• Bacteria culture
• Hospitalization cost
• Implants removal
• Poly-axial pedicle screw
• Revision surgery

• Trojan-horse hypothesis
• intestinal microbiome
• metastatic infection
• surgical site infection

• P30 DK042086 NIDDK NIH HHS
• R01 GM062344 NIGMS NIH HHS

• biofilm
• contamination
• implant removal
• implant retention
• readmission
• revision surgery
• surgical site infection

• contamination
• debris
• eye protection
• face shield
• space suit
• sterility
• surgical site infection

• Back pain
• Musculoskeletal infection
• Red flags
• Serious spinal pathology
• Spinal infection
• Spinal pain

• Humans
• Early Diagnosis
• Infections/diagnosis
• Spinal Diseases/diagnosis

• Chartered Society of Physiotherapy Charitable Trust

• C-reactive protein
• biomarkers
• cancer
• interleukin-6
• procalcitonin
• radiation pneumonitis
• radiotherapy

• Adult spinal deformity
• Infection
• Non-union
• Pseudarthrosis
• Spinal instrumentation

• Bacteria
• Bacterias
• Hiperoxigenación
• Hyperoxygenation
• Infección de la herida
• Infección del sitio quirúrgico
• Oxygen
• Oxígeno
• Surgical site infection
• Virulence
• Virulencia
• Wound infection

• Implant associated infections
• Local antibiotic
• Prevent infection
• Prophylactic antibiotic
• Spinal infection
• Surgical site infection

• ASEPSIS
• Elective orthopaedic surgery
• Orthopaedic patients
• Orthopaedic surgery
• Orthopaedic trauma
• Surgical wound infection

• Disease Susceptibility
• Gene-Environment Interaction
• Genomics
• Host-Pathogen Interactions
• Humans
• Microbiota
• Postoperative Complications/microbiology
• Precision Medicine

• R01 GM062344 NIGMS NIH HHS

The aim of the study was to investigate the efficacy and safety of minimally invasive segmentectomy in the treatment of lung cancer. A total of 86 lung cancer patients in early stage were selected for the treatment between May, 2010 and December, 2010. The patients were randomly divided into the control (n=43) and observation (n=43) groups. Patients in the control group received conventional thoracotomy as treatment, while thoracoscopic segmentectomy was performed for patients in the observation group. Factors including intraoperative bleeding amount, number of dissected lymph nodes, surgery duration, postoperative intubation time and length of stay (LOS) were compared between the two groups. A visual analogue scale was used for comparison of the postoperative incisional pain experienced by patients in the two groups. The incidence rate of postoperative complications of patients in the two groups was observed. We also assayed variations in the levels of serum inflammatory factors C-reaction protein (CRP), interleukin (IL) −6 and −10 of patients prior to operation and on the 3rd, 5th and 7th days and after operation via ELISA, and on the 7th day after operation, we determined the pulmonary function of patients. During the 5-year follow-up, the recurrence and survival rate of patients in the two groups were observed. In the observation group, the intraoperative bleeding amount of patients was significantly lower than that in the control group, and the surgery duration, postoperative intubation time and LOS were all shorter than those in the control group (P<0.05). By contrast, no significant difference was detected in a comparison of the number of dissected lymph nodes of patients between the two groups (P>0.05). Additionally, in the observation group, patients suffered less pain after operation than those in the control group (P<0.05), and on the 3rd, 5th and 7th days after operation, the levels of CRP, IL-6 and −10 in the observation group were significantly lower than those in the control group (P<0.05). After operation, the incidence rate of complications in the observation group was significantly lower than that in the control group (P<0.05), and the recovery in pulmonary function after operation was superior to that in the control group (P<0.05). In addition, the 5-year survival rate of patients in the observation group was significantly higher than that in the control group, and the recurrence rate was significantly lower than that in the control group (P<0.05). Minimally invasive segmentectomy shows better efficacy in the treatment of lung cancer at early stage than the conventional thoracotomy. In addition to the high safety during surgery, this technique can lower the incidence rate of postoperative complications, protect the pulmonary function, increase the survival rate and decrease the recurrence rate, which shows great value in clinical practice.

• lung cancer
• minimally invasive surgery
• thoracoscopic segmentectomy

• Intraoperative neurophysiological monitoring
• Lidocaine
• Motor-evoked potential
• Somatosensory-evoked potential

Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery.

We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital’s spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses.

Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients’ mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p < 0.05). Additionally, diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, preoperative antibiotics, type of disease, and operative type in the acute surgical site infection group were significantly different than those in the non-acute surgical site infection group (p < 0.05). Using binary logistic regression analyses, body mass index, smoking, diabetes mellitus, osteoporosis, preoperative antibiotics, fracture, operative type, operative time, blood loss, and drainage time were independent predictors of acute surgical site infection following lumbar surgery.

In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

The online version of this article (doi:10.1186/s13018-017-0612-1) contains supplementary material, which is available to authorized users.

• Lumbar surgery
• Postoperative infection
• Prevention
• Risk factor
• Strategy

• C-reactive protein
• bacterial infection
• interleukin-6
• procalcitonin
• septicopyemia

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.

• Postoperative infections
• Spine surgery

• I & D = incision and drainage
• IV = intravenous
• MRSA = methicillin-resistant Staphylococcus aureus
• SSI = surgical site infection
• instrumentation
• methicillin-resistant Staphylococcus aureus
• paraspinal and presacral
• postoperative infection
• spine

Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication.

• Spine
• infections
• orthopedic
• surgery

Retrospective study.

To evaluate the effect of intraoperative wound application of vancomycin on preventing surgical wound contamination during instrumented lumbar spinal surgery.

Postoperative infection is the one of the most devastating complications of lumbar surgery. There are a few reports showing the benefits of intraoperative wound application of vancomycin during spinal surgery. However, there is no report about the effectiveness of local vancomycin instillation in prevention of surgical wound contamination.

Eighty-six patients underwent instrumented lumbar spinal surgery. Mean patient age was 65.19 years (range, 23-83 years). There were 67 females and 19 males. During surgery, vancomycin powder was applied into the surgical site before closure in 43 patients (antibiotic group) and vancomycin powder was not applied into the surgical site before closure in 43 patients (control group). The tip of the surgical drain was cultured to evaluate surgical wound contamination. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured on the first, third, seventh, and fourteenth day after the operation.

We found two patients with a positive culture from the tip of surgical drains in the antibiotic group, and one patient with a positive culture from the tip of the surgical drain in the control group. Postoperative ESR and CRP levels did not show significant differences between the two groups. On the third postoperative day, ESR in patients of the antibiotic group was more significantly decreased than that in patients of the control group, while CRP level did not show a significant difference between the two groups.

There was no evidence to suggest that intraoperative vancomycin application is effective in decreasing the risk of postoperative wound infection after instrumented posterior lumbar fusion surgery.

• Contamination
• Fusion
• Lumbar spine
• Vancomycin

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection.

Twenty patients of lumbar open discectomy (LOD) and 20 patients of posterior lumbar interbody fusion (PLIF) were enrolled in this study. Preoperative and postoperative prophylactic antibiotics were administered routinely for 7 days. Blood samples were obtained one day before surgery and postoperative day (POD) 1, POD3, and POD7. Using repeated measures ANOVA, changes in effect measures over time and between groups over time were assessed. All data analysis was conducted using SAS v.9.1.

Changes in CRP, within treatment groups over time and between treatment groups over time were both statistically significant F(3,120)=5.05, p=0.003 and F(1,39)=7.46, p=0.01, respectively. Most dramatic changes were decreases in the LOD group on POD3 and POD7. Changes in ESR, within treatment groups over time and between treatment groups over time were also found to be statistically significant, F(3,120)=6.67, p=0.0003 and F(1,39)=3.99, p=0.01, respectively. Changes in WBC values also were be statistically significant within groups over time, F(3,120)=40.52, p<0.001, however, no significant difference was found in between groups WBC levels over time, F(1,39)=0.02, p=0.89.

We found that, dramatic decrease of CRP was detected on POD3 and POD7 in LOD group of non-infection and dramatic increase of ESR on POD3 and POD7 in PLIF group of non-infection. We also assumed that CRP would be more effective and sensitive parameter especially in LOD than PLIF for early detection of infectious complications. Awareness of the typical pattern of CRP, ESR, and WBC may help to evaluate the early postoperative course.

• C-reactive protein
• Erythrocyte sedimentation rate
• Open discectomy
• Posterior lumbar interbody fusion
• Postoperative infection
• White blood cell

For those of us who have read the 2 recently published articles by a Danish - British research group, it might appear that we are observing an impending paradigm shift on the origins of chronic low back pain. The results of this research indicate, that chronic low back pain associated with bone marrow edema in vertebral endplates that are adjacent to herniated intervertebral discs may be caused by infections with anaerobic bacteria of low virulence. According to these articles, treatment with certain antibiotics is significantly more effective than placebo against this low back pain. If these findings are to hold true in repeat studies by other researchers, they stand to fundamentally change our concepts of low back pain, degenerative disc disease and in consequence the suitable therapies for these entities. It may in fact require pain specialists to become familiarized with the details of antibiotic treatments and their specific risks in order to be able to properly counsel their patients. While this seems hard to believe at first glance, bacteria have been implicated in the pathogenesis of other conditions that do not primarily impose as infectious diseases such as gastric ulcers. While the authors refer to a few previous studies pointing into the same direction, the relevant research is really only from one group of collaborating scientists. Therefore, before we start prescribing antibiotics for chronic low back pain, it is imperative that other researchers in different institutions confirm these results.

• Modic changes
• Propionibacterium acnes
• antibiotics
• discitis
• low back pain

Postoperative surgical site infection (SSI) is a common complication after posterior lumbar spine surgery. This review details an approach to the prevention, diagnosis and treatment of SSIs. Factors contributing to the development of a SSI can be split into three categories: (1) microbiological factors; (2) factors related to the patient and their spinal pathology; and (3) factors relating to the surgical procedure. SSI is most commonly caused by Staphylococcus aureus. The virulence of the organism causing the SSI can affect its presentation. SSI can be prevented by careful adherence to aseptic technique, prophylactic antibiotics, avoiding myonecrosis by frequently releasing retractors and preoperatively optimizing modifiable patient factors. Increasing pain is commonly the only symptom of a SSI and can lead to a delay in diagnosis. C-reactive protein and magnetic resonance imaging can help establish the diagnosis. Treatment requires acquiring intra-operative cultures to guide future antibiotic therapy and surgical debridement of all necrotic tissue. A SSI can usually be adequately treated without removing spinal instrumentation. A multidisciplinary approach to SSIs is important. It is useful to involve an infectious disease specialist and use minimum serial bactericidal titers to enhance the effectiveness of antibiotic therapy. A plastic surgeon should also be involved in those cases of severe infection that require repeat debridement and delayed closure.

• Surgical site infection
• Spine surgery
• Discitis
• Postoperative infection