Pneumatic Kerrison rongeur: technical note.

BACKGROUND: We report our experience with the Aesculap Pneumatic Powered Kerrison Rongeur (Aesculap AG Company) Tuttlingen, Germany. METHODS: Between February 2007 and January 2008, 125 patients underwent spinal surgery for the treatment of spinal stenosis, spinal tumors, degenerative disk disease, and herniated disks in the cervical, thoracic, and lumbar areas using the pneumatic-powered Kerrison rongeur for bone and tissue removal. RESULTS: All bone removal for procedures ranging from cervical and lumbar microdiscectomies to extensive multilevel laminectomies was carried out with no complications from instrument design or malfunction. Most importantly, the manual labor required to forcefully squeeze and bite bone was virtually eliminated. The learning curve for instrument application was negligible. Operating room personnel similarly had no difficulty with the simplified tubing connections to an air supply and the Kerrison handle with interchangeable, multisized shafts. CONCLUSION: The new pneumatically powered Kerrison rongeur not only is safe and easy to use but also virtually eliminates the manual fatigue and, at times, pain associated with prolonged bone removal from the use of standard Kerrison rongeurs.

Risk factors for postoperative spinal infection: A retrospective analysis of 5065 cases.

BACKGROUND: Multiple factors increase the risk for spinal surgical site infection (SSI): prior SSI, obesity, diabetes mellitus, advanced age, American Society of Anesthesiologists class, alcohol abuse, low prealbumin levels, smoking, history of cancer, chronic steroids, immunosuppressive drugs, rheumatoid arthritis, and hypothyroidism. METHODS: Here, we performed a retrospective medical record review at one facility involving 5065 patients from 2010 to 2015. In 2011, there was an increase in the infection rate (1.07%) which prompted this analysis, resulting in the subsequent introduction of a protocol to reduce the infection risk. RESULTS: The overall infection rate in this series was 0.59%. The lowest infection rate was 0.00% for anterior cervical discectomy and fusion. The highest rate of infections occurred among patients undergoing posterior cervical fusions, lumbar fusions, and tumor resections. Higher infection rates were also correlated with diabetes mellitus, obesity, and increased surgical time. CONCLUSIONS: Since 2011, we instituted a protocol to limit the risks of spinal SSIs, particularly for patients exhibiting increased medical comorbidities.

Factors influencing the length of stay in patients with lumbar pedicle screw fixation.

BACKGROUND: Current health care practices aim for cost reduction to achieve maximal benefit. Because of the increasing number of spinal fusions, this area has become a target for both hospitals and payment organizations. Length of stay (LOS) is one potentially modifiable variable to help reduce overall cost. Attempting to predict the LOS in spinal surgery based on patient factors has not revealed a set of variables that are consistently associated with increased stay. METHODS: Medical records from all patients who underwent posterior lumbar spinal fusion by a single neurosurgeon at a single facility were retrospectively examined in a blind fashion. Data were obtained including age, gender, body mass index (BMI), American society of Anesthesiologists (ASA) and analyzed to determine a potential relationship with LOS. RESULTS: A total of 1360 patients were identified for analysis. There were significant but small correlations between age, ASA, BMI, and LOS. CONCLUSIONS: There is an effect of age, ASA, and BMI on LOS. However, the significance of this effect is small. Future studies aiming to identify additional factors, which could potentially be modifiable, in order to work on decreasing LOS in lumbar spinal fusion patients.

Outcomes after anterior cervical discectomy and fusion in professional athletes.

BACKGROUND: Significant controversy exists regarding when an athlete may return to contact sports after anterior cervical discectomy and fusion (ACDF). Return-to-play (RTP) recommendations are complicated due to a mix of medical factors, social pressures, and limited outcome data. OBJECTIVE: The aim of this study was to characterize our diagnostic and surgical criteria, intervention, postoperative imaging results, and rehabilitation and report RTP decisions and outcomes for professional athletes with cervical spine injuries. METHODS: Fifteen professional athletes who had undergone a 1-level ACDF by a single neurosurgeon were identified after a retrospective chart and radiographic review from 2003 to 2012. Patient records and imaging studies were recorded. RESULTS: Seven of the 15 athletes presented with neurapraxia, 8 with cervical radiculopathy, and 2 with hyperintensity of the spinal cord. Cervical stenosis with effacement of the cerebrospinal fluid signal was noted in 14 subjects. The operative level included C3-4 (4 patients), C4-5 (1 patient), C5-6 (8 patients), and C6-7 (2 patients). All athletes were cleared for RTP after a neurological examination with normal findings, and radiographic criteria for early fusion were confirmed. Thirteen of the 15 players returned to their sport between 2 and 12 months postoperatively (mean, 6 months), with 8 still participating. The RTP duration of the 5 who retired after full participation ranged from 1 to 3 years. All athletes remain asymptomatic for radicular or myelopathic symptoms or signs. CONCLUSION: After a single-level ACDF, an athlete may return to contact sports if there are normal findings on a neurological examination, full range of neck movement, and solid arthrodesis. There may be an increased risk of the development of adjacent segment disease above or below the level of fusion. Cord hyperintensity may not necessarily preclude RTP.