Postoperative Complications Within the First Year After Extreme Lateral Interbody Fusion: Experience of the First 108 Patients.

STUDY DESIGN: Retrospective chart review. OBJECTIVE: To determine complications within the first year after undergoing extreme lateral interbody fusion (XLIF). SUMMARY OF BACKGROUND DATA: There are a growing but limited number of reports in the literature regarding early postoperative complications after XLIF. METHODS: We performed a retrospective chart review of perioperative complications of a case series of the first 108 patients to undergo XLIF at our institution between 2007 and 2009. We also recorded estimated blood loss, surgical time, and hospital length of stay for each procedure. RESULTS: There were 25 complications (23%) overall in patients who underwent the XLIF procedure. Four patients (3.7%) experienced major complications including: vertebral body fracture, contralateral nerve root injury, dense quadriceps paresis, and persistent stenosis. Three of these patients underwent revision surgery. There were 21 minor (19.4%) complications the vast majority of which consisted of approach-related thigh pain and/or paresthesias that all ultimately resolved. CONCLUSIONS: Transient ipsilateral thigh numbness, pain, and/or hip flexor weakness is a frequent postoperative finding most commonly when the L4-L5 level is instrumented. Dense femoral nerve palsy is a debilitating complication that may occur despite intraoperative neurophysiological monitoring. It should be noted that this retrospective study may underreport the true incidence of complications among these patients.

The utility of routine postoperative radiographs after cervical spine fusion.

BACKGROUND CONTEXT: The senior author (JAG) recently published an article questioning the utility of routine postoperative radiographs after lumbar spine fusion. That study concluded that routine postoperative radiographs in the presence of a normal physical examination rarely change the clinician's management of these patients. Our aim was to repeat this protocol in patients after cervical spine fusion. We hypothesized that routine postoperative radiographs are unnecessary in most cases after cervical spine fusion. PURPOSE: The purpose of this study was to determine the usefulness of routine postoperative cervical spine radiographs after cervical spine fusion as to whether they help to guide clinical decision making within the first postoperative year. STUDY DESIGN: This is a retrospective chart review of 383 patients who underwent a cervical spine fusion over a 5-year period. Seven different surgeons performed the cervical spine fusions. Our review assessed a total of 1,155 postoperative clinic visits. METHODS: Each clinical postoperative visit was reviewed. The history and exam were graded as either normal or abnormal, and any plain radiographs obtained were graded similarly as either normal or abnormal. Each patient's notes were followed up to 1 year postoperatively. Each patient had to have at least two postoperative visits with X-rays to be included in the study. We then noted any further action taken by the clinician based on the appearance of the radiograph in conjunction with the history and exam. RESULTS: In patients with normal history and exam presentations, further action was taken only 5/879 (0.57%) of the time, sometimes even in the presence of abnormal radiographs. The actions included two surgical revisions, two prolongations of cervical collar immobilization, and one patient who underwent a flexion/extension radiographic evaluation and subsequent prolonged cervical collar immobilization. There were 276 visits with abnormal history and exam; of these, 34/276 (12.3%) had abnormal X-rays. Of the clinic visits with abnormal history and exam and abnormal X-rays, 15/34 (44%) went on to revision. CONCLUSIONS: Routine postoperative radiographs after cervical spine fusion rarely appear to be of value when patients present with a normal history and exam and may expose patients to unnecessary diagnostic studies and expenses. Patients exhibiting a normal postoperative history and exam are likely to have no further additional action taken in the presence of either normal or abnormal radiographs.

Control of a mucosal challenge and prevention of AIDS by a multiprotein DNA/MVA vaccine.

Heterologous prime/boost regimens have the potential for raising high levels of immune responses. Here, we report that DNA priming followed by a recombinant modified vaccinia Ankara (rMVA) booster has controlled a highly pathogenic immunodeficiency virus challenge in a Rhesus macaque model. Both the DNA and rMVA components of the vaccine expressed multiple immunodeficiency virus proteins. Two DNA inoculations at 0 and 8 weeks and a single rMVA booster at 24 weeks effectively controlled an intrarectal challenge administered 7 months after the booster. These highly promising findings provide hope that a relatively simple multiprotein DNA/MVA vaccine can help to control the AIDS epidemic.