Risk of Infection Associated with Transmucosal Placement of Instrumentation in Clean-Contaminated Field: Systematic Analysis

Woodhouse, Cody; Slobodian, O.V.; Nebor, Ivanna; Xu, Alice; Zhebrykov, Dmytro; Montemagno, Kora; Kashyrina, Oleksandra; Matern, Tyson; Hoang, Stanley; Mendez-Rosito, Diego; Cheng, Joseph; Forbes, Jonathan A.

doi:10.1016/j.wneu.2019.11.168

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…[20][21][22] The surgical corridor technically represents a clean-contaminated surgical route that is associated with hypothetical concerns of increased risk of infection and/or wound complications when compared with a completely sterile corridor, especially when hardware is used. 23 Yet there are numerous reports of successful anterior C1-2 transoral fusion with implants. Vender et al 24 (2000) described seven patients requiring C2 corpectomy who underwent retropharyngeal C1-3 fusion, followed by instrumentation with a Caspar plate, all without SSI.…”

Section: Discussionmentioning

confidence: 99%

“…The operative space is narrow and this, in combination with bone surgery in an inevitably contaminated area, may explain why serious complications can occur, including cerebrospinal fluid leakage, surgical site infections (SSI), or meningitis 20–22 . The surgical corridor technically represents a clean-contaminated surgical route that is associated with hypothetical concerns of increased risk of infection and/or wound complications when compared with a completely sterile corridor, especially when hardware is used 23 . Yet there are numerous reports of successful anterior C1-2 transoral fusion with implants.…”

Section: Discussionmentioning

confidence: 99%

“…Macki et al 26 (2018) could not show an increase in 30-day postoperative complications, especially SSI, in comparison to posterior surgery for atlantoaxial fusion. In a very recent extensive literature review, Wooodhouse et al 23 (2020) found no evidence suggesting that the placement of spinal hardware via transmucosal corridor is associated with an increased risk of SSI. Our motivation to avoid ventral osteosynthesis material was therefore mainly based on fracture morphology and the fact that there was marked hollowing of the odontoid process, and not that we were primarily worried about infection.…”

Section: Discussionmentioning

confidence: 99%

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Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis

Eid

Friedrich

Kudlek

et al. 2021

Spine

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Study Design. Case report and literature review. Objective. We present a case of a pathologic unstable fracture of the odontoid process due to vertebral osseous sarcoidosis. The surgical management of this unreported pathology is described and a review of the literature is given. Summary of Background Data. Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations. It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system. Osseous sarcoidosis is usually clinically asymptomatic and therefore frequently under-diagnosed. When it does affect the skull or vertebral column, specific surgical therapy is only necessary in cases with nonmanageable pain or where structural integrity is threatened. Methods. Our patient underwent a so-called semiconservative approach, consisting of a minimally invasive transoral-transpharyngeal approach, surgical debridement of the lytic bony lesion, transplantation of cancellous homologous bone, and carbon chest halo-immobilization. Halo-immobilization was left for 8 weeks, followed by a further 6 weeks with a hard cervical collar. Results. Routine computed tomography scans 3 days, 6, 12, 18 weeks, and 1 year after surgery showed good filling of the original defect with cancellous bone, correct alignment of the upper cervical spine, and progressive fracture consolidation and stability. Surgical site infection (SSI) was not observed. The patient had no neurological postoperative deficits. After initial dysphagia, swallowing was not permanently impaired. Conclusion. Sarcoidosis-induced odontoid fractures can be managed successfully using a semiconservative approach, consisting of transoral-transmucosal, minimally invasive surgical procedure for debridement of the lesion and transplantation of cancellous bone with additional halo-immobilization. Permanent fusion of C1-2 with loss of the cervical range of motion is avoided. Despite performing bone surgery in a potentially markedly contaminated site, bacterial infection was not an issue, possibly supported by the temporary discontinuation of immunosuppressive agents and the prudent use of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis

Eid

Friedrich

Kudlek

et al. 2021

Spine

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“…Even far more invasive transmucosal procedures including placement of instrumentation are usually not associated with an increased risk of infection. 9…”

mentioning

confidence: 99%

“…Even far more invasive transmucosal procedures including placement of instrumentation are usually not associated with an increased risk of infection. 9 With the description of our approach and development of the guidance tool, we did not intend to compete with the Härtel 7 or Mullan and Lichtor 8 method and their various modifications or even tried to replace them. In experienced hands, these procedures usually are associated with a low surgical risk, sufficient success rates, and acceptable surgery durations.…”

mentioning

confidence: 99%