A perioperative overview of a retained surgical swab in spinal surgery: Case report and prevention protocol.

INTRODUCTION: Retained wound swabs although classified as a 'never event' and well documented in many surgical specialties are uncommon in spinal surgery. The aim of this article is to highlight the perioperative circumstances of an incident of a retained surgical swab and present a prevention protocol, in an attempt to eliminate its incidence. CASE REPORT: The perioperative management of a 53-year-old male undergoing spinal surgery in whom a surgical swab was retained is reported. In addition to existing safety procedures such as the World Health Organization checklist, a Retained Surgical Swab-Prevention Protocol was implemented in our hospital and is presented to eliminate the occurrence of this 'never event' occurring again. CONCLUSION: Retained surgical swabs or instruments are rare in spinal surgery occurring mostly in the lumbar spine, during emergency and prolonged procedures in patients with high body mass index. Maintaining a high index of suspicion and utilising a prevention protocol will prevent further harm to the patient.

Experience of Spinal Surgery for the Over 70s During the COVID-19 Pandemic in a Tertiary Referral Centre in the United Kingdom and Ramifications for Future Management.

INTRODUCTION: The aim of this study was to assess the safety of our spinal surgery pathways for patients over the age of 70 years during the COVID-19 pandemic, to guide future management. METHODS: A retrospective, single-centre, observational cohort study of all patients over 70 years of age undergoing spinal surgery between June 1 to September 30, 2020, was performed. All patients were stratified by the British Orthopaedic Association (BOA) COVID-19 Patient Risk Assessment Tool. RESULTS: A total of 64 operations on 59 patients were performed. The BOA risk assessment placed 67.8% of patients (n=40) in the high or very high-risk category. A total of 60% of patients (n=36) were over 75 years old. All patients had at least one other comorbidity. Following our green, amber, and red pathways, we had no cases of post-operative COVID-19 on an average follow-up of 71 days. CONCLUSION: Our study illustrates safe pathways for spinal surgery on patients over 70 years old during the first wave of COVID-19. Risk assessment tools should be used with caution, as age over 65 years was immediately medium-risk. This study would be a useful guide in the management of all elderly patients requiring surgery in the face of further COVID-19 variants or a similar pandemic.

18F-FDG PET/CT scan standardised uptake value (SUV) score for diagnosis, staging and monitoring malignancy in spinal melanotic schwannoma.

Melanotic schwannoma (MS) is a rare nerve sheath neuroectodermal neoplasm. We highlight the use of F18-fluorodeoxyglucose positive emission tomography/computed tomography (18F-FDG PET/CT) standardised uptake value (SUV) results in the diagnosis, staging and monitoring of spinal MS. A 58-year-old female patient had a 6-month history of left leg pain (S1) and no skin lesions. Magnetic resonance imaging reported a possible schwannoma with CT-guided biopsy, indicating a metastatic malignant melanoma. 18F-FDG PET/CT scan revealed only sacral destruction and an SUV score of 3.6. Histopathology results confirmed a malignant melanotic peripheral nerve sheath tumour (schwannoma). In MS, the 18F-FDG PET/CT scan SUV cut-off point can be used to distinguish between benign and malignant lesions, whereas (SUVmax) can predict the histologic response and therefore useful as a 'screening test'. Our case highlights the increased uptake on PET/CT by melanocytic variant of neurogenic tumours and clinicians need to be aware of this.

A pragmatic single centre retrospective comparative review of complication profile between PEEK cages and Zero-P cage screw constructs.

BACKGROUND: Anterior Decompression and Fusion (ACDF) is a common surgery recommended for symptomatic cervical degenerative disc disease after failed conservative care. There is no consensus on the choice of implants, and it varies between surgeons. This study aims to analyse the early complications following ACDF performed using a standalone cage versus a Zero-P (Cage Screw - (CS)) construct for patients with cervical degenerative disc disease. METHODS: A total of 162 patients underwent an ACDF between August 2016 and July 2018. There were 83 patients (111 cervical disc levels) with standalone cage (SA) and 79 patients (111 cervical disc levels) with cage-screw (CS) fixation. There was no difference between the groups in terms of age, gender, and levels of surgery. The follow-up ranged from 2 months to 24 months. Complications, both clinical and radiological, were assessed between the groups. RESULTS: Both the SA and Zero-P (CS) groups were subdivided into single and multilevel surgery. Complications encountered in the SA group were temporary swallowing problems 10, hoarseness of voice 3, cage migration 1, delayed union 1, Horner's syndrome 1, cage subsidence 2. In the CS group swallowing problems 4, hoarseness of voice 4, CSF leak 1, recurrent symptoms 1. The observed difference in the incidence of complications between the groups did not reach statistical significance. Univariate analysis between the groups did not show any difference in the improvement of cervical sagittal balance, fusion rate, subsidence, and complications encountered. Multivariate logistic regression analysis for complications showed no difference between the groups when assessed for smoking, gender, age, Charlson comorbidity index, levels of surgery, fusion status, Odom score, or the type of implant. CONCLUSION: In this short-term study, the standalone (SA) cages showed no difference in their complication profile in comparison to a cage-screw construct for both single and multilevel ACDF. Standalone cages might be a cost-effective option without increased complication risks. Nevertheless, we propose a longer-term follow-up with a prospective randomized trial for further evaluation of this finding.

An unusual case of ectopic prostate tissue in an intradural lipoma of the conus medullaris.

We report the first case of ectopic prostate tissue in a lipoma of the spine. Ectopic prostate tissue is well documented at a number of sites within the human body. Ectopic prostate tissue has previously been reported in the spine but usually in the context of spinal teratomas. This case is unique in that this is the first description of the presence of benign prostatic tissue in a lipoma of the conus medullaris. This is a highly unusual finding and probably reflects divergent differentiation or a malformative process.

Spontaneous cranial extradural hematoma: case report and review of literature.

Extradural hematoma (EDH) is usually a post-traumatic sequel but a few cases of spontaneous EDH have been reported. Here we report a woman who presented with spontaneous acute EDH but was later found to have dural metastasis from lung carcinoma. Causal factors have been present in all reported cases, as well as in this case. We propose the term non-traumatic EDH.

'Surgical' causes of benign intracranial hypertension.

Benign intracranial hypertension is a clinical diagnosis linked to a number of medical and surgical disorders. A common aetiology has not yet been established. It would seem, however, that many, if not all, of these cases can be related to some degree of cerebral venous outflow obstruction. We present here a series of patients with extraluminal compression of the cerebral venous sinuses that has been amenable to surgical resection. These 'surgical' causes of BIH illustrate an important subset of the disease and inform us about the possible pathophysiological principles underlying the disorder.