Postoperative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and postoperative care, wound infection continues to compromise patient outcome after spinal surgery. Spinal instrumentation also has an important role in the development of postoperative infections. This review analyses the risk factors that influence the development of postoperative infection. Classification and diagnosis of postoperative spinal infection is also discussed to facilitate the choice of treatment on the basis of infection severity. Preventive measures to avoid surgical site (SS) infection in spine surgery and methods for reduction of all the changeable risk factors are discussed in brief. Management protocols to manage SS infections in spine surgery are also reviewed.
Anti-Bacterial Agents ; Classification ; Delivery of Health Care ; Diagnosis ; Humans ; Postoperative Care ; Risk Factors ; Spine* ; Wound Infection

An 18-year-old male presented after a motor vehicle rollover accident. Computed tomography (CT) scan confirmed the diagnosis of Type II odontoid fracture. Considering the patient's young age and the limitations of C1-C2 fusion including significant loss of cervical rotation, temporary internal fixation with a lateral mass fixation of C1 and pedicle fixation of C2 without fusion was done. CT scan done at 6-month follow-up visit showed healed odontoid fracture and excellent C1-C2 alignment. At ninth postoperative month, internal fixation was removed. Patient had normal movements of cervical spine at 1-year follow-up. Temporary internal fixation can be an important tool in the armamentarium of the surgeon in treating type II odontoid fractures in young adults and children. This strategy avoids the complications halo fixation and immobilizes the unstable C1-C2 segment without fusion. Removal of the internal fixation after healing allows restoration of the rotational motion.
Adolescent ; Child ; Diagnosis ; Follow-Up Studies ; Humans ; Male ; Motor Vehicles ; Spine ; Tomography, X-Ray Computed ; Young Adult

The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques.
Adult ; Congenital Abnormalities ; Constriction, Pathologic ; Decompression ; Humans ; Pathology ; Psoas Muscles ; Scoliosis ; Spondylolisthesis

STUDY DESIGN: Level 4 retrospective review. PURPOSE: To compare the radiographic and clinical outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) with posterior segmental spinal instrumentation (SSI) for degenerative lumbar spondylolisthesis. OVERVIEW OF LITERATURE: Both PLIF and LLIF have been performed for degenerative spondylolisthesis with good results, but no study has directly compared these two techniques so far. METHODS: The electronic medical and radiographic records of 78 matched patients were analyzed. In one group, 39 patients underwent PLIF with SSI at 41 levels (L3-4/L4-5), while in the other group, 39 patients underwent the LLIF procedure at 48 levels (L3-4/L4-5). Radiological outcomes such as restoration of disc height and neuroforaminal height, segmental lumbar lordosis, total lumbar lordosis, incidence of endplate fracture, and subsidence were measured. Perioperative parameters were also recorded in each group. Clinical outcome in both groups was assessed by the short form-12, Oswestry disability index and visual analogue scale scores. The average follow-up period was 16.1 months in the LLIF group and 21 months in the PLIF group. RESULTS: The restoration of disc height, foraminal height, and segmental lumbar lordosis was significantly better in the LLIF group (p<0.001). The duration of the operation was similar in both groups, but the average blood loss was significantly lower in the LLIF group (p<0.001). However, clinical outcome scores were similar in both groups. CONCLUSIONS: Safe, effective interbody fusion can be achieved at multiple levels with neuromonitoring by the lateral approach. LLIF is a viable treatment option in patients with new onset symptoms due to degenerative spondylolisthesis who have had previous lumbar spine surgery, and it results in improved sagittal alignment and indirect foraminal decompression.
Animals ; Decompression ; Follow-Up Studies ; Humans ; Incidence ; Lordosis ; Retrospective Studies ; Spine ; Spondylolisthesis*