Background: Infection is the most common complication of spinal surgeries. Surgical site infection (SSI) can result in high hospitalisation costs owing to prolonged hospital stays, repeated surgeries and an increase in the frequency of pseudoarthrosis. Objectives: The purpose of this study was to identify the risk factors of SSI in patients treated with thoracolumbar posterior spinal instrumentation. Methods: Inclusion criteria were treated by posterior thoracolumbar stabilization with transpedicular screw and posterolateral fusion in the neurosurgery clinic between March 2006 and June 2009. Overall, 260 consecutive patients were identified and 239 patients included in this study. Risk factors that may cause increase of rate of SSI were evaluated.

ObjectiveThe aim of this study was to evaluate the efficacy of the local application of vancomycin hydrochloride (HCl)–ceftriaxone disodium hemiheptahydrate onto implants before using them to prevent postoperative infection.MethodsThe study included 239 patients (153 women and 86 men; mean age: 48.23 ± 16.77 years) who had thoracolumbar stabilization with transpedicular screws. All surgeries were performed by the same surgeon. Patients were divided into two groups. In the group 1 (n = 104), implants were bathed in a solution of local prophylactic antibiotics for 5 seconds just before implantation. In the group 2 (n = 135), implants were not bathed before implantation. Local antibiotics used in the study was effective against gram positive bacteria (including methicillin resistant Staphylococcus aureus) and gram negative bacteria. The rate of surgical site infection and wound healing time were compared between the groups.ResultsA total of 10 patients (4.1%) had deep wound infection and 20 (8.4%) had superficial infection. The most common bacteria was Staphylococcus aureus. One patient died 21 days after the surgery because of sepsis. The wound healed in a mean of 9.66 ± 2.04 days in patients who had no infection and in 32.33 ± 19.64 days in patients with infection (p < 0.001). The patients in group 1 had significantly less deep infection than the patients in group 2 (p < 0.05). However, there was no statistically significant difference between the groups for superficial infection. Patients with vertebral fracture had significantly lower deep infection rate in group 1. The deep infection rate of group 1 patients with diabetes, with bleeding of more than 2000 mL, transfused with blood transfusions above 3 units and with dural injury was significantly lower than those in the group 2. None of the patients had allergic reactions to the drugs used for local prophylaxis.ConclusionsThis study shown that bathing implants in antibiotics solution was an effective local prophylactic method to prevent deep infections in spinal surgeries with instrumentation.Level of EvidenceLevel III, Therapeutic study.

Background: To investigate the prevalence of findings of spinal injury on computed tomography (CT) images of pediatric trauma patients and to define indicators for the possible presence of spinal injuries. Methods: Spinal CT for pediatric trauma patients (age ≤ 12 years) over a 2-year period was retrospectively evaluated for the presence of findings suggestive of spinal injury. Results: Of the 773 patients reviewed, 19 (2.4%) showed traumatic spinal lesions on their spinal CT images. These patients were significantly older than those without spinal lesions (mean age 7.9 AE 3.3 years vs 6.1 AE 3.3 years; P = 0.02). The prevalence of spinal trauma was significantly lower in patients aged 0-8 years than in those aged 9-12 years (P = 0.025). Spinal injury was significantly higher in female patients (P = 0.014). Most of the spinal injuries were located at the lumbar and sacral vertebral levels, and most did not cause neurological complications or require surgical treatment. Important indicators of the possible presence of spinal injuries were pain, tenderness, or ecchymosis over the spine, a low Glasgow Coma Scale score (≤12), head injury (for cervical injuries), or intrathoracic injuries and pelvic fractures (for lumbar and sacral injuries). Conclusions: Most spinal CT examinations for the diagnosis of spinal injuries in children did not show positive findings. Thus, many children were exposed to an unnecessary high dose of radiation. New clinical evaluation criteria and indicators should be defined to diagnose spinal injuries and avoid unnecessary radiological examinations.

ABSTRACTinjury classification and severity score (TLICS), described by Vaccaro et al. (7). In this system, most type A fractures of the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification system, even burst-type fractures in the thoracolumbar junction that had usually been operated on before, are classified within the conservative treatment group █ INTRODUCTION T raumatic spinal fractures are quite common lesions. In recent years, there has been a trend towards conservative treatment instead of surgery for thoracic, thoracolumbar, and lumbar fractures. This is partly due to the widening usage of a new classification system, thoracolumbar AIM: Conservative treatment is a frequently used treatment modality for traumatic thoracolumbar fractures. However, not many studies evaluating radiological and clinical results of conservative treatment are found. The aim of this study was to determine the risk factors, and compression and kyphosis rates after 1 year in patients with AO type A thoracic, thoracolumbar, and lumbar fractures treated conservatively. MATERIAL and METHODS:Radiological and clinical results of 79 thoracolumbar fractures in 57 patients, who were treated conservatively, were evaluated one year after trauma. Fractures were classified according to thoracolumbar injury classification and severity (TLICS) score and AO spinal trauma classification system. Compression rate, wedge and kyphosis angles, and sagittal index were calculated in early and late periods after trauma. RESULTS:Female/male ratio was 25/32, and mean age was 41.7±16.7 years. They were followed for 15.2±4.9 months. Mean compression rates were 19.6% and 25.2%; wedge angles were 10.1 and 12.7 degrees; kyphosis angles were 5.82 and 8.9 degrees; and sagittal indexes were 8.01 and 10.13 in all patients just after trauma and after one year, respectively. Fractures in older patients (>60 years of age) and in patients with osteopenia or osteoporosis, located in the thoracolumbar junction, AO type A2 and A3 fractures, and solitary fractures had higher compression and kyphosis rates at last follow-up. CONCLUSION:Early mobilization without bed rest for stable thoracolumbar fractures according to the TLICS system is a good treatment option, and radiological and clinical results are usually acceptable. However, fractures in patients older than 60 years, those with osteoporosis or osteopenia, fractures located in the thoracolumbar junction, solitary fractures, and fractures in AO type A2 or A3, are more inclined to increase in compression and kyphosis and may require a closer follow-up.

cases (8). The majority of the parents of children suffering a TV tip-over-related injury are unaware that this kind of event poses a significant risk for their children (19). The purpose of this study was to identify, report, and raise awareness of the risk factors for TV tip-over. █ MATERIAL and METHODS In total, 86 children who were brought to the emergency department and hospitalized in the neurosurgery clinic of our hospital because of TV tip-over-related head trauma between August 2011 and August 2016 were included in the study.