Does the Application of Topical Intrawound Vancomycin Powder Affect Deep Surgical Site Infection and the Responsible Organisms after Spinal Surgery?: A Retrospective Case Series with a Historical Control Group.

STUDY DESIGN: Retrospective case series with a historical control group. PURPOSE: To compare the deep wound infection rates in patients undergoing spinal surgery with the application of topical intrawound vancomycin powder (TIVP) in the surgical site in addition to standard systemic prophylaxis with those in a matched historical cohort of patients for whom TIVP was not used. OVERVIEW OF LITERATURE: Surgical site infection (SSI) after spine surgery is debilitating and is responsible for a significant increase in the health care costs, hospital stay, and morbidities. Although the application of TIVP before surgical closure is a promising method for reducing the SSI rate after spine surgery, its use is controversial, and currently, research trials are focusing on identifying its safety, efficacy, and the potential patient population. METHODS: A group of 88 patients who underwent posterior spinal surgery with TIVP administration (treatment group) was compared to a historical control group of 70 patients who had received only standard systemic intravenous prophylaxis (control group) for the analysis of deep SSI rate and the involved organisms. RESULTS: The overall rate of deep SSIs was 2.5% (4/158). All the SSIs were observed in patients who had posterior instrumentation and fusion for ≥3 levels. In the treatment group, the SSI rate was 3.4% (3/88), and the bacteria isolated were Escherichia coli (n=2) and Pseudomonas aeruginosa (n=1). In the control group, the infection rate was 1.4% (1/70), and the isolated bacteria were Morganella morganii and Staphylococcus epidermidis. No statistically significant association was found between the SSI rates of the treatment and control groups. CONCLUSIONS: Although the difference in the SSI rates was not statistically significant, the present results suggest that TIVP administration could not reduce the risk of deep SSIs after spinal surgery. Moreover, TIVP administration might also affect the underlying pathogens by increasing the propensity for gram-negative species.

Complementary Specific Pelvic Sequences on Routine Lumbar Magnetic Resonance Imaging Scans: An Imaging-Based Study Focused on Piriformis Syndrome.

AIM: To discuss the rationale and merit of specific pelvic sequences as an adjunct to routine lumbar magnetic resonance imaging (MRI) for early detection of piriformis syndrome (PS) and to disclose its frequency in patients who underwent radiological evaluation. MATERIAL AND METHODS: This retrospective, imaging-based study included all individuals who underwent lumbar MRI and those who were further evaluated with a pelvic MRI, but excluded all high-energy trauma cases. The patients' demographics and radiological features were reviewed using electronic patient records and hospital-based picture image archiving and communication system. RESULTS: Overall, 1321 individuals (659 females; 662 males) underwent lumbar MRI during the study period, and of these, 485 (238 females; 247 males) were further analyzed with a pelvic MRI for differential diagnosis. Forty patients (8.2%) (23 females; 17 males) were diagnosed with PS-all confirmed with MR neurography (MRN). On re-evaluation of all lumbar and pelvic MRIs and MRNs, we realized that adding just three specific pelvic sequences to routine lumbar MRI scans were enough to accurately delineate the piriformis muscle pathologies and sciatic nerve intensities. The calculated frequencies of PS in females, males, and the whole study population within 57 months were 3.49%, 2.57%, and 3.03%, respectively. CONCLUSION: Although PS being a clinical diagnosis, this study indicated that in patients whom PS was not suspected at the initial examination, 8.2% of them were finally diagnosed after MRI evaluations. Performing specific pelvic sequences as an adjunct to routine lumbar MRI can salvage underdiagnosed patients with PS and facilitate early detection of this pathological condition.

Cryo-Compression Therapy After Elective Spinal Surgery for Pain Management: A Cross-Sectional Study With Historical Control.

OBJECTIVE: Postoperative dynamic cryo-compression (DC) therapy has been proposed as a method of reducing pain and the inflammatory response in the early postoperative period after orthopedic joint reconstruction surgery. Our aim was to analyze the analgesic efficacy of DC therapy after adult lumbar spinal surgery. METHODS: DC was applied for 30 minutes every 6 hours after surgery. Pain was measured by a visual analogue scale (VAS) in the preoperative period, immediately after surgery, and every 6 hours postoperatively for the first 72 hours of the hospital stay. Patients' pain medication requirements were monitored using the patient-controlled analgesia system and patient charts. Twenty patients who received DC therapy were compared to 20 historical controls who were matched for demographic and surgical variables. RESULTS: In the postanesthesia care unit, the mean VAS back pain score was 5.87 ± 0.9 in the DC group and 6.95±1.0 (p=0.001) in the control group. The corresponding mean VAS scores for the DC vs. control groups were 3.8±1.1 vs. 5.4±0.7 (p < 0.001) at 6 hours postoperatively, and 2.7±0.7 vs. 6.25±0.9 (p<0.001) at discharge, respectively. The cumulative mean analgesic consumption of paracetamol, tenoxicam, and tramadol in the DC group vs. control group was 3,733.3±562.7 mg vs. 4,633.3±693.5 mg (p<0.005), 53.3±19.5 mg vs. 85.3±33.4 mg (p<0.005), and 63.3±83.4 mg vs. 393.3±79.9 mg (p<0.0001), respectively. CONCLUSION: The results of this study demonstrated a positive association between the use of DC therapy and accelerated improvement in patients during early rehabilitation after adult spine surgery compared to patients who were treated with painkillers only.