Thermographic assessment of skin temperature after lumbar spine surgery: Useful method for detection of wound complications? A pilot study.

BACKGROUND: Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. OBJECTIVE: The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. METHODS: 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient's sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels were noted and compared to thermographic measurement of local surface temperature in the wound area. RESULTS: Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p> 0.05). CONCLUSIONS: This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch.

Postoperative Surgical Site Infections in Spine Surgery: Can the Duration of Surgery Predict the Pathogen Spectrum?

BACKGROUND/AIM: Surgical site infection (SSI) is a severe complication of spinal surgery, which typically results in prolonged length of hospital stay, an increased number of revision surgeries, re-hospitalizations, worse clinical functional outcomes, and increased healthcare costs. The aim of the present study was to analyse if the duration of surgery can predict the spectrum of pathogens causing SSI in orthopaedic spine surgery. PATIENTS AND METHODS: We conducted a retrospective study over a period of two years at the University Hospital of Cologne in which all patients with postoperative surgical site infections were included. In addition to descriptive characteristics (such as sex, age, BMI), the duration of the surgery, the administration of intra-operative antibiotics, the main diagnosis, the postoperative course of the infection parameters (CRP & WBC) and the responsible pathogens were analysed. RESULTS: A total of 75 patients were included with a median age of 64 years. The mean time of operation time was 131.52±70.91 min (range=23-285 min). The most frequently isolated germs in the postoperative blood culture were S. aureus (n=7), S. haemolyticus and S. hominis (n=2). There was a significant correlation between the duration of the primary surgical intervention and the postoperatively detected pathogens (p=0.002). CONCLUSION: A significant correlation was shown between the duration of surgery and the species of pathogens detected causing postoperative SSI. The use of perioperative antibiotics, the use of longer-lasting antibiotics or the repeated intravenous administration of prophylactic antibiotics should be evaluated.

Suggestion of a safe zone for C1 pedicle screws depending on anatomical peculiarities.

OBJECTIVE: For surgical treatment of instable upper cervical injuries, the Harms technique using lateral mass screws provides rigid fixation and favourable clinical outcomes. The use of the posterior arch of C1 as a "pedicle" allows for screw anchorage, giving improved biomechanical stability. Therefore, the aim of this study was to introduce a bilateral safe zone for C1 pedicle screws, regarding screw angulation and pedicle height. MATERIAL AND METHODS: We retrospectively reviewed the CT scans of 500 patients. Three-dimensional reformats were generated for detailed measurements. Centre screw entry point (EP), length of lateral mass as screw trajectory, lateral mass width (LMW), length of screw trajectory (ST), maximal divergence (DI) and maximal convergence (CON) from EP without perforation, and pedicle height (PH) of the posterior arch were measured. RESULTS: The 500 cases consisted of 335 males and 165 females, with a mean age of 49.5 years. Measurements did not demonstrate significant side-related differences. The mean screw entry point was 22.8 mm from the midline-axis (left 22.6 mm; right 23.0 mm). From this point, a safe zone between 11.6° of divergence and 19.6° of convergence was detected. Measurements of female patients were generally smaller, with significant differences from male patients (p < 0.05). 158 subjects (31.6%) had a PH < 4 mm. DISCUSSION: C1 pedicle screws were feasible in the majority of patients. Proposing a safe zone for screw angulation may provide safety and avoid screw perforation. However, detailed knowledge of the individual C1 anatomy and the preoperative measurement is essential in the operative planning.