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Study Design: Retrospective Case-Control series., Objective: The objective of this study is to define the overall postoperative rate of surgical site infection (SSI) in patients undergoing spine surgery and examine the effects of intrawound Vancomycin on postoperative infection rates., Summary of Background Data: Surgical site infections (SSI) account for 22% of all health care-associated infections. The use of intrawound Vancomycin in an attempt to reduce the incidence of postoperative SSI has not been sufficiently evaluated in the existing literature., Methods: All spine surgeries (n=19,081) from our institution were reviewed from 2003 to 2013. All cases of verified SSI were identified from the database. Cases were then matched to controls in a 1:1 fashion based on age, gender, and date of surgery (+/-30 d). Patient demographics, comorbidities, estimated blood loss, duration of surgery, intrawound administration of Vancomycin, and smoking status were evaluated., Results: At total of 316 cases of SSI after spine surgery were identified, representing an infection rate of 1.7%. The mean follow-up for cases and controls was 31.5 and 41.6 months, respectively. OR for intrawound Vancomycin was 0.44 (95% CI 0.23-0.88, P =0.019). OR for BMI greater than 30 was 1.63 (95% CI 1.04-2.56, P =0.03)., Conclusions: In this large cohort of spine surgery patients, administration of intrawound Vancomycin was associated with a significant reduction in postoperative surgical site infections. Further studies are needed to determine appropriate dosing and application as well as long-term safety in spine surgery., Competing Interests: A.N.: American Orthopaedic Association: Board or committee member; AO Spine: Research support; Cervical Spine Research Society: Board or committee member; Lumbar spine research society: Board or committee member; Pfizer: Research support; Scoliosis Research Society: Board or committee member; Synthes: Research support; Techniques in Orthopedics: Editorial or governing board; Vikon Surgical: Unpaid consultant. B.F.: Medtronic: Other financial or material support. M.Y.: AAOS: Board or committee member; Journal of Biomedical Materials Research-J. Wiley, Inc.: Editorial or governing board; K2M, Inc.: Paid consultant; Medtronic: Paid consultant; Society of Military Orthopaedic Surgeons: Board or committee member; Techniques in Orthopedics: Editorial or governing board. P.H.: Minnesota Orthopedic Society: Board or committee. E.B.: Pfizer: Research support; UpToDate: Publishing royalties, financial or material support; PI Strive Study; Pfizer vaccine study trial patients undergoing multilevel spine fusion. B.C.: DePuy, A Johnson & Johnson Company: IP royalties; Lumbar Spine Research Society: Board or committee member; Spine Study Group: Board or committee member; SpinologyTenex: Stock or stock Options; Stryker: IP royalties; Wolters Kluwer Health-Lippincott Williams & Wilkins: Publishing royalties, financial or material support; Zimmer: IP royalties. The remaining authors (Z.P., R.L.H., and A.S.S.) declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Retrospective matched cohort study., Objective: To determine if low-pressure lumbar provocation discography (PD) results in long-term accelerated disc degeneration, internal disc disruption, or disc herniation in patients with symptomatic low back pain (LBP)., Summary of Background Data: Study of subjects without clinically-significant LBP suggests that high-pressure PD may accelerate disc degeneration., Methods: Consecutive patients with symptomatic LBP who underwent magnetic resonance imaging (MRI), PD, and repeat MRI more than 7 years later, but did not undergo subsequent spinal fusion surgery, were included. Punctured discs were matched (1:2 to 1:4) to corresponding discs in a control cohort by age, BMI, Pfirrmann score (±2), and presence of disc herniation; control cohort inclusion required MRIs for symptomatic LBP, separated by more than 7 years. The primary outcome of the study was a progression in Pfirrmann score category (I-II, III-IV, V). MRI disc-to-CSF T2 signal-intensity ratio, disc height, disc herniations, high intensity zones (HIZs), and Modic changes were assessed., Results: Baseline and follow-up MRIs were available for 77 discs exposed to PD, and for 260 discs in the matched control cohort. There was no difference in the proportion of punctured discs that advanced in Pfirrmann score category in the PD group (17%, 95% CI 9-27%) compared with corresponding discs in the Control group (21%, 95% CI 17-27%), P = 0.3578, or in non-punctured discs in the PD group (35%, 95% CI 21-51%) compared with corresponding discs in the Control group (34%, 95% CI 27-42%), P = 0.1169. There were no differences in disc-to-CSF T2 signal-intensity ratio, presence of disc herniations, HIZs, or Modic changes following puncture in the PD versus matched cohort discs or in the non-punctured PD cohort discs versus corresponding control cohort discs (P > 0.05)., Conclusion: Patients with symptomatic LBP who underwent low-pressure PD, but who did not undergo a subsequent spinal fusion surgery, developed disc degeneration and new disc herniations at a similar rate to corresponding discs in matched control patients., Level of Evidence: 3.

Background Context: The incidence of surgical site infection (SSI) following posterior cervical surgery has been reported as high as 18% in the literature. Few large studies have specifically examined posterior cervical procedures., Purpose: The study aims to examine the incidence, timing, and risk factors for SSI following posterior cervical surgery., Design: This is a retrospective cohort study of prospectively collected data in a national surgical outcomes database., Patient Sample: The sample includes patients who underwent posterior cervical spine surgery between 2005 and 2012 identified in the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) Participant Use Data File., Outcome Measures: The 30-day rate of postoperative SSI, timing of diagnosis, and associated risk factors were determined., Methods: The ACS NSQIP was used to identify 5,441 patients who underwent posterior cervical spine surgery by Current Procedural Terminology codes from 2005 to 2012. Thirty-day readmission data were obtained for 2011-2012. The incidence and timing of SSI were determined. Multivariable logistic regression analysis was then performed to identify significant risk factors., Results: Of the 5,441 patients identified as having undergone posterior cervical surgery, 3,724 had a posterior cervical decompression, 1,310 had a posterior cervical fusion, and 407 underwent cervical laminoplasty. Surgical site infection within 30 days was identified in 160 patients (2.94%), with 80 of those cases being superficial SSI. There was no significant difference in SSI rate among the three procedure groups. The average time for diagnosis of SSI was over 2 weeks. In 2011-2012, 36.9% of patients with SSI were readmitted within 30 days. Several significant predictors of SSI were identified in univariate analysis, including body mass index (BMI) >35, chronic steroid use, albumin <3, hematocrit <33, platelets <100, higher American Society of Anesthesiologists class, longer operative time, and longer hospital admission. Independent risk factors, including BMI >35 (odds ratio [OR]=1.78, p=.003), chronic steroid use (OR=1.73, p=.049), and operative time >197 minutes (OR=2.08, p=.005), were identified in multivariable analysis., Conclusions: Optimization of preoperative nutritional status, serum blood cell counts, and operative efficiency may lead to a reduction in SSI rates. Obese patients and patients on chronic steroid therapy should be counseled on elevated SSI risk., (Copyright © 2016. Published by Elsevier Inc.)