive any treatment. One month later, he had a mass with purulent discharge at the surgical scar site, and he visited our hospital on December 29th, 2020. Based on the physical examination and MRI findings, delayed -SSI was diagnosed. The patient underwent removal of the intraspine device, debridement and wound closure with closed drainage. The wound healed satisfactorily, and the patient had no complaints more than 2 years later. Conclusion: A delayed surgical site infection following intraspine insertion may have occurred.
ABSTRACT
Background: The radiological complications including correction loss and hardware failure of short segment posterior pedicle screw fixation in the treatment of unstable thoracolumbar burst fractures remain a main concern. Several procedures aiming to reinforce the anterior column have been introduced to solve these limitations, including transforaminal interbody fusion (TIF). The purposes of this study were to evaluate the radiological complications of short-segment pedicle screw fixation in combination with transforaminal interbody fusion in the treatment of unstable thoracolumbar burst fractures. Methods: This retrospective case series study enrolled patients with isolated unstable thoracolumbar burst fractures, who were treated by posterior short fixation with TIF between January 2013 and January 2017. Patients were followed up for a minimum of one and half years. For evaluation of correction loss, % loss of anterior vertebral body height (%AVB), vertebral kyphotic angle (VA) and regional kyphotic angle (RA) were collected preoperatively, postoperatively and at the final follow-up. Hardware failure was assessed on radiological images at the last follow-up. Results: There were 36 patients who met the inclusion criteria with a mean follow-up duration of 53 months. The mean correction loss of %AVB, VA and RA were 10.2%, 2.9° and 5.6°, respectively. There were 6 patients (16.7%) with hardware failure at the final follow-up. Conclusion: Short-segment posterior pedicle screw fixation with TIF using bone chip grafts does not completely prevent hardware failure and progressive kyphosis in the treatment of unstable thoracolumbar burst fractures.
ABSTRACT
BACKGROUND CONTEXT: To our knowledge, there is no clinical study analyzing the feasibility and complications of the routine insertion of the lateral mass screw via the posterior arch for C1 fixation in a live surgical setting. PURPOSE: To evaluate the feasibility of routine insertion of the lateral mass screw via the posterior arch and related complications. STUDY DESIGN: Prospective clinical-radiological analysis. PATIENT SAMPLE: Fifty-two consecutive patients with 102 C1 lateral mass screws inserted via the posterior arch. OUTCOME MEASURES: Cortical perforation, vertebral artery injuries, and visual analog scale score of occipital neuralgia recorded on a prospective database. METHODS: All consecutive patients in whom lateral mass screw placement via the posterior arch was attempted as the first choice whenever C1 posterior fixation was necessary were enrolled. Prospective database, clinical records, questionnaires regarding occipital neuralgia, pre- and postoperative computed tomography (CT) angiograms, and follow-up radiographs and CT scans were analyzed. This study was supported by a $9,000 academic research grant by the first author's hospital. The last author receives royalties for a posterior cervical fixation system, which is not the topic of this study and is not used or mentioned in this article. RESULTS: One hundred two screws were attempted in 52 consecutive patients by a single surgeon. The height of 43 posterior arches (42%) was smaller than 4 mm on preoperative CT angiography. Lateral mass screws could be inserted via the posterior arch in all cases including eight with nine ponticuli posticus and seven with seven persistent first intersegmental arteries, but the posterior arch was perforated cranially by 7, caudally by 30, and craniocaudally (partially) by 3 screws and vertically split by 14 screws. Among the last 28 screws for which the authors' overdrilling technique was used, only one vertical split occurred, whereas among the first 74 screws without overdrilling, 13 vertical splits occurred. None of them led to screw loosening or nonunion. There were no vertebral artery injuries. Among the 19 patients with preoperative occipital neuralgia, 12 had complete resolution and seven had alleviation at the last follow-up. Among the 33 patients without preoperative neuralgia, seven developed new neuralgia postoperatively. Three of them underwent C2 root transection and the other four underwent C2 root dissection for intraarticular fusion of the facet joints. Of the seven, five had complete resolution and two had mild discomfort at the last follow-up. CONCLUSIONS: Routine insertion of the lateral mass screw via the C1 posterior arch was feasible in even those with a small posterior arch, ponticulus posticus, or persistent first intersegmental artery. Although cortical perforation or vertical splitting of the posterior arch was often inevitable, it did not lead to significant weakening of the fixation or nonunion. Vertical split could be minimized by overdrilling the posterior arch. Vertebral artery injury was preventable by mobilization before screw insertion. Occipital neuralgia was not uncommon but thought to be unrelated to screw placement in most cases.
