Study Design Retrospective analysis. Objective The objective of this study was to evaluate the efficacy of a surgical site infection (SSI) prevention protocol instituted in the Orthopaedic Spine Department at our institution. Summary of Background Data SSI is an undesired complication of orthopaedic spine surgeries. It poses a significant risk to the patient, as well as a financial toll on the healthcare system. A wide range of prophylactic measures have been used to attempt to reduce SSI rates. Methods A protocol consisting of a combination of 0.3% Betadine wound irrigation and 1 gram of intra-wound Vancomycin powder application was developed at our institution. Multiple data sources were consolidated for thorough evaluation of changes in SSI rates, patient risk factors, and changes in bacteriology. Identification of risk factors that predispose patients to SSI was performed using mixed effects logistic regression in a univariate fashion. Risk factors with p-values of ≤ 0.05 in univariate analysis were included together in a multivariate mixed effects logistic regression model. Results SSI rates were reduced by 50% following the intervention; Chi square analysis comparing the SSI rates between the pre- and post-intervention periods yielded a p-value of 0.042. Rates of methicillin resistant Staphylococcus aureus dropped from 30% to 7% and the rates of multi-bacterial infections dropped from 37% to 27%. The risk factors that were statistically significant in multivariate analysis were the following: age (OR 0.93), anemia (OR 30.73), prior operation (OR 27.45), and vertebral fracture (OR 22.22). Conclusion The combination of Betadine wound irrigation and intra-wound vancomycin powder application led to both a clinically and statistically significant decrease in SSI rates by 50%. Bacteriology analysis and risk factor assessment proved to be valuable tools in assessing the efficacy of a new prophylactic measure and in the planning of future protocols.

Study Design Retrospective review of scoliosis progression, pulmonary and cardiac function in a series of patients with Duchenne Muscular Dystrophy (DMD). Objective To determine whether operative treatment of scoliosis decreases the rate of pulmonary function loss in patients with DMD. Summary of Background Data It is generally accepted that surgical intervention should be undertaken in DMD scoliosis once curve sizes reach 35 degrees to allow intervention before critical respiratory decline has occurred. There are conflicting reports, however, regarding the effect of scoliosis stabilization on the rate of pulmonary function decline when compared to non operative cohorts. Methods We reviewed spinal radiographs, echocardiograms, and spirometry, hospital, and operative records of all patients seen at our tertiary referral center from July 1, 1992 to June 1, 2007 Data was recorded to Microsoft Excel and analyzed with SAS and R statistical processing software. Results The percent predicted forced vital capacity (PPFVC) decreased 5% /year prior to operation. The mean PPFVC was 54% (sd=21%) prior to operation with a mean postoperative PPFVC of 43% (sd=14%). Surgical treatment was associated with a 12% decline in PPFVC independent of other treatment variables. PPFVC after operation declined at a rate of 1% per year and while this rate was lower, it was not significantly different than the rate of decline present prior to operation (p=0.18). Cardiac function as measured by left ventricular fractional shortening declined at a rate of 1%/year with most individuals exhibiting an LVFS rate of >30 prior to operation. Conclusion Operative treatment of scoliosis in DMD using the Luque Galveston method was associated with a reduction of FVC related to operation. The rate of pulmonary function decline after operation was not significantly reduced when compared to the rate of preoperative FVC decline.

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The consistency obtained in torsional loading indicates that this type of loading will provide the most useful data from patients in vivo. Excellent bonebonding and accurate strain transmission using a long-term strain measurement system and miniature radio transmitter indicate that strains collected from patients with this system will be accurate.

Currently, spine fusion is determined using radiography and clinical evaluation. There are discrepancies between radiographic evidence and direct measurements of fusion, such as operative exploration and biomechanical or histological measurements. In order to facilitate the rapid return of patients to normal activities, a monitoring technique to accurately detect fusion in vivo and to prevent overload during the postoperative period would be useful. The objectives of this study were to develop an implantable monitoring system consisting of CPC-coated strain gauges and a radio transmitter to detect the onset of fusion and measure strain during postsurgical activities. A patient underwent anterior release and fusion, followed by posterior instrumentation and fusion with segmental spinal instrumentation. Four strain gauges were placed during surgery. One was attached to the left-side rod and one to each of the lamina at T9, T10, and T11. An externally powered implanted radio transmitter attached to the gauges was placed in a subcutaneous pouch. Strains were monitored weekly and tabulated during various activities for 7 months. Peak strains during twisting and bending were tabulated to detect the onset of fusion. Strains were also recorded during activities such as climbing off an examination table, rising from a chair, and climbing stairs. Strains collected from the left rod indicated that, immediately postoperatively, it was loaded at acceptable levels. The largest and most consistent strain changes measured from the lamina were recorded during twisting.

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Study Design Retrospective chart review and review of literature. Objective Few case reports of traumatic L5–S1 displacement have been presented in the literature. Here we present two cases of traumatic spondylolisthesis showing both anterior and posterior displacement, the treatment algorithm, and a review of the literature. Methods The authors conducted a retrospective review of representative patients and a literature review of traumatic spondylolisthesis at the L5–S1 junction. Two representative patients were identified with traumatic spondylolisthesis: one with an anterior dissociation, and the other with a posterior dissociation. Results Radiographic, computed tomography, and magnetic resonance imaging illustrated the bony and soft tissue injury found in each patient, as well as the final stabilization and outcomes. Operative stabilization was necessary, and both patients were treated with open reduction internal fixation. The patient with posterior dissociation had complete recovery without neurologic sequelae. The patient with anterior dissociation had persistent bilateral L5–S1 radiculopathy with intact rectal tone, due to neurologic compression. Conclusions Few cases of traumatic spondylopelvic dissociation that are isolated to the L5–S1 disk space are described in the literature. We examined both an anterior and a posterior dissociation and treated both with L5–S1 posterior spinal fusion. The patient with anterior dissociation had persistent L5–S1 root injury; however, the patient with posterior dissociation had no neurologic deficits. This is the opposite of what is expected based on anatomy. These cases offer insight into the management of anterior and posterior L5–S1 spondylopelvic dissociation.