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Deep wound infection after spinal surgery is a potentially devastating complication and is associated with higher morbidity, mortality and healthcare costs. Different measures including intraoperative application of vancomycin powder to wounds have been employed previously to decrease the infection rate. The primary objective of this ongoing clinical study is to evaluate the systemic uptake of prophylactically applied vancomycin in instrumented spinal fusion surgery. Secondary outcomes are to show any side effects including nephrotoxicity related to its local application and record superficial and deep wound infections. A prospective study has been designed to recruit consecutive patients, between September 2013 and September 2014, operated by a single surgeon. All patients undergoing instrumented spinal fusion surgery (elective and trauma) in a single institution over a 12-month period were included. One gram of vancomycin powder was applied to the subfascial layer, and serum levels were measured at 6, 12 and 24 h post-administration. All patients routinely had renal functions checked postoperatively to evaluate nephrotoxic effects. A second cohort of patients was then recruited to apply 2 g of vancomycin subfascially. The patients were followed up for a 2-year period. Twenty-four patients, both trauma and elective, had 1 g of vancomycin powder applied to the subfascial layer. Twenty-eight patients had 2 g of vancomycin powder applied to the subfascial layer. Four patients reached systemic levels in the 2-g group; however, only one patient had clinically detectable but nonsignificant levels in the 1-g group. There were no adverse effects detected. This study demonstrates that systemic uptake of vancomycin after local application to the wound is negligible for the vast majority of patients. However, it has shown clinical and biochemical safety for its use and remains a cost-effective and low-risk strategy to combat surgical site and deep wound infections.

Sub-axial cervical spine(C spine) distraction flexion injuries, known as cervical sprains, have been divided into either "benign" or "severe" sprains depending on the integrity of the posterior longitudinal ligament (PLL) of the spinal column. It is a very uncommon injury and rarely reported in the literature. Most of the reports in the literature discuss this injury in the adult age group and so the adolescent age group was also considered to follow the same model of progression of mechanical instability depending on the degree and extent of structures injured, including the PLL as a cutoff factor between a "stable" and an "unstable" injury.We report three cases of adolescents with severe cervical sprains at the C2-C3 level and argue the integrity of PLL as a determinant factor in the sagittal stability of the C spine in this age group.

Background: Rotator cuff problems are frequently seen by orthopedic surgeons and accurate diagnosis is essential for appropriate management. Value of the clinical assessment of a shoulder is often limited, therefore, imaging studies have important implications in the management of rotator cuff pathologies. Aim: The purpose of this retrospective study is to compare the accuracy of ultrasonography (US) and magnetic resonance imaging (MRI) for detection of full-thickness rotator cuff tears. Materials and Methods: We reviewed 91 consecutive cases of shoulder arthroscopy and open rotator cuff repair, who had undergone preoperative investigation in the form of either an ultrasound or MRI. Thirty-six patients had an ultrasound and 55 had an MRI for their affected shoulders. We compared the accuracy of US and MRI for detection of full-thickness rotator cuff tears, using the operative findings as the 'gold standard'. Data regarding a supraspinatus tear was assessed for the purpose of this study. Results: Ultrasonography correctly diagnosed 15 out of 17 tears (sensitivity of 0.88). There were 17 true-negative and two false-positive ultrasounds (specificity of 0.89). MRI accurately identified 33 of the 36 tears (sensitivity of 0.91). There were 16 true-negative and three false-positive tears on MRI (specificity of 0.84). The positive predictive value (PPV) was 88% for US and 92% for MRI. The negative predictive value (NPV) was 89% for US and 84% for MRI. The overall accuracy of the ultrasound was 88.89% (95% confidence interval (CI) = 74.09 to 96.18) as compared to 89.09% (95% CI = 77.82% to 95.26%) for the MRI. Conclusion: Full-thickness rotator cuff tears can be identified using ultrasound and MRI with comparable accuracy. US being a dynamic study and better tolerated by the patient, can therefore be used as the first-line investigation for rotator cuff tear, where appropriate skills are available to reduce the waiting time and cost of investigation.