Introduction:Reported rate of infections after lumbar discectomy is 1%–15 %. This complication may result in disability or even the death.AimThe aim of the study is to assess the rate of infection associated with lumbar discectomies when combined systemic and local antibiotic prophylaxis was employed.Patients and methods:In this retrospective study we analyzed all patients operated for herniated lumbar disc from 2009 -2012 in our institute. Beside of receiving systemic prophylaxis with 2g of Cefazoline, all patients had their operative field irrigated at the end of operation with Amikacin sulfate injection. Wound was considered infected when local and systemic signs of infection were revealed and were associated with elevated ESR, leukocytosis and elevated CRP. Assessment of infection is done by neurosurgeon during the hospitalization and later at outpatient’s clinic along postoperative course of three months.Results:A total of 604 patients were operated, of those 285 patients (47.2 %) females and 319 males (52.8 %), 12 patients were operated on two levels (1.98 %). Average patient age was 32.5 years (range 20–65 years) Localization of herniated disc was: in L/2-L/3 20 patients or 3.3 %, the L/3-L/4 level 42 patients or 7 % , the L/4 -L /5 262 patients or 43.3 % at the level L/V- S/1 280 patients or 46.3 %. Three patients (0.49%) developed wound infection, two of them superficial infection only with local signs: local pain, redness and leakage. They were treated with oral antibiotics. One with deep wound infection. He presented with local and systemic signs and treated with i.v antibiotics. All the cultures from wound swab revealed staphylococcus aureus.Conclusion:Prophylaxis with systemic antibiotic (Cefazoline 2.0) intravenous administration 30 minutes before the incision and irrigation of operative field with local antibiotic Amikacine sulfate at the end of procedure reduces the infection rate in patients operated for herniated lumbar disc when compared with systemic antibiotic prophylaxis only.
Background: Patients suffering from cervical spondylotic myelopathy (SCM) and that do not respond to conservative treatment could benefit from anterior cervical spine surgery. However, surgical intervention is associated with increased risk of complications and therefore the decision to operate should be weighed against benefits. The purpose of this study was to describe the effectiveness and the rate of complications of anterior cervical spine surgery among CSM who do not respond to conservative treatment in Albania. Material and Methods: A total of 100 CSM patients who did not respond to conservative treatment and who showed up at our Service during 2014-2019 were subjected to anterior cervical spine surgery to resolve the CSM related signs and symptoms. The success rate as well as short-term and long-term complication of surgery were evaluated and reported. Results: The mean age of CSM patients (59% males) in the study was 51.5 years. One surgical procedure was employed in 90% of CSM patients whereas two procedures were necessary in the remaining 10%. The overall success rate of anterior cervical spine surgery was 70% (excellent in 40% of CSM patients and good in 30% of patients) whereas in 30% of CSM patients’ surgery did not bring any benefit or there were no changes compared to before the surgery. The overall rate of complications was 16%; no patients died following surgery. Specific complications were rare and varying from 1% of patients (Brown-Sequard syndrome, vocal cord paresis, wound infection) to 3% (subcutaneous hematoma). Conclusion: Anterior cervical spine surgery is associated with a relatively high success rate and a low level of post-operative complications and it might be regarded as a safe treatment among these CSM patients who do not respond to conservative treatment.
Background: Spinal cord contrast enhancement is an unusual radiological finding in chronic degenerative disorders of the spine and often it is misdiagnosed with neoplastic or inflammatory disease. Case Description: Here we present the case of a 62-year-old male with cervical degenerative spondylosis at the C4–C5 and C6-C7 level. Preoperative magnetic resonance imaging showed severe spinal cord compression with intramedullary hyperintensity on T2-weighted sequences and spinal cord enhancement at the C4-5 level after administration of Gadolinium. The patient with several weeks’ history of worsening spastic tetraparesis, underwent two-level anterior discectomy with fusion and anterior stabilization at the myelopathy level. Conclusion: Intramedullary gadolinium enhancement due to cervical spondylotic myelopathy (CSM) is an important consideration in the differential of inflammatory disease or intramedullary tumors, especially since misdiagnosis may result in serious consequences, including neurological disability from delayed surgical interventions and unnecessary treatments. Persistent enhancement for months to years following decompressive surgery is usual. Recognition is important to prevent inappropriate interventions or delay in consideration of a potentially beneficial decompressive surgery.
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