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STUDY DESIGN: Observational Study. OBJECTIVES: Surgical site infections (SSIs) are one of the major complications in spine surgery. Numerous factors that increase the risk of SSI have been widely described. However, clinical guidelines on antibiotic prophylaxis are usually common for all patients. There are no specific guidelines for patients with a high risk of infection. The aim of this paper is to create a specific protocol for patients at high risk of SSI. METHODS: This is a three-cohort study using a prospective database. Risk patients are those who meet at least two of the following criteria: obesity, diabetes, reoperation and immunosuppression. Between October 2021 and April 2023, 132 patients were recruited.They were divided into three cohorts: cohort A, 46 patients, standard prophylaxis with cefazolin 2 g/8 h for 24 h; cohort B, 46 patients, cefazolin 2 g/8h and amikacin 500 mg/12 h for 24 h; cohort C, 40 patients, cefazolin 2 g/8h and amikacin 500 mg/12 h for 72 h. RESULTS: There was a significant decrease in the infection rate depending on the prophylaxis (23.9% in cohort A, 8.7% in cohort B, and 2.5% in cohort C). When logistic regression models were applied and cohorts B and C were compared with A, the following results were obtained: OR of 0.30 (CI: 0.08 - 0.97; P = 0.057) and 0.08 (IC: 0.00 - 0.45; P = 0.019), respectively. CONCLUSIONS: Prophylaxis with prolonged double antibiotic therapy with cefazolin and amikacin is associated with a statistically significant decrease in the rate of SSI in patients with a high risk of infection.
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BACKGROUND: Despite the advances in anterior cervical corpectomy and fusion (ACCF) as a reconstructive surgical technique, the rate of complications related to artificial implants remains high. The purpose of this study was to investigate the long-term clinical course of ACCF with tantalum trabecular metal (TTM)-lordotic implants. Focus is placed on the relevance and influence of implant subsidence on sagittal alignment and the related clinical implications. METHODS: Retrospective, observational study of prospectively collected outcomes including 56 consecutive patients with degenerative cervical disc disease (myelopathy and/or radiculopathy). All patients underwent 1-level or 2-level ACCF with TTM-lordotic implants. The mean duration of follow-up was 4.85 years. RESULTS: The fusion rate at the end of follow-up was 98.11% (52/53). Implant subsidence occurred in 44 (83.01%) cases, including slight subsistence (<3 mm) in 37 (69.81%) and severe subsidence (>3 mm) in 7 cases (13.2%). The greatest degree of subsidence developed in the first 3 months postoperatively (P = 0.003). No patients presented a significant increase in implant subsidence beyond the second year of follow-up. The most common site of severe subsidence was the anterior region of the cranial end plate (4/7). At the end of follow-up, C1-C7 lordosis and segmental-Cobb angle of the fused segment increased on average by 5.06 ± 8.26 and 1.98 ± 6.02 degrees, respectively, though this difference failed to reach statistical significance (P > 0.05). Visual analog scale and Neck Disability Index scores improved at the conclusion of follow-up (P < 0.05). CONCLUSIONS: ACCF with anterior cervical reconstruction using TTM-lordotic implants and anterior cervical plating for treatment of cervical degenerative disease has high fusion rates and good clinical outcome. The osteoconductive properties of TTM provide immediate stabilization and eliminate the need for bone grafts to ensure solid bone fusion. Before fusion occurs, asymptomatic implant settlement into the vertebral body is inevitable. However, lack of parallelism and reduced contact surface between the implant and the vertebral end plate are major risk factors for severe further subsidence, which may negatively affect the clinical outcomes.