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Aim To investigate the role of short-term diazepam therapy for improving long-term outcomes and reducing neck pain after whiplash injury. Methods A total of 89 patients suffering from whiplash injury were included. They were randomly assigned into 2 groups: group A (study group), and group B (control group). The test group was prescribed with diazepam 5 mg tablets one time per day for 7 days and the control group did not get the recommendation to use diazepam. Three previously validated scales, Visual Analogue Pain Scale (VAS), the Neck Disability Index (NDI), and the Whiplash Disability Questionnaire (WDQ), were used at different intervals (7 days, 6 weeks and 6 months after the injury). Results Among 89 patients, 50 (56.2%) were males, 39 (43.8%) females. The mean age of all participants was 34.80±12.531 years. According to the Mann Whitney U -Test, no significant difference was observed in VAS, NDI, and WDQ scores between the control group and study group at any time point (p>0.05). Conclusion Diazepam provides no substantial advantage in the treatment of whiplash, and accordingly, we do not recommend diazepam therapy in patients who suffered whiplash injury. The trial was registered in the database of the Federal National Library of Medicine (NLM) (https://clinicaltrials.gov) under clinical trials (unique protocol ID:1703016).
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BACKGROUND: Postoperative infection after posterior spondylodesis of thoracic and lumbal spine is the most common complication, and a reason for revision surgery. Aim of this work is to analyze rate of postoperative spine infections at our institution, and to determine eventual risk factors. SUBJECTS AND METHODS: In our paper we analyze incidence of deep surgical infections after posterior spondylodesis, performed on our Spine department during last 5 years (September 1, 2008 - September 1, 2013). Including criteria were: posterior spondylodesis with transpedicular screws from Th1 to S2 due to different spine indications (injuries, degenerations, deformities, tumors), absence of local or general infection prior the index surgery, surgery performed by the same surgeon (MB). Excluding criteria were: needle procedures (kypho/vertebro-plasties, nerve root and faset blocades), anterior spine surgeries, cervical spine surgeries, and decompresive surgeries. RESULTS: One hundred sixty five patients with 183 surgeries have been included in this study. Early surgical infection (within a month after the surgery) has appeared at five patients (2.7%). There have been no late surgical infections. Analyzing patients' charts, we have found that Meticillin-susceptible Staphylococcus aureus (MSSA) and Methicillin-resistant Staphylococcus aureus (MRSA) have caused infections in two patients, while Clebisiela pneumoniae ESBL has caused infection in one patient. Those five patients with infections have had further risk factors: long preoperative hospitalization at four patients, polytrauma, diabetes and advanced age at one patient, each. Three patients with postoperative infection had completely non-titanium surface of implants, and other two had about 20% of non-titanium implant surface, although vast majority of surgeries have been performed by implants whose surface was completely titanium alloy. Infections have appeared between 10-30 postoperative days. In two patients where revision surgeries (debridement, drainage, antibiotic according the species) had been performed in two weeks after appearance of infection, infections have been cured. In three patients where revisions had been postponed for longer than two weeks, additional surgeries (removal of implants) were necessary for curing the infections. CONCLUSIONS: This study presented that rate of infection, microbiological species and risk factors are similar to the other orthopedics procedures and other institutions. Early revision is preferable, since it effectively avoids implant removal.
