Thus, determining bone mineral density before surgery by quantitative computed tomography is recommended to ensure a proper selection of screw type and thereby increase the success of surgical fixation.

Object. Both C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were measured prospectively in 51 cases in which uncomplicated cervical anterior fusion was performed. The object of the authors was to quantify the differences in the responses of these parameters recorded in the immediate postoperative period and to determine factors influencing their course. Methods. Nineteen one-level, 23 two-level, and nine three-level procedures for disc herniation and degenerative disease of the cervical spine were performed in 22 female and 29 male patients (mean age 49.2 years). Blood samples were obtained 1 day before as well as on 10 consecutive days and 3 months following anterior cervical fusion. Serum CRP level was measured using a fluorescence polarization immunoassay and ESR was determined from the same samples. Operative time, the number of blood transfusions, and drugs administered in the postoperative period were recorded. In addition, hemoglobin, hematocrit, red blood cell count, platelet count, white cell count, and axillary body temperature were checked daily. Conclusions. Monitoring of CRP level is superior to that of ESR for early detection of infections after cervical spine surgery. Although CRP was not related to any of the factors that have been proposed to explain its peak value variance in previous studies, individual acute-phase protein metabolism response to tissue affection appears to be a more decisive element in this respect.

Spondylodiscitis after lumbar disc surgery is a well-known complication with a frequency of 0.1 to 3%. According to the authors, the etiological factors are: combination of operated segment instability, damage to the lower and upper plates due to disc space curettage and transmission of germs. After treatment of 100 selected cases, all with increased risk of postoperative spondylodiscitis, distinct possibilities for prevention have been discovered. Basic treatment consisted of 3 x 80 mg perioperative doses of Gentamicin i.m. In addition a collagen sponge (Sulmycin Implant) containing 50 mg Gentamycin was inserted in the cleared disc spaces of 50 patients. Complications in this procedure were not observed. The following is recommended for prevention of postoperative spondylodiscitis: a careful operating technique, perioperative antibiotics, and in particularly endangered patients, insertion of Sulmycin Implant in the disc-spaces.

Earlier studies have shown that single-energy quantitative computed tomography (SEQCT) is a reliable method for bone mineral density (BMD) measurements in thoracic and lumbar vertebrae. Moreover, SEQCT has proved to be a useful parameter in the selection of appropriate implants in cervical spondylodesis. The aim of this study was to determine the accuracy of SEQCT in cervical vertebrae BMD measurement. BMD with reference to calcium hydroxyapatite (Ca10[PO4]6[OH]2) was assessed by SEQCT in 100 human vertebral bodies of the cervical spine. Bone cylinders were then cut from the appropriate region of interest. The cylinder volume was determined by the liquid displacement technique. The density of the mineral component was measured following incineration at 1100 degrees C for 24 h. The calculated BMD was correlated with the SEQCT values, resulting in a coefficient of r = 0.79 (P < 0.01). Mean SEQCT values were significantly lower than those determined by direct density assessment (t-test for coupled sampling, P < 0.02). This result was in agreement with studies on thoracic and lumbar vertebrae. These data suggest that SEQCT can reliably measure BMD in the cervical spine.