ABSTRACT
Key Clinical Message: Successful management of cervical tuberculosis and severe kyphosis was achieved using a PEEK expandable cage and titanium plate, demonstrating favorable outcomes in restoring cervical alignment and stability. This approach represents a promising alternative for addressing complex cervical pathologies, highlighting the potential of PEEK-based interventions in surgical management. Abstract: Cervical tuberculosis can lead to severe vertebral destruction and kyphosis, posing challenges in surgical management. Recent advancements, including the use of polyetheretherketone (PEEK) expandable cages and titanium plates, show promise in addressing multilevel cervical pathologies. This report details the successful treatment of a 27-year-old male with cervical tuberculosis and severe kyphosis. Surgical intervention involved prevertebral abscess evacuation, C5-C7 corpectomy, and insertion of a PEEK expandable cage with an anterior titanium plate. Postoperative care included a Philadelphia collar, and follow-up demonstrated restored cervical alignment and stability. The use of PEEK-based surgical interventions, as demonstrated in this case, represents a significant evolution in managing complex cervical conditions. The successful outcome highlights the potential benefits of PEEK expandable cages in addressing cervical tuberculosis and kyphosis. Further research is needed to validate these findings and establish PEEK-based interventions as a viable alternative in such cases.
ABSTRACT
Cervical spine metastasis from primary intracranial solitary fibrous tumors (SFTs) is an extremely rare clinical entity. This report focuses on its metastatic tendency, radiological imaging, management plan, and follow-up strategies in view of its long latency period for metastasis. A 35-year-old female presented with right-side cervical radiculopathy. Magnetic resonance imaging spine showed C7 vertebral body collapse with retropulsion and neural compression. Two years ago, the patient had surgical resection of intracranial SFT (World Health Organization grade 3) with no evidence of recurrence on follow-up imaging. Cervical C7 metastasis has been decompressed and fused by the anterior cervical approach. Histopathology confirmed SFT metastasis to the spine, and the patient received adjuvant radiotherapy. Cervical metastasis from well-controlled primary intracranial SFT poses a significant challenge for its diagnostic and management planning. Serial pre-emptive surveillance is warranted with regular imaging and appropriate patient counseling.
ABSTRACT
OBJECTIVE: There is no consensus among neurosurgeons regarding whether the application of topical vancomycin after performing craniotomy has a role in reduction of the risk of surgical site infection and consequently reduction of treatment costs. In order to compare the rate of surgical site infections after craniotomies with and without the use of topical vancomycin, a meta-analysis of the available studies in the literature was carried out. METHODS: Multiple electronic health databases were searched to identify all the studies published from July 1988 to July 2021 that examined the role of application of topical vancomycin in reduction of the risk of surgical site infection after craniotomy (cSSIs). Effect sizes were expressed in pooled odds ratio (OR) estimates and, because of heterogeneity between studies, random effect of the inverse variance weighted method was used to perform the meta-analysis. RESULTS: Three observational retrospective cohort studies and 1 prospective controlled cohort study were identified, comparing the incidence of surgical site infection after 605 craniotomies in which topical vancomycin was used and after 716 craniotomies in which no such intervention was done. Meta-analysis showed that topical vancomycin decreased incidence of cSSIs (OR 0.13; 95% confidence interval 0.04-0.43). CONCLUSIONS: The results of this meta-analysis suggest that the use of topical vancomycin after performing craniotomies is safe and effective in decreasing the incidence of cSSIs, although there is a need to perform randomized controlled trials to strongly support this conclusion.
