Search

Study Design: Retrospective single-center data analysis., Objective: The aim of this investigation was to give advises for choosing the LIV in selective fusion to reach the best correction of the minor curve and sagittal profile., Summary of Background Data: Scoliotic curves can be classified as structural or nonstructural. If selective fusion is performed, the nonstructural curves are not instrumented. The choice of the lowest instrumented vertebra (LIV) and the impact of different levels of the LIV on the correction of the minor curve in the frontal profile and on the sagittal balance is under debate., Methods: Forty-seven consecutive patients treated by posterior instrumented fusion were included in this retrospective investigation. Impact of the level of the LIV with regard to distance to end vertebra (EV), to the stable vertebra (StV), to the sagittal infliction point (IP), and to the apex of the lumbar lordosis on the correction of the minor curve was analyzed., Results: Distance of LIV to EV was significant with regard to correction of the minor curve if it was more than 5 levels (P<0.001). Distance of LIV to StV was significant with regard to correction of the minor curve if it was more than 4 levels (P<0.01). Distance of LIV to IP was significant with regard to correction of the minor curve if it was more than 2 levels (P<0.01)., Conclusions: Choosing a LIV that was more than 2 levels higher or lower than the sagittal infliction point showed a significantly higher correction of the minor curve. We therefore recommend to keep that distance when LIV is chosen., Competing Interests: M.P. Medtronic; M.R.K. Globus Medical, Depuy Synthes. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective data analysis., Objection: The primary objective of this investigation was to analyze if treatment of Postoperative surgical site infections (PSSI) after posterior stabilization of the spine (PS) without radiological signs of screw loosening (RSL) shows a sufficient success rate without implant removal and if there was any difference between early and late PSSI., Summary of Background Data: PSSI after PS are usually treated by implant removal and reinstrumentation if loosening of one of more screws is detected. There is presently no conclusive data that shows the success rate of the treatment of PSSI after PS without implant removal if no RSL are perceived., Materials and Methods: All patients who were treated for a PSSI after PS without RSL in a single spine center from 12/2009 to 03/2020 were enrolled in a retrospective analysis. Patients were treated by revision surgery with debridement and irrigation and subsequent antibiotic therapy. Implant removal was performed if the initial treatment did not lead to an improvement in wound healing and normalization of laboratory values. Statistical analysis was performed by Statistical Package for the Social Sciences 25. Descriptive data are given as mean and standard error of mean, a χ 2 test was performed., Results: Of the 32 enrolled patients, 17 had an early PSSI, 15 a late PSSI. In 71.9% (23/32), the PSSI was treated without implant removal: 12/17 in early PSSI, 11/15 in late PSSI. The difference was not significant ( P >0.05). One patient died, all other patients were discharged from the hospital with no remaining laboratory signs of the infection and with closed soft tissues., Conclusions: In our group of patients, the success rate of irrigation and debridement without implant removal was 71.9%. In the light of this data, performing at least two irrigations and debridement before implant removal seems to be a valid treatment option in PSSI after PS if there are no RSL in early and late PSSI., Competing Interests: M.R.K. personal fees from Globus medical outside of this work. The remaining authors declare no conflict of interest relevant to this work., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: This study was a retrospective radiographic analysis of consecutive patients., Objectives: To analyze exposure to radiation of the surgeon and-separately-of patients in minimally invasive surgery (MIS) of multilevel posterior stabilization by percutaneous pedicle screw insertion guided by navigation (PIN) versus percutaneous pedicle screw insertion guided by fluoroscopy (PIF)., Summary of Background Data: Spine surgeons are exposed to a 12-fold higher dose of radiation than other nonspinal musculoskeletal surgeons and PIF in MIS leads to a 2-fold higher dose of radiation than in open surgery. PIN might reduce the dose of radiation for the surgeon and the patient, especially in multilevel MIS surgery. To the best of our knowledge, there are only rare data of short-segment fusions that do not focus on exposure to radiation of surgeons., Methods: After power analysis, we included 205 consecutive screws (22 patients). We monitored dose of radiation (recorded separately for patient and surgeon), accuracy of screw placement, time of operation, and approach-related complications., Results: In PIN, only 58.7% of dose area product (cGy×cm) per screw of PIF was determined for patients (P<0.01). The surgeon was only exposed to 19.9% of radiation per screw in PIN compared with dosage in PIF (P<0.01). Four of 205 screws (2.0%) were classified as being incorrectly positioned: 2 of 87 screws (2.3%) in PIF and 2 of 118 screws (1.7%) in PIN (P>0.05). We did not observe any wound infections., Conclusions: PIN in MIS is a safe procedure and does, compared with PIF, lead to significant reduction of radiation dose for patients and-even more-for spine surgeons.