Postoperative spinal infection mimicking systemic vasculitis with titanium-spinal implants

<p>Abstract</p> <p>Background</p> <p>Secondary systemic vasculitis after posterior spinal fusion surgery is rare. It is usually related to over-reaction of immune-system, to genetic factors, toxicity, infection or metal allergies.</p> <p>Case Description</p> <p>A 14 year-old girl with a history of extended posterior spinal fusion due to idiopathic scoliosis presented to our department with diffuse erythema and nephritis (macroscopic hemuresis and proteinuria) 5 months post surgery. The surgical trauma had no signs of inflammation or infection. The blood markers ESR and CRP were increased. Skin tests were positive for nickel allergy, which is a content of titanium alloy. The patient received corticosteroids systematically (hydrocortisone 10 mg) for 6 months, leading to total recess of skin and systemic reaction. However, a palpable mass close to the surgical wound raised the suspicion of a late infection. The patient had a second surgery consisting of surgical debridement and one stage revision of posterior spinal instrumentation. Intraoperative cultures were positive to Staphylococcus aureus. Intravenous antibiotics were administered. The patient is now free of symptoms 24 months post revision surgery without any signs of recurrence of either vasculitis or infection.</p> <p>Literature Review</p> <p>Systemic vasculitis after spinal surgery is exceptionally rare. Causative factors are broad and sometimes controversial. In general, it is associated with allergy to metal ions. This is usually addressed with metal on metal total hip bearings. In spinal surgery, titanium implants are considered to be inert and only few reports have presented cases with systemic vasculitides. Therefore, other etiologies of immune over-reaction should always be considered, such as drug toxicity, infection, or genetic predisposition.</p> <p>Purposes and Clinical Relevance</p> <p>Our purpose was to highlight the difficulties during the diagnostic work-up for systemic vasculitis and management in cases of posterior spinal surgery.</p

The effect of autologous platelet factors in autograft integration following ACL reconstruction

Purpose: In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods: This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results: Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions: The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important.Σκοπός: Στην παρούσα μελέτη, εξετάζονται τα πρώιμα και μεσοπρόθεσμα κλινικά και απεικονιστικά αποτελέσματα με και χωρίς τη χρήση συμπυκνωμένων αυτόλογων αιμοπεταλιακών στην ανακατασκευή των ΠΧΣ. Η μελέτη επικεντρώνεται στην διερεύνηση της επίπτωσης των παραγόντων αυτών στο φαινόμενο της διεύρυνσης των σηράγγων. Μέθοδος: Πρόκειται για μια διπλή τυφλή, προοπτική, τυχαιοποιημένη μελέτη. 51 ασθενείς συμπλήρωσαν το πρωτόκολλο. Οι ασθενείς που έλαβαν μέρος τυχαιοποιήθηκαν σε 2 ομάδες: στην μία ομάδα έγινε χρήση ΣΑΑΠ ενώ η άλλη χρησιμοποιήθηκε ως ομάδα ελέγχου. Οι ασθενείς αναλύθηκαν με βάση τις μαγνητικές τομογραφίες και την κλινική τους εξέταση, πρώιμα μετεγχειρητικά (1 μήνα) αλλά και όψιμα (1 χρόνο) μετεγχειρητικά. Η διάμετρος των σηράγγων μετρήθηκε στην είσοδό τους στην άρθρωση, στην μεσότητά τους αλλά και στον “πάτο” τους.Αποτελέσματα: Η μελέτη επιβεβαίωσε την ύπαρξη του φαινομένου της διάταση των σηράγγων. Η μορφολογία της διάτασης ήταν κατά μέσο όρο κωνική και στις 2 ομάδες. Υπήρξε στατιστικώς σημαντική διαφορά στην διεύρυνση των τούνελ στην μεσότητα (μικρότερη διεύρυνση στους ασθενείς που έγινε χρήση ΣΑΑΠ).Το εύρημα αυτό πιθανώς επιβεβαιώνει τον ρόλο μιας δευτερογενούς βιολογικής απάντησης σε ένα μηχανικό ερέθισμα στο συγκεκριμένο φαινόμενο.Συμπεράσματα: Η χρήση ΣΑΑΠ στην ανακατασκευή του ΠΧΣ παραμένει μια ασφαλής επιλογή και δυνητικά μπορεί να αποβεί ωφέλιμη περιορίζοντας την βιολογική απάντηση σε μηχανικά ερεθίσματα που ευθύνονται για την διάταση των σηράγγων ανακατασκευής

Outcome of a Dynamic Neutralization System for the Spine

One hundred fourteen patients (66 men and 48 women; mean age, 49 years) underwent spine stabilization using a dynamic neutralization system between January 1999 and August 2010 for degenerative disk disease, spinal instability, or spinal stenosis. Mean follow-up was 6.8 years (range, 1-11 years). Seven patients were lost to follow-up. Radiological examination and clinical evaluation, including the Oswestry Disability Index, the Roland-Morris Disability Questionnaire, and patient satisfaction, were performed. Mean Oswestry Disability Index score improved from 57% (severe disability) preoperatively to 22% (moderate disability) postoperatively. Mean Roland-Morris Disability Questionnaire score improved from 52% preoperatively to 35% postoperatively; 79 (74%) patients declared themselves very satisfied with the end result of the operation. Postoperatively, 27 (25%) patients experienced complications, including screw loosening (n=22), infection (n=2), back (n=5) and leg (n=2) pain, and endplate vertebral fracture (n=1). Three patients with screw loosening, 2 with deep infection, and 1 with severe persistent back and leg pain underwent rigid spine arthrodesis. Dynamic neutralization systems can be considered for degenerative disk disease, spinal instability, and stenosis. Patient satisfaction with the procedure is excellent. However, in the long term, the complication rate, most commonly screw loosening, is high and reoperations are common. In this setting, long-term follow-up is recommended, and the use of this system should be reconsidered

Posterior Decompression and Stabilization, and Surgical Vertebroplasty With the Vertebral Body Stenting for Metastatic Vertebral and Epidural Cauda Equina Compression

WC, present the technique of combined posterior decompression and spinal instrumentation. and Surgical (open) vertebroplasty using it novel system called vertebral body stenting (VBS) during a single session in it patient with metastatic vertebral and epidural cauda equina compression. J, surg. oncol. 2010;101.-253-258. (C) 2010 Wiley-Liss, Inc

A new type of reconstruction of the hemipelvis after Type 3 amputative sacrectomy using pedicled fibula

This is a technical note of pelvic reconstruction performed by an advanced multidisciplinary team. The authors report a new 3-stage reconstruction of the hemipelvis after Type 3 sacrectomy involving instrumented spinoiliac arthrodesis and pedicled fibula grafting in 2 patients. The anterior stage of the procedure begins with a transabdominal approach to mobilize the viscera and to free up the tumor from the vessels. The posterior divisions of internal iliac vessels, the middle sacral vessels, and the lateral sacral vessels are then ligated. An anterior vertebrectomy is done at the appropriate level, followed by an anterior osteotomy through the lateral planed surgical margin of the sacrum close to the salvaged sacroiliac joint. The second stage includes a major sacral resection with lower-extremity amputation from the pubic symphysis through the intact side of the sacrum, ipsilateral pedicled fibula harvesting, and closure with an ipsilateral pedicled quadriceps flap. The final stage involves reconstruction with lumboiliac instrumentation. The pedicled fibular graft left from the second stage is then placed distally within the previously created iliopectineal docking site and proximally within the L-5 docking site. The authors believe that this is a feasible and reproducible technique with theoretical advantages that have to be proved in the long-term follow-up