RESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Antibacterianos/uso terapêutico , Guias de Prática Clínica como Assunto , Fusão Vertebral , Infecção da Ferida Cirúrgica/prevenção & controle , HumanosRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 11 focused on risk factors and prevention questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Antirreumáticos , Consenso , Diarreia/prevenção & controle , Humanos , Staphylococcus aureus Resistente à Meticilina , Ortopedia , Período Perioperatório , Philadelphia , Propionibacterium acnes , Músculos Psoas/patologia , Medição de Risco , Fatores de Risco , Revisões Sistemáticas como Assunto , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/tratamento farmacológicoRESUMO
In July of 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 7 focused on wound care, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Antibacterianos/uso terapêutico , Procedimentos Ortopédicos/efeitos adversos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Consenso , Humanos , Ortopedia , Philadelphia , Falha de Prótese , Sociedades Médicas , Coluna Vertebral/cirurgia , CicatrizaçãoRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 8 questions focused on general principles in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Procedimentos Ortopédicos/efeitos adversos , Ortopedia/métodos , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Consenso , Conferências de Consenso como Assunto , Humanos , Ortopedia/normas , Osteomielite/microbiologia , Philadelphia , Período Pós-Operatório , Propionibacterium acnes , Sociedades Médicas , Infecção da Ferida Cirúrgica/tratamento farmacológicoRESUMO
In July 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 15 focused on the use of imaging, tissue sampling, and biomarkers in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Biomarcadores/metabolismo , Biópsia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Consenso , Conferências de Consenso como Assunto , Humanos , Imageamento por Ressonância Magnética , Ortopedia/normas , Philadelphia , Tomografia por Emissão de Pósitrons , Falha de Prótese , Fatores de Risco , Sociedades Médicas , Infecção da Ferida Cirúrgica/sangue , Tomografia Computadorizada por Raios X , CicatrizaçãoRESUMO
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 9 focused on implants questions in spine surgery, for which this article provides the recommendations, voting results, and rationales.
Assuntos
Ortopedia/normas , Próteses e Implantes/efeitos adversos , Desenho de Prótese , Falha de Prótese , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Aloenxertos , Antibacterianos/uso terapêutico , Substitutos Ósseos , Humanos , Meningites Bacterianas/etiologia , Philadelphia , Período Pós-Operatório , Fatores de Risco , Infecção da Ferida Cirúrgica/terapiaRESUMO
STUDY DESIGN: Retrospective cohort. OBJECTIVE: Determine the effect of duration of symptoms (DOS) on health-related quality of life (HRQOL) outcomes for patients with cervical radiculopathy. SUMMARY OF BACKGROUND DATA: The effect of DOS has not been extensively evaluated for cervical radiculopathy. METHODS: A retrospective analysis of patients who underwent an anterior cervical decompression and fusion for radiculopathy was performed. Patients were grouped based on DOS of less than 6 months, 6 months to 2 years, and more than 2 years and HRQOL outcomes were evaluated. RESULTS: A total of 216 patients were included with a mean follow-up of 16.0 months. There were 86, 61, and 69 patients with symptoms for less than 6 months, 6 months to 2 years, and more than 2 years, respectively. No difference in the absolute postoperative score of the patient reported outcomes was identified between the cohorts. However, in the multivariate analysis, radiculopathy for more than 2 years predicted lower postoperative Short Form-12 Physical Component Score (Pâ=â0.037) and Short Form-12 Mental Component Score (Pâ=â0.029), and higher postoperative Neck Disability Index (Pâ=â0.003), neck pain (Pâ=â0.001), and arm pain (Pâ=â0.004) than radiculopathy for less than 6 months. Furthermore, the recovery ratios for patients with symptoms for less than 6 months demonstrated a greater improvement in NDI, neck pain, and arm pain than for 6 months to 2 years (Pâ=â0.041; 0.005; 0.044) and more than 2 years (Pâ=â0.016; 0.014; 0.002), respectively. CONCLUSION: Patients benefit from spine surgery for cervical radiculopathy at all time points, and the absolute postoperative score for the patient reported outcomes did not vary based on the duration of symptoms; however, the regression analysis clearly identified symptoms for more than 2 years as a predictor of worse outcomes, and the recovery ratio was statistically significantly improved in patients who underwent surgery within 6 months of the onset of symptoms. LEVEL OF EVIDENCE: 3.
Assuntos
Vértebras Cervicais/cirurgia , Descompressão Cirúrgica , Radiculopatia , Fusão Vertebral , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/estatística & dados numéricos , Humanos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Radiculopatia/epidemiologia , Radiculopatia/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Resultado do TratamentoRESUMO
STUDY DESIGN: A retrospective review of prospectively collected data. OBJECTIVE: Compare health-related quality of life (HRQOL) outcome metrics in patients undergoing primary and revision anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: ACDF is associated with significant improvements in HRQOL outcome metrics. However, 2.9% of patients per year will develop symptomatic adjacent segment disease and there is a paucity of literature on HRQOL outcomes after revision ACDF. METHODS: Patients were identified who underwent either a primary or revision ACDF, and who had both preoperative and a minimum of 1-year postoperative HRQOL outcome data. Pre- and postoperative Short Form 12 Physical Component Score (SF12 PCS), Short Form 12 Mental Component Score (SF12 MCS) Visual Analog Scale for neck pain (VAS-Neck), VAS-Arm, and Neck Disability Index (NDI) scores were compared. RESULTS: A total of 360 patients (299 primary, 61 revision) were identified. Significant improvement in SF12 PCS, NDI, VAS-Neck, and VAS-Arm was seen in both groups; however, only a significant improvement in SF12 MCS was seen in the primary group. When comparing the results of a primary versus a revision surgery, the SF12 PCS score was the only outcome with a significantly different net improvement in the primary group (7.23â±â9.72) compared to the revision group (2.9â±â11.07; Pâ=â0.006) despite similar baseline SF12 PCS scores. The improvement in each of the other reported HRQOL outcomes did not significantly vary between surgical groups. CONCLUSION: A revision ACDF for cervical radiculopathy or myelopathy leads to a significant improvement in the HRQOL outcome, and with the exception of the SF12 PCS, these results are similar to those of patients undergoing a primary ACDF. LEVEL OF EVIDENCE: 2.