Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management.

BACKGROUND: Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare complication. Most cases of infection occur early after surgery that involve skin and soft tissue and can be managed with debridement, antibiotics, and implant retention (DAIR). AIM: To identify pVOM risk factors and evaluate management strategies. METHODS: From a multicentre cohort of deep infection after spine instrumentation (IASI) cases (2010-2016), pVOM cases were compared with those without vertebral involvement. Early and late infections were defined (<60 days and >60 days after surgery, respectively). Multivariate analysis was used to explore risk factors. FINDINGS: Among 410 IASI cases, 19 (4.6%) presented with pVOM, ranging from 2% (7/347) in early to 19.1% (12/63) in late IASIs. After multivariate analysis, age (adjusted odds ratio (aOR): 1.10; 95% confidence interval (CI): 1.03-1.18), interbody fusion (aOR: 6.96; 95% CI: 2-24.18) and coagulase-negative staphylococci (CoNS) infection (aOR: 3.83; 95% CI: 1.01-14.53) remained independent risk factors for pVOM. Cases with pVOM had worse prognoses than those without (failure rate; 26.3% vs 10.8%; P = 0.038). Material removal was the preferred strategy (57.9%), mainly in early cases, without better outcomes (failure rate; 33.3% vs 50% compared with DAIR). Late cases managed with removal had greater success compared with DAIR (failure rate; 0% vs 40%; P = 0.067). CONCLUSION: Risk factors for pVOM are old age, use of interbody fusion devices and CoNS aetiology. Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.

[Evolution of blood loss in total knee prosthesis with blood recovery system vs conventional drainage]. / Evolución de la pérdida sanguínea en la prótesis total de rodilla con recuperador de sangre vs drenaje convencional.

INTRODUCTION: knee prosthetic surgery can be associated with significant blood loss that can account for up to 20% of blood volume. The objective of our study is to analyze blood loss (BL) after total knee replacement (TKR), with the use of a blood recovery system vs a normal drain. MATERIAL AND METHODS: prospective, comparative, and observational study of two groups of 30 patients who underwent TKR, one control (CG) and another study group with a recovery system (RG). We analyzed PS, hemoglobin (Hb), hematocrit (Htc), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) at 3-, 24-, 48-, 72- and 96-hours post-surgery, the need for transfusion, and the percentage of discharges in 72 hours and complications. RESULTS: the highest percentage of change in Htc and Hb occurred in the first 3 hours post-surgery and recovery began at 72 hours in the RG (p = 0.02) and at 96 hours in the CG (p = 0.04). The decrease in Hb and Htc began his recovery at 72 hours in the RG and at 96 hours in the CG. The TAS, TAD and FC began their recovery at 72 hours in both groups. The decrease in SBP was greater in the CG at 3 hours (p = 0.02), 24 hours (p = 0.02) and 48 hours (p = 0.01) post-surgery. Six patients were transfused in RG and 10 in CG (p = 0.22). 20% and 74% of the patients were discharged at 72 hours in the CG and RG, respectively. CONCLUSION: the greatest BL occurs in the first 3 hours post-surgery and recovery begins at 72-96 hours. Recovery blood system decreases BL during the first 3 hours, enhance the recuperation of Hb and SBP, decreases the need for transfusion and favors early discharge.

INTRODUCCIÓN: la cirugía protésica total de rodilla (PTR) se puede asociar a pérdidas sanguíneas (PS) significativas. El objetivo es analizar la evolución de la PS tras PTR con recuperador sanguíneo vs drenaje convencional. MATERIAL Y MÉTODOS: estudio prospectivo de dos grupos de 30 pacientes intervenidos de PTR, uno control (GC) y otro estudio con recuperador (GR). Se analizó la PS, hematocrito (Hcto), hemoglobina (Hb), tensión arterial sistólica (TAS) y diastólica (TAD) y frecuencia cardíaca (FC) a las tres, 24, 48, 72 y 96 horas postquirúrgicas, la necesidad de transfusión, el porcentaje de altas en 72 horas y las complicaciones. RESULTADOS: la mayor PS y porcentaje de cambio de Hcto y Hb se produjo a las tres horas postquirúrgicas e inició su recuperación a las 72 horas en el GR (Hcto, p = 0.02) (Hb, p = 0.04) y a las 96 horas en el GC. La TAS, TAD y FC empezó su recuperación a las 72 horas en ambos grupos. El descenso de TAS fue mayor en el GC a las tres horas (p = 0.02), 24 horas (p = 0.02) y 48 horas (p = 0.01) postquirúrgicas. Veinte y 33% de los pacientes fueron transfundidos, además 20 y 74% fueron dados de alta a las 72 horas en el GC y GR, respectivamente. CONCLUSIÓN: la mayor PS y porcentaje de cambio de Hcto y Hb se produce a las tres horas postquirúrgicas y empieza su recuperación a las 72-96 horas. El recuperador favorece la recuperación del Hcto, Hb y TAS, disminuye la necesidad de transfusión y favorece el alta precoz.

Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica / Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica

Antecedentes y objetivos: La correlación entre el equilibrio sagital de la columna y el resultado clínico tras una vertebroplastia (VP) en pacientes con fractura vertebral osteoporótica por compresión (FVOC) ha sido poco estudiada. Analizamos el resultado clínico de la VP en pacientes con FVOC teniendo en cuenta el equilibrio sagital. Material y método: El objetivo primario es valorar el cambio en el dolor axial, la discapacidad y la calidad de vida relacionada con la salud mediante la escala analógica visual (VAS), índice de discapacidad de Oswestry (ODI) y el test SF-36, respectivamente. Todo ello, correlacionado con el eje sagital vertical (SVA) que define el equilibrio sagital. El estudio radiográfico consistió en una radiografía de perfil de columna completa en bipedestación. Los controles clínico-radiológicos se realizaron pre- y post-VP (1, 3 y 12 meses). Resultados: Se incluyeron 51 pacientes con un total de 113 FVOC; 30 pacientes (60,7%) presentaron múltiples FVOC. Comparando la evolución del resultado del VAS y del ODI durante el seguimiento no se observaron diferencias significativas entre los grupos de pacientes con SVA<50mm y >50mm (p>0,05). Por el contrario, en pre-VP los resultados del SF-36 presentaban peores puntuaciones en el grupo de SVA>50mm en la sección de función física (FP) (p<0,05) y de componente de salud física (CSF) (p<0,05). Estas diferencias se mantenían hasta los 3 meses de seguimientos en CSF y hasta el final del seguimiento en la sección de FP (p<0,05). Conclusiones: Los pacientes con SVA>50mm presentan una recuperación más lenta de su calidad de vida relacionada con la salud tras VP por FVOC, pero sin diferencias significativas con respecto al dolor o discapacidad cuando se comparan con pacientes con SVA<50mm.(AU)

Background and objectives: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. Material and method: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. Results: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). Conclusions: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.(AU)

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

Artritis séptica de rodilla por Staphylococcus warneri / Septic arthritis of the knee by Staphylococcus warneri

Resumen: La artritis séptica suele presentarse como un proceso articular agudo que puede provocar una rápida destrucción del cartílago, si no se toman las medidas terapéuticas necesarias. De manera poco frecuente, el Staphylococcus warneri puede ser la causa de esta patología aunque por su dificultad diagnóstica podemos cometer errores en su tratamiento. Presentamos el caso de un paciente con artritis séptica de rodilla por este germen y pretendemos remarcar cuáles son las medidas diagnósticas y recomendaciones a tener en cuenta para esta infección osteoarticular.

Abstract: Septic arthritis usually occurs as an acute joint process that can cause a rapid destruction of the cartilage, if the necessary therapeutic measures were not taken. Rarely, Staphylococcus warneri may be the cause of this pathology although due to its diagnostic difficulty we can make mistakes in its treatment. We present the case of a patient with septic arthritis of the knee by this germ and we intend to remark what are the diagnostic measures and recommendations to consider for this osteoarticular infection.

[Septic arthritis of the knee by Staphylococcus warneri]. / Artritis séptica de rodilla por Staphylococcus warneri.

Septic arthritis usually occurs as an acute joint process that can cause a rapid destruction of the cartilage, if the necessary therapeutic measures were not taken. Rarely, Staphylococcus warneri may be the cause of this pathology although due to its diagnostic difficulty we can make mistakes in its treatment. We present the case of a patient with septic arthritis of the knee by this germ and we intend to remark what are the diagnostic measures and recommendations to consider for this osteoarticular infection.

La artritis séptica suele presentarse como un proceso articular agudo que puede provocar una rápida destrucción del cartílago, si no se toman las medidas terapéuticas necesarias. De manera poco frecuente, el Staphylococcus warneri puede ser la causa de esta patología aunque por su dificultad diagnóstica podemos cometer errores en su tratamiento. Presentamos el caso de un paciente con artritis séptica de rodilla por este germen y pretendemos remarcar cuáles son las medidas diagnósticas y recomendaciones a tener en cuenta para esta infección osteoarticular.