Decompression vs. Decompression and Fusion in Cauda Equina Syndrome Secondary to Massive Lumbar Disc Herniation

Posterior spinal surgery through either a decompression or additional fusion procedure is the widely accepted standard of care for patients presenting with cauda equina syndrome (CES) secondary to massive disc herniation. A plethora of literature has been published regarding post- surgical outcome, particularly in regards to improvement of lower sacral nerve symptoms in relation to timing of surgery. There is a paucity of data with regards to long term clinical outcomes in patients between the decompression and decompression and fusion groups. We initially hypothesized was that there would be no longer term clinical differences in outcome between the two groups, which was the objective of this thesis. The initial post-operative data showed no statistically significant difference between the decompression and fusion groups with regards to lower extremity weakness, presence of radicular symptoms, and improvement in lower sacral symptoms, those being bladder, bowel, and sexual function. Our long-term follow up cohort yielded patients the decompression group alone and showed general trends of improvement from their initial presentation in the aforementioned domains

Use of incisional vacuum-assisted closure in the prevention of postoperative infection in high-risk patients who underwent spine surgery: A proof-of-concept study

© 2019 AANS. Objective: This proof-of-concept study was conducted to determine whether negative-pressure wound therapy, through the use of incisional vacuum-assisted closure (VAC), is associated with a reduction in surgical site infections (SSIs) when compared to standard wound dressings in patients undergoing open posterior spinal fusion who have a high risk of infection. Methods: A total of 64 patients were examined; 21 patients received incisional VAC application (VAC group) versus 43 diagnosis-matched patients who received standard wound dressings (control group). Patients in the VAC group were prospectively enrolled in a consecutive series between March 2013 and March 2014 if they met the following diagnostic criteria for high risk of infection: posterior open surgery across the cervicothoracic junction; thoracic kyphosis due to metastatic disease; high-energy trauma; or multilevel revision reconstructive surgery. Patients in the VAC group also met one or more comorbidity criteria, including body mass index ≥ 35 or \u3c 18.5, diabetes, previous radiation at surgical site, chemotherapy, steroid use, bedridden state, large traumatic soft-tissue disruption, or immunocompromised state. Consecutive patients in the control group were retrospectively selected from the previous year by the same high-risk infection diagnostic criteria as the VAC group. All surgeries were conducted by the same surgeon at a single site. The primary outcome was SSI. All patients had 1 year of follow-up after their surgery. Baseline demographics, intraoperative parameters, and postoperative wound infection rates were compared between groups. Results: Patient demographics including underlying comorbidities were similar, with the exception that VAC-treated patients were malnourished (p = 0.020). VAC-treated patients underwent longer surgeries (p \u3c 0.001) and required more postoperative ICU admissions (p = 0.039). The median length of hospital stay was not different between groups. In total, 9 control patients (21%) developed an SSI, versus 2 VAC-treated patients (10%). Conclusions: Patients in this cohort were selected to have an increased risk of infection; accordingly, the rate of SSI was high. However, negative-pressure wound therapy through VAC application to the postoperative incision resulted in a 50% reduction in SSI. No adverse effects were noted secondary to VAC application. The preliminary data confirm the authors\u27 proof of concept and strongly support the need for a prospective randomized trial