Serum IL-6 as a Surrogate Biomarker of Post-operative Complications in Invasive Orthopaedic Surgeries: A Prospective Observational Study.

Background: Interleukin-6 (IL-6) is a cytokine released in response to tissue injury. Elevated serum IL-6 levels in trauma patients have been linked with increased risk of complications such as inapparent hypoxia (SpO2 < 94%), acute respiratory distress syndrome, fat embolism syndrome (FES), systemic inflammatory response syndrome, multiple organ dysfunction syndrome and sepsis. This study aims to determine the role of serum IL-6 as surrogate biomarker of post-operative complications after invasive orthopaedic surgeries. Methods: Thirty-seven adults between 18 and 65 years of age undergoing invasive orthopaedic surgeries were included in this hospital-based study. Serum IL-6 levels were estimated serially in the pre-operative period, after 24 h and 7 days post-operatively. Cases were monitored for post-operative complications. Results: Serum IL-6 levels showed maximum rise in the first 24 h post-operatively especially among older patients (> 60 years). Older patients undergoing bipolar hemiarthroplasty for neck of femur fracture showed highest median post-operative IL-6 level of 258 pg/ml. Serum IL-6 level > 130 pg/ml measured 24 h after surgery was predictive of post-operative complications (sensitivity of 75%). Among the cases with post-operative complications, inapparent hypoxia was the most common complication/event observed. Cases with sub-clinical FES had highest level of serum IL-6 in first 24 h following surgery with median IL-6 level of 300 pg/ml (range 155-444 pg/ml). Conclusion: Monitoring serum IL-6 level may help in both anticipation and early detection of post-operative complications in patients undergoing invasive orthopaedic surgeries; potentially enhancing patient safety.

Short-term neurological and functional outcome of surgical intervention in spinal cord injuries: a single center prospective observational study.

Introduction: the management of an acute spinal cord injury remains controversial. The patient of acute spinal cord injury undergoes several phases of care beginning with the initial trauma management, surgical intervention, and perioperative medical management. The aim of this study was to evaluate the neurological and functional outcome of operative management of traumatic spinal cord injury patients admitted to a tertiary care centre in Northeast India. Methods: thirty patients with spinal cord injury admitted to a tertiary care centre from December 2019 to November 2021, and treated with instrumented stabilisation for spinal cord injury were evaluated until 6 months postoperatively. Patients were evaluated with validated neurological (American Spinal Injury Association scale) and functional outcome measures (Barthel index). Demographic details, mode of injury, morphology, patterns of fractures, neurological level, and management methods in the hospital were recorded and analysed using the Statistical Package for the Social Science (SPSS) version 27.0. Results: thoracolumbar spinal cord was more commonly injured with 16 (53.3%) patients compared to cervical spinal cord injury patients at 14 (46.7%). Eight patients had complete recovery, 7 patients had incomplete recovery and 15 patients had no recovery. At 6 months post-injury, 18 (60%) patients had favourable functional outcome. American Spinal Injury Association (ASIA) grade at admission was found to be significantly associated with the functional outcome. Conclusion: after surgery half of the patients had an improvement in their neurology, and functional outcome was favorable which suggests that surgery still holds the key to a better functional and rehabilitation outcome.

Recovery from White cord Syndrome after Anterior Cervical Corpectomy and Fusion: A Case Report.

Introduction: A new neurologic deficit after spine surgery is always the biggest surgeon's nightmare. Worsening of neurology post-operatively in the absence of obvious per operative injury and with no extrinsic cause, the deficit is attributable to be caused by reperfusion injury of the spinal cord called as white cord syndrome (WCS). Hereby, we report 1-year follow-up of a case attributed as WCS after anterior cervical corpectomy with complete recovery. Case Report: A 64-year-old female patient presented with C5 - C6 tubercular lesion with extradural compression with ASIA C grade, treated with C5 - C6 corpectomy with harm cage reconstruction and tissue biopsy. Acute neurologic deterioration of both upper and lower extremities (ASIA A grade) was found 4 h after the operation upon extubation. Emergent imaging revealed no extrinsic causes. Methylprednisolone was initiated with rehabilitation therapies; her neurological status improved dramatically with complete neurological recovery at 1-year follow-up. Conclusion: New-onset neurologic deficit is always an unexpected complication. Early identification and correct treatments can avert incomplete spinal cord from permanent damage. Our experience in dealing with this patient and following up the case for nearly 1 year showed a good neurological recovery.