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Case Series of the Management of Surgical Site Infection Following Thoracic Spinal Surgeries During COVID Pandemic

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Volume 3 | Issue 1 | April-September 2022 | page: 24-31 | Neetin Mahajan, Sunny Sangma, Jayesh Mhatre, Pritam Talukder

DOI: https://doi.org/10.13107/bbj.2022.v03i01.036

Authors: Neetin Mahajan [1], Sunny Sangma [1], Jayesh Mhatre [1], Pritam Talukder [1]

[1] Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sunny Sangma,
Department of Orthopaedics, Grant Government Medical College, Mumbai, Maharashtra, India.
E-mail: Sunnysangma11@gmail.com

Abstract

Introduction: Post-operative spinal wound infection increases the morbidity of the patient and the cost of healthcare. Despite the development of prophylactic antibiotics and advances in surgical technique and post-operative care, wound infection continues to compromise patient outcome after spinal surgery. This kind of infection places the patient at risk for pseudoarthrosis, adverse neurologic sequelae, chronic pain, deformity, and even death. In spite of all preventive measures, the SSI following spinal surgeries are 1% among operated spinal instrumentation.
Case Series: Here, we present a series of three patients who presented to us with post-operative surgical site infection (SSI) in spine surgery in the form of wound, discharge, and other complaints. Out of all, two of them were operated with debridement and skin closure followed by broad spectrum IV antibiotics and one of them managed with vacuum-assisted closure dressing and high antibiotics sensitive to organisms found in wound culture. Optimization by building up hemoglobin, supplementing micronutrients including Vitamin C, D, and B12 and high protein diet was started as adjuvant therapy and all of them was discharged with healthy wound.
Conclusion: SSI in spine surgery is a common but challenging complication, particularly after instrumental spinal arthrodesis. Using meticulous aseptic technique, intra-operative irrigation, prophylactic antibiotics, and optimizing patient factors preoperatively are key to preventing a SSI. In patients who still develop an infection despite efforts at prevention, timely diagnosis and treatment are critical. Instrumentation can be retained while still successfully clearing an early infection, although following fusion, instrumentation can be removed if lifetime oral antibiotic suppression is either not indicated or undesirable.
Keywords: Spine surgery, Postoperative infections, Surgical site infection, Spinal instrumentation.

References

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How to Cite this Article: Mahajan N, Sangma S, Mhatre J, Talukder P | Case Series of the Management of Surgical Site Infection Following Thoracic Spinal Surgeries During COVID Pandemic | Back Bone: The Spine Journal | April-September 2022; 3(1): 24-31.    https://doi.org/10.13107/bbj.2022.v03i01.036

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Spine Surgery: A Narrative Review About Recent Updates and Future Directions

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Volume 3 | Issue 1 | April-September 2022 | page: 07-13 | Nandan A. Marathe, Pauras P. Mhatre, Sudeep Date, Ayush Sharma
DOI: https://doi.org/10.13107/bbj.2022.v03i01.033

Authors: Nandan A. Marathe [1], Pauras P. Mhatre [1], Sudeep Date [2], Ayush Sharma [3]

[1] Department of Orthopaedics, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Cumberland Infirmary, Newtown Road, Carlisle CA2 7HY, United Kingdom.
[3] Consultant Spine Surgeon and Head of Spine unit, Railway Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Pauras P. Mhatre,
Seth G.S. Medical College & KEM Hospital, Mumbai, India.
E-mail: paurasmhatre@gmail.com

Abstract

Background: Advances in case selection, operative methods, and postsurgical care have facilitated spine surgeons to manage complex spine cases with short operative times, decreased hospital stay and improved outcomes.
Methods: This is an overview of recent updates and future directions in the field of spine surgery. All the articles were obtained through a literature review on PubMed.
Results: Minimally invasive spine procedures like Endoscopic spine surgeries, Oblique Lumbar Interbody Fusion, use of retractor systems, etc. are emerging in rapidly in modern world. Fusion surgeries are associated with adjacent level disease hence, motion preservation surgeries that mimic the natural biomechanics of the spine are being explored as alternatives. In view of risks to vital structures, nerve injury due to mal-positioning, etc.; robotic spine surgery has paved a way to allow surgeons real-time procedural manipulation along with instrument control, real-scale magnification. Many high-impact discoveries in cancer research, stereotactic radiotherapy, newer combinations of chemotherapy, and tumor-specific antibodies have increased our understanding of spine oncology. Past two decades have seen many advancements in treatment of spine deformities right from initial radiographic assessment, surgical planning to postoperative care.
Conclusion: All in all, all stakeholders in innovation including the industry, scientists and surgeons must work in an open and honest collaboration to benefit the future patients and continue the evolution in Spine Surgery.
Keywords: Spine surgery, Recent updates, Minimally invasive surgery, Artificial disc replacement, Artificial intelligence.

References

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How to Cite this Article: Marathe NA, Mhatre PP, Date S, Sharma A | Spine Surgery: A Narrative Review About Recent Updates and Future Directions | Back Bone: The Spine Journal | April-September 2022; 3(1): 07-13. https://doi.org/10.13107/bbj.2022.v03i01.033

 

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Integrated Operation Theater Spine Suite (IOTSS) History of Spine Surgery: Lord Krishna the First Eternal Spine Surgeon

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Volume 2 | Issue 2 | October 2021-March 2022 | page: 56-59 | Bharat R Dave
DOI: 10.13107/bbj.2022.v02i02.021

Authors: Bharat R Dave [1]

[1] Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. Bharat R Dave,
Consultant Spine Surgeon, Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India.
E-mail: Brd_172@yahoo.com

Abstract

The Mission has been to improve the quality of human life and do no harm. The significant change experienced during the training at England 1991 to 1996. Saga to be the best, be different and be unique continued. Necessary equipment installed like C Arm for fluoroscopy, radiolucent operation table and Anaesthesia machine. Safety increased due to optimisation of the operating room by implementation of available gadgets.
Many of us have witnessed the transition of an era, from handwritten Operation schedule call books to smartphone apps., from manual typewriters to high tech computers for research, from manual slide carousel to virtual presentations, from written high-risk consent to video consent and now from high radiation and lead aprons to Zero radiation exposure with O-Arm and navigation.
Integrated Operation Theatre Spine Suite– Enabling Technology – IOTSS is the latest version in optimising and additionally maximising the advantage of the surgery.
Keywords: Integrated spine suite, Optimizing results, Spine surgery

References

1. Brahmavaivarta Purana Sri-Krishna Janma Khanda (Fourth Canto) Chapter 72 English translation by Shantilal Nagar Parimal Publications. Available from: https://www.archive.org/details/brahma-vaivarta-purana-all-four-kandas-english-translation.
2. Bhishagratna K, Kaviraj KL. An English Translation of the Sushruta Samhita in Three Volumes. Vol. 1. Toronto: Archived by University of Toronto; 1907.
3. Carstensen K, Jensen EK, Madsen ML, Thomsen AM, Løvschall C, Dehbarez NT, et al. Implementation of integrated operating rooms: how much time is saved and how do medical staff experience the upgrading? A mixed-methods study in Denmark. BMJ Open 2020;10:e034459.
4. Gen ZT. Nikhil Raval. Available from: http://www.healthcaredesignmagazine.com/architecture/integrated-operating-room.

How to Cite this Article:  Dave BR Integrated Operation Theater Spine Suite | (IOTSS) History of Spine Surgery: Lord Krishna the First Eternal Spine Surgeon| Back Bone: The Spine Journal | October 2021-March 2022; 2(2): 56-59.

 

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SARS-CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India

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Volume 2 | Issue 1 | April-September 2021 | page: 23-26 | Bharat R. Dave, Ajay Krishnan, Ravi Ranjan Rai, Devanand Degulmadi, Shivanand Mayi, Kirit Jadhav

Authors: Ghanshyam Kakadiya [1], Kalpesh Saindane [1], Prashant Gedam [1], Nitin Pothare [1]

[1] Department of Orthopedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Ghanshyam Kakadiya,
Department of Orthopedics, TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
E-mail: drghanshyam89@gmail.com

Abstract

The Coronavirus SARS-CoV-2 (COVID-19) pandemic has had a substantial effect on spine surgery worldwide. India, with its large population and limited health resources, will be overwrought due to the number of cases of critically ill patients with COVID-19. It is important to understand the challenges for spine surgeons in India when dealing with patients during the COVID-19 pandemic. In India, elective spine surgeries stand cancelled whilst trauma and emergency surgeries have been reorganised following Indian Orthopaedic Association and recent urgent British Orthopaedic association guidelines.
This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in spine surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties.
Keywords: COVID-19, coronavirus disease, Spine surgery, India.

References

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How to Cite this Article:  Kakadiya G, Saindane K, Gedam P, Pothare N | SARS- CoV-2 (COVID-19) and Spine Surgeries in Tertiary-care Hospital of India | Back Bone: The Spine Journal | April-September 2021; 2(1):
23-26.

 

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Primary Ewing’s Sarcoma of Lumbar Spine Treated with Neoadjuvant Chemotherapy and Surgery – A Case Report

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Volume 1 | Issue 1 | October 2020-March 2021 | page: 28-32 | Rohit A Thaker, Himanshu Dodiya, Shrikant Dhanani, Ankur Patel

Authors: Rohit A Thaker [1][2], Himanshu Dodiya [2], Shrikant Dhanani [2], Ankur Patel [3]

[1] Orthoplus Hospital, Spine Care Associates, Ahmedabad, Gujarat, India.
[2] Spine Care Associates, Ahmedabad, Gujarat, India.
[3] Sparsh Spine Hospital, Himmatnagar, Gujarat, India.

Address of Correspondence
Dr. Rohit A Thaker,
Consultat Spine Surgeon, Orthoplus Hospital, Spine Care Associates, Ahmedabad, Gujrat, India.
E-mail: thakerrohit1@gmail.com

Abstract

Primary involvement of mobile spine compared to non-mobile spine is very less in case of Ewing’s sarcoma (ES). There are no fixed guidelines for these types of tumors because of their low incidence. These tumors usually have very high sensitivity to chemotherapy and radiotherapy. Goal for the management of ES of the spine is adequate local control through complete removal of tumor by doing aggressive resection along with restoration of spinal stability and preservation of neurology. En bloc spondylectomy or extralesional resection with wide disease-free margin provides good oncological results with a longer survival. Whenever it is possible to give neoadjuvant chemotherapy, it is always better because it helps to shrink tumor, treat micrometastasis, and make surgical excision easier with wide margin resection. However, in some case of spinal ES, it may not be possible because of neurological compromise and they might have to be addressed first by surgery and neurological decompression. We report here one such cases of primary ES of mobile lumbar spine treated with neoadjuvant chemotherapy and then with en bloc excision of tumor. The clinical picture and imaging characteristics of patient were analyzed as well as the management modalities and outcome has been discussed.
Keywords: Ewing’s sarcoma, spine surgery, neoadjuvant chemotherapy, lumbar spine.

 

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How to Cite this Article:  Thaker RA, Dodiya H, Dhanani S, Patel A| Primary Ewing’s Sarcoma of Lumbar Spine Treated with Neoadjuvant Chemotherapy and Surgery – A Case Report| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 28-32.

 

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