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Recent CommentsSurgical Infections Following Spinal Operation
May 8, 2008
Question:
Surgical infections are relatively rare with spinal surgery, but can have serious consequences when they occur. Are there any specific risk factors that surgeons should watch out for?
Answer:
A recent article in the Journal for Bone and Joint Surgery reported a surgical infection rate of 2% with spinal operations. The single biggest risk factor for infection was diabetes, and patients with elevated blood glucose levels pre- and postoperatively were at higher risk. This is in agreement with current understanding of blood glucose levels and bacterial growth.
Other factors associated with increased risk of infection were suboptimal timing of prophylactic antibiotic therapy, obesity and the presence of multiple surgical residents in the operating room.
It can be difficult to control serum glucose levels in operative patients. These findings underscore the need for tight glucose control in diabetic patients and frequent monitoring of blood glucose levels. Administration of prophylactic antibiotics within one hour before the operation and increasing the antibiotic dosage to adjust for obesity are also important strategies to decrease the risk of surgical site infection after spinal operations.
Source:
The Journal of Bone and Joint Surgery (American). 2008;90:62-69.
doi:10.2106/JBJS.F.01515
© 2008 The Journal of Bone and Joint Surgery, Inc.
Midline Rectus Approach to Disc Replacement: Evidence for Benefits?
May 8, 2008
Question:
Is there any evidence of a benefit associated with the midline rectus (MR) over the paramedian lateral rectus (PLR) approach to disc replacement?
Answer:
A recent article in the journal Spine retrospectively analyzed patient outcomes with the midline rectus (MR) and PLR approaches. Radiographically, the PLR approach showed a significantly higher rate of postoperative malalignment in the sagittal plan. Despite this, there was no significant difference in clinical outcomes between the two groups.
What was found to affect patient outcome was the degree of prosthetic displacement. Patients with displacement of at least 5 mm were significantly more likely to have postoperative disability, regardless of the surgical approach, than patients with malalignment of less than 3mm.
The authors suggest that the finding of increased disability with more severe malaligment may warrant use of the MR approach over the PLR approach.
Source:
Spine. 2008 Jan 15;33(2):205-9.Click here to read Links
A comparison of two retroperitoneal surgical approaches for total disc arthroplasty of the lumbar spine.
Facet Solutions Unveils New Joint Reconstruction System
May 5, 2008
Question:
Facet Solutions, Inc recently completed evaluation of a new total joint reconstruction system . What are the details of this device, and is it available for clinical use?
Answer:
Facet Solutions combined their Anatomic Facet Replacement System (AFRS) with a semi-constrained disc replacement product to create a total joint replacement device for the lumbar spine. The device is a motion preservation system, designed to allow for physiologic movement about the facets and simultaneous replacement the adjacent disc.
“The use of facet replacement in combination with repair of the anterior column of the spine will have dramatic implications on how we treat patients with degenerative diseases of the spine,” stated Mr. Geoff Pardo, President and CEO of Facet Solutions, Inc. “The finite element model shows how properly designed, anatomically shaped implants work in harmony with one another.”
Facet Solutions recently received landmark patent for a combination intervertebral disc-facet replacement prosthesis. Currently, AFRS is approved only as an investigational device in the U.S. The company plans additional clinical trials of the product, but nationwide marketing is not expected to begin for several years.
Source: Facet Solutions (www.facetsolutions.com)
Nunec Cervical Arthroplasty Device
May 5, 2008
Question:
The Nunec Cervical Arthroplasty Device was used for the first time recently in China. What are the benefits of this new system?
Answer:
Pioneer Surgical Technology, Inc. announced the first human implantations of its next generation cervical total disc replacement (TDR), NuNec Cervical Arthroplasty Device, earlier this month. The surgeries were performed on patients with degenerative disc disease.
Dr. Yuan, a designing surgeon team member for NuNec said, “This (NuNec) . . . features a unique cam locking mechanism which provides optimum fixation without keel cutting as well as an HA coating on the outer surfaces of the PEEK plates to facilitate consistent biological fixation.” Yuan added, “Unlike many cervical disc devices, the radiolucency of the PEEK material in NuNec causes no artifact in MRI or CT imaging.”
The NuNec device includes Pioneer’s articulating P3. The device is manufactured from ‘PEEK’ (poly-ether-ether-keton), which has shown long term durability and resistance to the effects of accelerated aging. P3 Technology is also used in other Pioneer products, including NuBac(TM) Intradiscal Arthroplasty System, NuNec(TM) Cervical Arthroplasty System, and BacJac(TM) Interspinous Decompression System.
Source: Pioneer Surgical Technology