Clinically apparent adverse reactions to intra-wound vancomycin powder in early onset scoliosis are rare.

PURPOSE: Spine surgeons have increasingly used intraoperative application of topical vancomycin powder (TVP) to prevent surgical site infections (SSIs). The goals of this study were to define the rate of pharmacological adverse reaction to TVP in young patients undergoing posterior spinal surgery and to summarise institutional variation in TVP dosing. METHODS: This retrospective observational study included ten spine centres in the United States and one in Europe. Patients with early onset scoliosis who underwent posterior spine surgery were eligible for inclusion. Age, weight, TVP dose and surgery type were recorded. Surgeries where patient age was > 12 years were excluded. Pharmacological adverse reactions were defined as clinical instances of Red Man Syndrome, rash, nephrotoxicity, proteinuria, hepatotoxicity or ototoxicity. The rate of pharmacological adverse reaction to TVP was calculated. Dosing practices were summarised. RESULTS: Patient age was in the range of seven months to 12 years (median ten years). Of 1398 observations, there was one possible pharmacological adverse reaction. This was in a ten-year-old, 20.4-kg female patient with neuromuscular sco-liosis undergoing growing rod implantation. She was dosed with 1500 mg of TVP and immediately developed a transient rash without systemic symptoms. This abated over minutes without any medical intervention. There were no other adverse reactions in the sample. The population rate of pharmacological adverse reaction was 0.072% (95% confidence interval 0 to 0.4). Significant variability in dosing practices existed between centres. CONCLUSION: Pharmacological adverse reactions to TVP are rare. Future work may establish evidence-based guidelines for TVP dosing based on patient weight and other variables.

Successful large volume leukapheresis on a small infant allogeneic donor.

We successfully performed a hematopoietic stem cell apheresis on the smallest allogeneic donor reported to date, a 6.1 kg female. After placement of a dialysis catheter in the left femoral vein, the COBE Spectra was primed with one unit of paternal whole blood. Heparin and anticoagulant citrate dextrose, solution A (ACD-A) were slowly administered to the patient. Ionized calcium levels were checked hourly and calcium gluconate was given for hypocalcemia. Coagulation parameters were checked throughout the procedure. We collected 4.4 x 10(6) CD34+ cells/kg (recipient). The donor tolerated the procedure well and was discharged the following day. Five months later, the child manifests no obvious late effects.

[Sagittal balance and compensatory mechanism after segmental instrumentation for adolescent idiopathic scoliosis]. / Sagittale Balance und Kompensationsmechanismen nach operativer Versorgung bei idiopathischer Skoliose mittels segmentaler Pedikelschraubeninstrumentation.

PURPOSE: Previous studies have demonstrated good ability to improve the sagittal profile with the use of segmental instrumentation for adolescent idiopathic scoliosis (AIS) by analysing the sagittal vertical axis (SVA). However, several authors recommend analysing the spinopelvic relation in addition to the SVA. While compensatory mechanisms may neutralise a positive SVA, these mechanisms are energy consuming and may lead to unphysiological biomechanics, which can negatively influence the quality of life. The purpose of this radiographic analysis was to analyse global sagittal balance and to identify potential compensatory mechanisms after segmental instrumentation for AIS. METHODS: From a prospectively collected multicentre database, patients with segmental instrumentation for AIS and a minimum follow-up of 2 years were identified. An additional inclusion criterion was the ability to measure lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and SVA on each X-ray (preoperative, 1st erect, and the 2-year follow-up visits). LL was analysed in relation to PI in order to identify iatrogenic changes. Changes in LL were correlated to changes in PT and SVA. RESULTS: 91 patients were included. On the 1st erect X-ray, LL significantly decreased from pre-op but the SVA remained stable due to a significant increase of PT. At two years follow-up, PT recurred to preoperative values, accompanied by a significant increase of SVA despite a compensatory hyperlordosis below the instrumentation. The temporary increase of PT on the 1st erect was significantly correlated to an iatrogenic decrease of LL. An iatrogenic decrease of LL was significantly correlated to an increase of SVA on the 1st erect and at 2 years follow-up. CONCLUSION: An iatrogenic decrease of LL after segmental instrumentation for AIS is initially compensated for by pelvic retroversion and later by a hyperlordosis below the instrumentation.