Postoperative antimicrobial prophylaxis following spinal decompression surgery: is it necessary?

BACKGROUND: Antimicrobial prophylaxis (AMP) can reduce the risk of surgical-site infection (SSI) following many types of surgery, particularly spinal surgery. After publication of the Guideline for Prevention of Surgical Site Infection by the Centers for Disease Control and Prevention in 1999, a large number of studies confirmed the effectiveness of AMP. However, because the concept of AMP is not clear in Japan, the duration of postoperative AMP tends to be long. The purpose of this study was to compare the infection rates following spinal surgery for postoperative AMP versus no postoperative AMP. METHODS: The study comprised 284 patients who underwent spinal surgery without instrumentation at our hospital from October 2003 to August 2009. The patients were divided into two groups based on the method of AMP administration: a postoperative dose group and a no postoperative dose group. SSI incidences were calculated for the two groups. RESULTS: The incidence of SSI was 2.1% (6/284) overall and 2. 8% (4/141) vs. 1.4% (2/143) for the postoperative dose and no postoperative dose groups, respectively. The infection rate difference between the two groups was not significant. The incidence of SSI showed a downward trend as the frequency of antibiotics decreased. Two cases of pseudomembranous colitis, both in the postoperative dose group, were the only complications of the antibiotics. CONCLUSIONS: AMP duration was not related to the SSI rate. SSIs trended lower in the no postoperative dose group compared with the postoperative dose group. Postoperative administration of AMP appears to be unnecessary for spinal decompression surgery without instrumentation.

[Bone and joint diseases in children. Effects of sports on bone and joint disorders during childhood].

Recently, opposing trends have appeared to be either excessiveness or lack in the frequency of exercise or sports during childhood, both of which are believed to be associated with various sports-related injuries. In childhood, the bones, muscles, and ligaments are developing and not yet matured; though soft and flexible, their relative low strength is inadequate to tolerate abnormal external forces. Although a child's body normally has substantial self-healing ability, there is the risk of causing a lifelong deformity or growth disorder if not treated properly. A comprehensively organized system for the prevention, early detection, and treatment of bone and joint disorders in children should be developed in the future.

Dumbbell-type spinal solitary fibrous tumor with paraplegia.

Solitary fibrous tumors are rare tumors that most commonly arise in the pleura. This article describes a case of a large dumbbell-shaped solitary fibrous tumor of the thoracic spine that was causing partial paraplegia. The patient was a 75-year-old woman who presented with swelling of the upper back and weakness of the lower extremities. Magnetic resonance imaging revealed a dumbbell-shaped tumor mass compressing the spinal cord, predominantly at the level of T8. The tumor extended transversely from the bilateral foramen of T8-T10 to the back muscles. The patient experienced increasing weakness of the lower extremities, so a T7-T11 laminectomy was performed and the tumor was excised piecemeal. Microscopically, the tumor was found to be composed of a proliferation of fibroblastic spindle cells. Immunohistochemically, it was strongly positive for CD34 but negative for S100. These findings were consistent with a solitary fibrous tumor. Three months postoperatively, thoracic radiographs showed progression of spinal kyphosis. Posterior fusion with instrumentation was performed. Three years postoperatively, there was no clinical evidence of tumor recurrence. Spinal solitary fibrous tumors are rare, particularly dumbbell-shaped tumors; to our knowledge, only 2 have been reported in the literature. The correct diagnosis is aided by noting the bland fibrous histology, strong CD34 immunostaining, and absence of S100 and cytokeratin positivity. Although solitary fibrous tumors of the spine are rare, they should be considered in the differential diagnosis of intraspinal lesions, particularly those occurring near pleura.