No abstract

(1) Incisional biopsy or intralesional resection significantly increases the risk of local recurrence, therefore, transcutaneous computed tomography-guided trocar biopsy is recommended. When there is a suspicion of primary spine tumor, the surgeon who performs the definitive surgery should ideally perform or direct the biopsy procedure. (2) En bloc resection is achievable if staging determines that it is feasible. The adverse event profile of these surgeries is high even at experienced centers. Therefore, experienced, multidisciplinary teams should perform these surgeries. (3) Grade of Recommendation can be "strong recommendation, low-quality evidence."

Object. Posterior lumbar spinal fusion for degenerative spine disease is a common procedure, and its use is increasing annually. The rate of infection, as well as the factors associated with an increased risk of infection, remains unclear for this patient population. A better understanding of these features may help guide treatment strategies aimed at minimizing infection for this relatively common procedure. The authors' goals were therefore to ascertain the incidence of postoperative spinal infections and identify factors associated with postoperative spinal infections.Methods. Data obtained in adult patients who underwent instrumented posterior lumbar fusion for degenerative spine disease between 1993 and 2010 were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection. Variables with p < 0.05 were considered statistically significant.Results. During the study period, 817 consecutive patients underwent lumbar fusion for degenerative spine disease, and 37 patients (4.5%) developed postoperative spine infection at a median of 0.6 months (IQR 0.3-0.9). The factors independently associated with an increased risk of infection were increasing age (RR 1.004 [95% CI 1.001- Conclusions. This study identifies that several factors-older age, diabetes, obesity, prior spine surgery, and length of hospital stay-were each independently associated with an increased risk of developing infection among patients undergoing instrumented lumbar fusion for degenerative spine disease. The overwhelming majority of these patients were treated effectively without hardware removal.

Object Resection of sacral tumors has been shown to improve survival, since the oncological prognosis is commonly correlated with the extent of local tumor control. However, extensive soft-tissue resection in close proximity to the rectum may predispose patients to wound complications and infection. To identify potential risk factors, a review of clinical outcomes for sacral tumor resections over the past 5 years at a single institution was completed, paying special attention to procedure-related complications. Methods Between 2002 and 2007, 46 patients with sacral tumors were treated with surgery. Demographic data, details of surgery, type of tumor, and patient characteristics associated with surgical site infections (SSIs) were collected; these data included presence of the following variables: diabetes, obesity, smoking, steroid use, previous surgery, previous radiation, cerebrospinal fluid leak, number of spinal levels exposed, instrumentation, number of surgeons scrubbed in to the procedure, serum albumin level, and combined anterior-posterior approach. Logistic regression analysis was implemented to find an association of such variables with the presence of SSI. Results A total of 46 patients were treated for sacral tumor resections; 20 were male (43%) and 26 were female (57%), with an average age of 46 years (range 11–83 years). Histopathological findings included the following: chordoma in 19 (41%), ependymoma in 5 (11%), rectal adenocarcinoma in 5 (11%), giant cell tumor in 4 (9%), and other in 13 (28%). There were 18 cases of wound infection (39%), and 2 cases of repeat surgery for tumor recurrence (1 chordoma and 1 giant cell tumor). Factors associated with increased likelihood of infection included previous lumbosacral surgery (p = 0.0184; odds ratio [OR] 7.955) and number of surgeons scrubbed in to the operation (p = 0.0332; OR 4.018). Increasing age (p = 0.0864; OR 1.031), presence of complex soft-tissue reconstruction (p = 0.118; OR 3.789), and bowel and bladder dysfunction (p = 0.119; OR 2.667) demonstrated a trend toward increased risk of SSI. Conclusions Patients undergoing sacral tumor surgery may be at greater risk for developing wound complications due to the extensive soft-tissue resections often required, especially with the increased potential for contamination from the neighboring rectum. In this study, it appears that previous lumbosacral surgery, number of surgeons scrubbed in, patient age, bowel and bladder dysfunction, and complex tissue reconstruction may predict those patients more prone to developing postoperative SSIs.

Object In patients with cervical spondylotic myelopathy (CSM), ventral disease and loss of cervical lordosis are considered to be relative indications for anterior surgery. However, anterior decompression and fusion operations may be associated with an increased risk of swallowing difficulty and an increased risk of nonunion when extensive decompression is performed. The authors reviewed cases involving patients with CSM treated via an anterior approach, paying special attention to neurological outcome, fusion rates, and complications. Methods Retrospectively, 67 cases involving consecutive patients with CSM requiring an anterior decompression were reviewed: 46 patients underwent anterior surgery only (1-to3-level anterior cervical discectomy and fusion [ACDF] or 1-level corpectomy), and 21 patients who required > 3-level ACDF or ≥ 2-level corpectomy underwent anterior surgery supplemented by a posterior instrumented fusion procedure. Results Postoperative improvement in Nurick grade was seen in 43 (93%) of 46 patients undergoing anterior decompression and fusion alone (p < 0.001) and in 17 (81%) of 21 patients undergoing anterior decompression and fusion with supplemental posterior fusion (p = 0.0015). The overall complication rate for this series was 25.4%. Interestingly, the overall complication rate was similar for both the lone anterior surgery and combined anterior-posterior groups, but the incidence of adjacent-segment disease was greater in the lone anterior surgery group. Conclusions Significant improvement in Nurick grade can be achieved in patients who undergo anterior surgery for cervical myelopathy for primarily ventral disease or loss of cervical lordosis. In selected high-risk patients who undergo multilevel ventral decompression, supplemental posterior fixation and arthrodesis allows for low rates of construct failure with acceptable added morbidity.