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The release of "neutrophil extracellular traps" (NETs) has been identified as a novel immune response in innate immunity. Neutrophil extracellular traps are composed of neutrophil-derived circulating free DNA (cf-DNA), histones, and neutrophil cytoplasm-derived proteins such as proteases. Here, we studied the putative predictive value of plasma cf-DNA/NETs for the development of sepsis and mortality after multiple trauma. In a prospective pilot study with 45 multiple trauma (Injury Severity Score>16) patients, cf-DNA was directly quantified in plasma. Blood samples were sequentially obtained daily from admission to our Trauma Center until day 10. Because of limited intensive care unit (ICU) stay of less than 3 days, 8 patients have been excluded, resulting in 37 patients that were evaluated. Time kinetics of cf-DNA/NETs was compared with C-reactive protein (CRP), interleukin (IL) 6, leukocyte counts, and myeloperoxidase. The severity of the injury was calculated on the basis of the Injury Severity Score, as well as Multiple Organ Dysfunction Score, Sequential Organ Failure Assessment, and Simplified Acute Physiology Score II on ICU. Initially high cf-DNA/NETs values (>800 ng/mL) with recurrent increased values between days 5 to 9 were associated with subsequent sepsis, multiple organ failure, and death. In conjunction with cf-DNA/NETs, IL-6 was significantly elevated after admission. However, the development of a second hit was not indicated by IL-6. In contrast to cf-DNA/NETs, no difference in CRP kinetics was observed between patients with and without development of sepsis. Circulating free DNA/NETs kinetics rather followed kinetics of Multiple Organ Dysfunction Score, Sepsis-related Organ Failure Assessment, leukocyte counts, and partially of myeloperoxidase. Circulating free DNA/NETs seems to be a valuable additional marker for the calculation of injury severity and/or prediction of inflammatory second hit on ICU. However, a large clinical trial with severely injured patients should confirm the prognostic value of neutrophil-derived cf-DNA/NETs.

Object Cage subsidence occurs after anterior cervical discectomy and fusion (ACDF). The aim of this prospective study was to evaluate subsidence and total segmental height after implantation of a newly designed Wing titanium cage. Furthermore, alignment of the entire cervical spine was analyzed 2 years after surgery. Methods Fifty-four patients (26 women and 28 men) whose mean age was 48.3 years underwent ACDF. Follow-up examinations were performed at discharge and 6, 12, and 24 months postoperatively by an independent investigator. The clinical course was evaluated using the visual analog pain scale and the Prolo scales. Measurements of subsidence and total segmental height were conducted, and the alignment of the entire cervical spine was classified using two methods. In 54 patients 64 levels were fused. The patients noted a significant reduction of pain, and scores on both Prolo scales were significantly improved. At the 2-year follow-up examination, subsidence was present in 30 of the 67 fused segments. There was a statistically significant correlation between subsidence and the presence of posterior spondylosis at the initial surgery. Furthermore, there was a significant correlation between reduction of total segmental height and the presence of subsidence; however, subsidence did not prevent the development of a solid bone arthrodesis (fusion rate 98%) or have an adverse effect on the alignment of the cervical spine. Conclusions Titanium Wing cage–augmented ACDF was associated with comparatively good long-term results. Subsidence was present but did not cause clinical complications. Furthermore, radiological studies demonstrated that the physiological alignment of the cervical spine was preserved and a solid bone arthrodesis was present at 2 years after surgery.

In our study the first clinical assessment of a new bone mounted robot system guiding percutaneous pedicle screw placement was done. A deviation <2 mm to the surgeon 's plan in 91.0% to 98.5% verifies the system's accuracy.

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