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  • ISSN: 2373-9479
    Early Online
    Volume 6, Issue 1
    Research Article
    Charles H. Crawford, Jeffrey L. Gum, Lawrence G. Lenke, Jacob M Buchowski, Charles C. Edwards, Steven D. Glassman, and Leah Y. Carreon*
    In an effort to reduce the rate of Surgical Site Infections (SSIs), recent studies have reported using intrawound, topical vancomycin powder. Although cost-effective and promising results have been published, there is concern for development of antibiotic resistance and catastrophic superbug infections. The purpose of this study was to evaluate and compare the culture profile of Surgical Site Infection (SSI) in patients undergoing posterior lumbar instrumented fusions with topical vancomycin powder utilized versus controls prior to the use of topical vancomycin powder. Patients who had a posterior lumbar instrumented fusion and subsequently developed SSI requiring operative treatment from June 2007 to June 2008 and from June 2011 to June 2012 were identified. Standard demographic and surgical data were collected. Culture results and timing of the SSI relative to index surgery were also collected. Comparison of SSIs pre-vancomycin (2007-2008) and post-vancomycin (2011-2012) identified 31 versus 26 patients, respectively; no difference in demographic or surgical characteristics between time-dependent cohorts. There was no difference in the culture profile between groups (p=0.667). When comparing the culture profile of surgical site infections after posterior lumbar instrumented fusions, there appears to be no difference comparing a pre-Vancomycin interval versus a post-vancomycin interval. Additionally, comparing SSIs with or without topical vancomycin, regardless of time interval, showed no difference in culture profile. The results of this study suggest that topical vancomycin powder did not increase the incidence of vancomycin-resistant, super bug infections in the time period studied. Continued surveillance of this increasingly common practice is warranted.
    Review Article
    Alberto Gotfryd* and Avanzi O
    Shoulder's asymmetry is one of the most notable clinical manifestations in individuals with Adolescent Idiopathic Scoliosis (AIS). Several papers have reported a correlation between shoulders unbalance and patients' dissatisfaction. Despite the availability of several clinical and radiographic methods for the evaluation of the shoulders leveling in the current literature, there are still many controversies about how to do it properly. Moreover, the correlation between cosmetic deformity and x-rays images is also questionable and surgeons may be giving excessive attention to radiographic images in detriment to the clinical deformity. The present study aims to highlight the most recent methods for the clinical and radiographic measurements of the shoulder balance, as well as the advantages and limitations of each of them.
    Pavlos Gkikas PT and Nicolas Mazis*
    Background & Purpose: Over the last decades research evidence has been published examining the correlation of low back pain (LBP) with alterations in paraspinal muscles characteristics. The aim of the present study was to critically review the existent literature concerning alterations in CSA and muscle fiber size, fiber type distribution and histopathological abnormalities in patients presenting LBP.
    Methodology: An electronic literature search was conducted in Pub Med, Science Direct, EMBASE, MEDLINE and Scopus by using MeSH terms. Identified abstracts and titles were screened and relevant research evidence, fulfilling the eligibility criteria was acquired. Additionally, previous studies reference lists were examined and researches were yielded by manual searching.
    Results: A reduction of the cross-sectional area (CSA) and fiber size in multifidus muscle at L3/L4 and L4/L5 levels were evident in patients with LBP compared to healthy subjects. However, no significant differences were observed for erector spinae. The findings concerning fiber type distribution were ambiguous; although in terms of histopathological abnormalities, the frequencies of pathological findings were greater in patients with LBP.
    Conclusion: Morphological and histopathological alterations were presented in patients with LBP. Nevertheless, further research is required addressing specific methodological issues such as small sample size, methodological design, and inconsistency in biopsy analysis.
    Mehmet Soy* and Pamir Atagunduz
    Spondyloarthritides (SpA) is a group of diseases, which are characterized by inflammation of the spine, asymmetrical oligoarthritis of the lower extremities and enthesitis, skin or mucous membrane lesions, uveitis and bowel inflammation.
    Gian Paolo Tassi*
    Introduction: This scientific study aimed to analyze the results of 250 Percutaneous Laser Disc Decompression (PLDD) lumbar procedures using a new model of diode laser 1470 nm. The PLDD is a valid and serious alternative to microdiscectomy and endoscopic herniectomy in carefully selected patients affected by disc hernia or protrusion. Several scientific publications in the last 20 years have stated this one and PLDD si spreading worldwide. Only a few scientific publications have used criticisms toward PLDD but all the Authors of these last publications were never involved to practice PLDD directly.
    Material and Methods: Seven hundred and fifty patients affected by lumbar disc hernia or protrusion not responding to conservative therapies for 6 weeks were treated with PLDD using a new model of diode laser machine. The wealth of news is that this laser machine is a 1470 nm of wavelength. In the past, some spine surgeons used diode laser for PLDD but only 808 or 980 nm of wavelength. So this is the first study analyzing the result of lumbar PLDD using a 1470 nm diode laser. The inclusion and exclusion criteria for PLDD treatment are the large international accepted criteria (not extruded disc hernia, not calcified hernia, not large intradiscal vacuum phenomena, not infections or fractures or tumors of nearest vertebral bodies, not haemorrhagic phatologies of the patients, not spondylolisthesis more than I Frankels degree). Age, gender, multiple level involved, associate pathologies and distribution were not statically different. The results were evaluated using the MacNab criteria, the Visual Analogic Scale (VAS) and the Oswestry Disability Scale (ODS). The follow-up period range from 6 months to 1,5 years (average 10 months). Results according to the MacNab criteria are: 87% of excellent/good results, 5% of recurrences and no complications.
    Conclusions: The analysis of the results support that the new 1470 diode laser is a safe and an excellent laser for lumbar PLDD procedures. The 1470 nm diode laser has the advantages of compact size and lower costs of purchase and maintenance than Nd: YAG 1064 nm laser.
    Case Report
    Ganapathy S*, Lingaraju TS, and Venugopal S
    Introduction: Drug resistant epilepsy is difficult to treat. Surgical management was first introduced by Dandy in 1928 when he performed the first anatomical hemispherectomy for infantile seizures. The treatment was very effective in the management of seizures but was associated with significant complications such as hydrocephalus, hemiplegia, aphasia and cortical hemosiderosis which develops later and is the cause of significant disability. The procedure now has been gradually replaced by functional Hemispherotomy where the epileptiform foci in the affected hemisphere are disconnected from the rest of the brain thereby containing the electrical discharges and preventing their translation into physical symptoms. This clinical remission from disabling epilepsy is highly successful with minimal complications in the short and long term to the patient.
    Case series: We present our experience in a case series of 3 patients who underwent this procedure at different ages for hypoxic insults suffered in the immediate perinatal period. They were subjected to different combinations of antiepileptic drugs, but stayed away from surgery for different reasons. All underwent functional Hemispherotomy for their epilepsy. Post op they all had deficits which gradually improved to complete resolution after 3-6 months of physiotherapy.
    Conclusion: For the right indications, Hemispherotomy is the correct surgical choice for disabling drug resistant seizures and offers good clinical improvement. Irrespective of the technique used, proper pre-operative assessment coupled with proper post-operative follow up and postoperative rehabilitative care are critical in ensuring complete return to functionality at the earliest.
    Case Report
    Shirin Alougly1,2, Suliman Elbragathy, Alia Alhsony, Aisha Elarwah, Abdulhamid ElShiky, Emhemed Mousa, Fatma F. Almijbri and Awad Magbri*
    Posterior reversible encephalopathy syndrome (PRESS) is a disorder of reversible subcortical vasogenic brain edema predominantly involving the parieto-occipital regions of the brain bilaterally. The pathophysiology of PRESS is not yet well known. PRESS occurs more in patients with acute neurological symptoms (seizures, encephalopathy, headache, and visual disturbances) or patients with renal failure and fluctuation of blood pressure. PRESS can also happen with the use of cytotoxic drugs, autoimmune disorders, sepsis, and pre-eclampsia or eclampsia. PRESS after scorpion sting is uncommon and rarely reported in literature. PRESS is generally reversible, both radio logically and clinically. Treatment of PRESS is symptomatic and involves determining and treating the underlying cause. We report on a case of 2.5-year old female developed PRESS with normal blood pressure after being stung by a scorpion. Her outcome was favorable despite the tumultuous hospital course. To the best of our knowledge, this is the third child reported with PRESS in the literature following a scorpion sting.
    Yakhya Cisse*, Jean Michel Nzisabira, Mouhamadou Moustapha Ndongo, Aissatou Kebe, Nantenin Doumbia, Lounceny Fatoumata Barry and Alioune Badara Thiam
    Cerebral venous thrombosis is a rare pathology in children. Its clinical and radiological presentation is varied and non-specific, thus delaying diagnosis. It is a pathology with a dreadful prognosis in this age group with a high morbi-mortality compared to that of adults. The diagnosis is obtained by MRI angiography, which is the reference examination. The preferential location is superficial, particularly in the lateral sinuses and longitudinal sinuses; deep sites are rare. Infectious etiology is the most frequent and treatment consists of the use of anticoagulants. We report in this article the case of a cerebral venous thrombosis in a 9-month-old infant revealed by axial hypotonia with bi-thalamic infarction lesions, managed at the neurosurgery department of the Fann University Hospital in Dakar, followed by a review of the literature.
    Original Research
    William R. Hotchkiss*
    Surgical site infection (SSI) and wound dehiscence are among the most common postoperative spinal surgery complications. Treatment can be complex, costly, and may require hospital readmission. Type 1 Hydrolyzed Collagen (T1HC) powder can be used during surgery to support the healing environment of the surgical wound. This study is a retrospective review of 154 patients who underwent spinal surgery using CellerateRX Surgical powder. A total of three (1.9%) high-risk patients developed postoperative wound complications (SSI or dehiscence). All complications resolved with local wound care and oral antibiotics; no hospital readmissions were required. This low incidence of surgical complications further supports the use of TIHC as an effective wound therapy agent in spinal surgery.
    Research Article
    Adam Bruggeman, and Kelly (Frank) Van Schouwen*
    Background/Intro: Scar tissue following spine surgery is expected, but hypothesized to be related to complications such as incidental durotomy, vessel injury, further increase in scar tissue formation, failed back surgery syndrome, and diminished patient outcomes. Scar tissue prevention remains elusive, but advancements in adhesion barriers have shown compelling results in minimizing complications.
    Methods: A retrospective review of one orthopedic surgeons patients that received VersaWrap (VW) during spine surgery. VW is a bioresorbable hydrogel sheet made of polysaccharides alginate and hyaluronic acid designed to separate tissues, allow gliding and prevent tethering.
    Pre-operative demographics, surgical details, patient reported outcomes, complications, and reoperations were collected and analyzed for all patients. Statistical analysis was completed on the appropriate data using a paired t-test.
    Results: Data for 169 patients that received posterior lumbar decompression were collected and analyzed. Patient reported outcomes showed significant improvement (p<0.05) in mean scores from pre-operative to 3-month follow-up for Visual Analogue Scale (VAS) neck/arm, VAS back/leg, NDI, and ODI. Four complications were reported, all peri-operative incidental durotomies that were repaired during surgery with no lasting impacts. Eleven patients underwent reoperations, unrelated to VW, but allowed for visual inspection of the VW post-operatively.
    Conclusion: The use of VW during spine surgery appears to reduce potential complications from scar tissue formation, specifically in the event a reoperation occurs in the same anatomic region.
    There are limitations to this study, including that it is retrospectively collected, but exploration of adhesion barriers in spine surgery applications appear promising and warrant further study.
    Study Design: Retrospective review of a case series.
    Objective: Define objective parameters to differentiate between Adults Degenerative Scoliosis (ADS), and Adult Idiopathic Scoliosis (AdIS). These are at the L3-L5 segment.
    Methods: A series of 53 adult scoliosis (mean age 55 y.o., median 57 y.o. range: 20-84 y.o.), was studied. Variables: age, curve parameters (Cobb, end vertebra), coronal and sagittal balance, spinopelvic parameters, and L3-L5 parameters (distance from the center of the disc to CSVL, and endplate coronal tilt). Statistical study: R package software, some variables not normal distribution, non-parametric tests. Approved by the IRB.
    Results: Distance of L3-L4 disc (18 mm; 2-52), showed a bimodal distribution that also correlated to spinopelvic parameters: if 15mm or less, then PT 22+/-8; if > 15 mm, then PT 32+/-17 (p=0.04 U Mann-Whitney). L4 endplate tilt inversely correlates to SS (Pearson -0.3; p<0.01) and positively to PT (Pearson 0.4;p=0.002), L3-L5 segment helps differentiate ADS from AdIS.
    Conclusions: Distance of the center of the disc L3-L4 to the central sacral line is an objective parameter to differentiate ADS from AdIS. It also correlates with compensatory mechanisms (PT), with statistical differences in PT between types of adult scoliosis.
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