The spine journal : official journal of the North American Spine Society
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There is very little evidence to guide treatment of patients with spinal surgical site infection (SSI) who require irrigation and debridement (I&D) in deciding need for single or multiple I&Ds or more complex wound management such as vacuum-assisted closure dressing or soft-tissue flaps. ⋯ Patients with positive methicillin-resistant Staphylococcus aureus culture or those with distant site infection such as bacteremia were strong predictors of need for multiple I&D. Presence of instrumentation, location of surgery in the posterior lumbar spine, and use of nonautograft bone graft material predicted multiple I&D. Diabetes also proved to be the most significant medical comorbidity for multiple I&D. The validation of this predictive model revealed excellent PPV and good NPV with appropriately chosen probability cutoff points. This study forms the basis for an evidence-based classification system, the Postoperative Infection Treatment Score for the Spine that stratifies patients who require surgery for SSI, based on specific spine, patient, infection, and surgical factors to assess a low, indeterminate, and high risk for the need for multiple I&D.
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Implants subsidence is a frequent complication of interbody fusion, which can result in pain, deformity, nerve damage, and even failure of surgery. The end plates as the interface between implants and the vertebral bodies play a very important role in sharing the compression on the vertebral bodies. The information on the structural property distribution of the end plate and its relationship with bone mineral density (BMD) and disc degeneration will be of great significance for the reduction in implants subsidence and improvement in related operative procedures to increase the success rate of interbody fusion. ⋯ Preoperative evaluation of the states of intervertebral discs and BMD of patients is necessary for predicting risks of implants subsidence after interbody fusion. For patients with or without disc degeneration or osteoporosis, the implants should be placed at the peripheral regions, especially the posterolateral sites, to acquire higher mechanical strength to reduce subsidence as much as possible.
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Lee MJ, Konodi MA, Cizik AM, et al. Risk factors for medical complication after spine surgery: a multivariate analysis of 1,591 patients. Spine J 2012;12:197-206 (in this issue).
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Comment
Commentary: revision lumbar surgery and revisiting the role of preoperative depression screening.
Adogwa O, Parker SL, Shau DN, et al. Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 2012;12:179-85 (in this issue).