Negative pressure wound therapy in the management of postoperative spinal wound infections: a systematic review.

INTRODUCTION: Postoperative wound infection after spinal surgery might be a challenge to manage. A wide range of procedures have been described for managing infected spinal wounds. An increasingly common procedure in the management of surgical site infections (SSI) is negative pressure wound therapy (NPWT), also known as vacuum-assisted closure. As there is a paucity of clear clinical advice the present investigation aims to update current evidence on the use of NPWT to manage postoperative SSI occurring after instrumented spine surgery. METHODS: This systematic review was conducted according to the preferred reporting Items for systematic reviews and meta-analyses: the 2020 PRISMA statement. In January 2024, the following databases were accessed: PubMed, Web of Science, and Google Scholar. No time constraint was set for the search. All the clinical studies investigating the unique use of NPWT in treating postoperative spinal wound infections were accessed. RESULTS: A total of 381 patients were included in the present study. Of them 52.5% (200 of 381 patients) were women. The mean age was 52.2 ± 15.2 years. The average length of the NPWT was 21.2 days (range 7-90 days). CONCLUSION: NPWT could be a valuable adjuvant therapy for the management of SSI after spine surgery. Additional high-quality investigations are required to assess the efficacy and safety of NPWT in SSI after spine surgery, especially if combined with contraindications or risk factors, such as the presence of intraoperative CSF leak. LEVEL OF EVIDENCE: Level IV, Systematic review.

Between guidelines and clinical trials: evidence-based advice on the pharmacological management of non-specific chronic low back pain.

The pharmacological management of nonspecific chronic low back pain (NCLBP) aims to restore patients' daily activities and improve their quality of life. The management of NCLBP is not well codified and extremely heterogeneous, and residual symptoms are common. Pharmacological management should be considered as co-adjuvant to non-pharmacological therapy, and should be guided by the symptoms reported by the patients. Depending on the individual severity of NCLPB, pharmacological management may range from nonopioid to opioid analgesics. It is important to identify patients with generalized sensory hypersensitivity, who may benefit from dedicated therapy. This article provides an evidence-based overview of the principles of pharmacological management of NCLPB.

Recovery from Chronic Diseases of Consciousness: State of the Art in Neuromodulation for Persistent Vegetative State and Minimally Conscious State.

Chronic diseases of consciousness (CDC) can still be considered a challenging frontier for modern medicine, probably because of their not completely understood physiopathological mechanisms. Following encouraging evidence on cerebral hemodynamics, some authors have hypothesized a role for neuromodulation in the treatment of CDC patients. In the past 40 years, spinal cord stimulation (SCS) and deep brain stimulation (DBS) have been used experimentally for the treatment of patients in a severe altered state of consciousness, with some interesting but not conclusive results. The present review summarizes the data currently available in the literature on this particular and debated topic. On these grounds, further clinical studies are needed to better understand the altered dynamics of neuronal network circuits in CDC patients as a step towards novel therapeutic strategies.

Experimental Endoscopic Angular Domains of Transnasal and Transoral Routes to the Craniovertebral Junction: Light and Shade.

STUDY DESIGN: We investigate on the surgical reliability of nasal palatine line for the transnasal approach and introduce a conceptually analogue radiological line as a reliable predictor of the maximal superior extension of the transoral approach. We have also compared radiological and surgical lines to find possible radiological references points to predict preoperatively the maximal extent of superior dissection for the transoral approach. OBJECTIVE: After comparing the surgical exposition angle and the working channel volume of both the approaches in our previous article, now we compare the radiological (theoretical) with the "surgical" (effective) Nasopalatine line and the latter with the recently introduced Nasal Axial Line. We conceived a radiological line with a similar significance for the transoral approach and we called it Mandibulopalatine line; then we compared the radiological with the "surgical" one. SUMMARY OF BACKGROUND DATA: Endoscopy represents both an alternative and a useful complement to the standard microsurgical approach to the anterior craniovertebral junction (CVJ). Both the surgical routes have a limitation caused by the hard palate. METHODS: Ten fresh nonperfused cadavers were studied. Transnasal and transoral linear and angled exposure of the CVJ were evaluated by means of X-ray and CT scan in the sagittal plane. RESULTS: The angular difference between the radiological and surgical transoral endoscopic lines was significantly smaller compared with the difference between the radiological and surgical transnasal lines. Finally we found how to calculate preoperatively the "surgical" (effective) Mandibulopalatine line by a simple lateral preoperative radiological study of the CVJ. CONCLUSION: Naso-axial line is confirmed to be a reliable preoperative predictor of the maximal extent of inferior dissection for transnasal approach. Surgical Palatine Inferior dental Arch line will draw the maximal extent of superior dissection for the transoral approach with simple lateral head X-ray examination by open mouth. LEVEL OF EVIDENCE: 3.