Effects of extended oral antibiotic prophylaxis on surgical site infections after instrumented spinal fusion: a cohort study of 901 patients with a minimum follow-up of 1 year.

BACKGROUND AND PURPOSE: We aimed to determine whether an extended oral antibiotic prophylaxis protocol may reduce the rate of surgical site infection (SSI) in patients undergoing instrumented spinal fusion. PATIENTS AND METHODS: This retrospective cohort study comprise 901 consecutive patients subjected to spinal fusion between September 2011 and December 2018 with a minimum 1-year follow-up. 368 patients operated on between September 2011 and August 2014 were administered standard intravenous prophylaxis. 533 patients operated on between September 2014 and December 2018 were administered an extended protocol with 500 mg of oral cefuroxime axetil every 12 hours (clindamycin or levofloxacin in allergic individuals) until the removal of sutures. SSI was defined following the Centers for Disease Control and Prevention criteria. The association between risk factors and the incidence of SSI was evaluated by odds ratio (OR) with a multiple logistic regression model. RESULTS: The bivariate analysis showed a statistically significant association between SSI and the type of prophylaxis used ("extended"' = 1.7% vs. "standard" = 6.2%, p= 0.001), with a lower proportion of superficial SSIs with the extended regimen (0.8% vs. 4.1%, p = 0.001). The multiple logistic regression model showed an OR = 0.25 (95% confidence interval [CI] 0.10-0.53) for extended prophylaxis and an OR = 3.5 (CI 1.3-8.1) for non-beta-lactams antibiotics. CONCLUSION: Extended antibiotic prophylaxis seems to be associated with a reduction in the incidence of superficial SSI in instrumented spine surgery.

Study of fall risk-increasing drugs in elderly patients before and after a bone fracture.

BACKGROUND: Accidental falls have a significant economic and human impact. The use of certain drugs is one of the modifiable risk factors associated with these events. OBJECTIVE: The aim of this study was to determine the prevalence of use and to explore changes in treatment with fall-related drugs in patients over 65 years of age admitted as a result of a fall-related fracture. METHODS: Observational and prospective study performed in a tertiary level hospital. A list of fall risk-increasing drugs (FRIDs) was drawn up. The main study variables were number and type of FRIDs prescribed at admission and 1 month after the fracture and number, type, treating physician and place where changes in FRIDs were implemented. RESULTS: In total, 252 patients were included. At admission, 91.3% were receiving at least one FRID, mean daily use was 3.1 FRIDs and the most frequently prescribed FRIDs were diuretics (18%), renin-angiotensin system-acting agents (15.8%) and antidepressants (15%). One month later, mean daily use was 3.4 FRIDs (p=0.099) and a significant increase was detected in the use of hypnotics (p=0.003) and antidepressants (p=0.042). A total of 327 changes in treatment were recorded (1.3 changes/patient). Of the changes, 52.6% were new prescriptions, 72.2% occurred at discharge and 56.6% were ordered by a geriatrician. CONCLUSIONS: The use of FRIDs among patients with a fall-related fracture is very high. This use rises 1 month after the fracture, significantly in the case of hypnotics and antidepressants.

Developmental anterior dislocation of the radial head resulting from a congenital solitary osteochondroma of the proximal ulna in an infant.

A 4-month-old female infant was brought to our office by her parents, who had noticed a lump on the child's right elbow. Examination revealed a hard, painless lump in the antero-external region that was not reducible in flexion-extension or in pronation-supination. Neither palpation nor passive motion produced pain. Preoperative radiographs revealed a bony mass in the anteroexternal region of the proximal ulnar metaphysic (solitary osteochondroma), which was displacing the radial head into anteroexternal dislocation. No physiological bowing of the proximal metaphysis of the ulna was present. The infant underwent surgery at 6 months of age. No remains of the annular ligament were found. A complete resection of the tumour mass was performed, after which it was possible to reduce the radial head, together with the humeral condyle. Trans-radiocapitellar fixation was applied, with immobilization for 6 weeks. Subsequent radiological study revealed a congruent reduction of the radial head, with a progressive periosteal reaction of the posterior cortex of the ulna that evolved towards remodeling of the physiological bowing. Eight years after the surgery, the child remains asymptomatic, with complete range of motion and symmetric carrying angles. There were no relapses of osteochondroma, the deformity, or radioulnar synostosis.

L3-L4 dislocation without neurological lesions.

Vertebral dislocations are high energy injuries that rarely occur in the low back, but are found more frequently at the level of the thoracolumbar and sacrolumbar junctions. Dislocations of the mid-lumbar vertebrae are exceptional, with only 16 cases found in the literature. All previously reported cases were treated surgically. In four of these cases, the patients had no initial neurological lesions, and most of those who did have a neurological defcit exhibited some degree of recovery. We present the case report of an L3-L4 dislocation, without neurological lesions, resulting from an airplane crash. The anatomopathological mechanism of injury is discussed, together with treatment, which consisted of an initial closed reduction using a halo-bifemoral system, followed by pedicle instrumentation and arthrodesis from L2 to L5.

Complete medial dislocation of the first cuneiform: a case report.

Isolated dislocation of the first cuneiform bone is an extremely rare lesion that can usually be diagnosed on plain radiography. Few cases of this injury have been previously described in the literature. The case presented here resulted from a torsion injury and was treated by means of closed reduction with the aid of pointed reduction forceps. After fixation with Kirschner wires, the foot was immobilized for 6 weeks. The patient recovered uneventfully and remains asymptomatic 3 years later.

Intradural disc herniation and epidural gas: something more than a casual association?

STUDY DESIGN: The case of a patient with an intradural disc herniation associated with gas in the spinal canal is presented. OBJECTIVE: To alert spine surgeons to this potential association. SUMMARY OF BACKGROUND DATA: This association was described previously in five patients, a fact that seems surprising given the relative rarity of both intraspinal gas and intradural herniations. METHODS: The case is presented of a female patient with lumbosciatic pain who developed an incomplete cauda equina syndrome. An asymmetric discopathy of the L2-L3 space and a gas bubble with disc material within the spinal canal was noticed in the radiologic explorations. The literature and the authors' experience are reviewed with the aim of confirming the frequency of intradural herniation in association with gas in the spinal canal. RESULTS: A laminoarthrectomy of the involved space was performed followed by direct intradural examination, which revealed a disc fragment that was excised. An instrumented L2-L3 arthrodesis was performed. Postoperative evolution was satisfactory. To date, the authors have found this association in 2% of the patients with intraspinal gas. CONCLUSION: The potential presence of an intradural disc herniation must always be considered when performing an open discectomy on a patient whose CT scan study shows the presence of epidural gas. This association is particularly striking given the relative rarity of intradural herniations and intraspinal gas. In the event that no clear disc herniation was found, an intradural examination may be indicated to justify clinical signs and symptoms or previous radiologic studies.

L5 root compression resulting from an L2-L3 disc herniation.

We present the rare case of a patient affected by low back pain and bilateral L5 sciatica from an L2-L3 herniation. Only 2 cases of monoradicular L5 compression in the high lumbar spine have been reported. The initial computed tomography study of the L4-L5 and L5-S1 spaces revealed no significant alterations. Magnetic resonance imaging showed a disc herniation at L2-3. The electrophysiological study confirmed clinical suspicions of L5 root involvement. A bilateral laminotomy with discectomy on both sides of the L2-3 space was performed. Pain disappeared completely after surgery. The patient remains asymptomatic 2 years after the operation.