Joseph M. Zavatsky

Establishing a Role for Vancomycin Powder Application for Prosthetic Joint Infection Prevention—Results of a Wear Simulation Study

Topical vancomycin powder (VP) has shown efficacy and safety in decreasing post-operative spine infections. VP use in arthroplasty has not been established. Concerns remain for third-body wear with the addition of crystalline substrate at the implant interface. The studys purpose was to compare wear behavior of CoCr on UHMWPE to identical wear couples with VP. A six-station wear simulator was utilized and cyclic articulations were run for 10 million cycles (Mc). UHMWPE wear was measured using photography, stereomicroscopy, and gravimetric measurement. There were no differences in wear mark length (P = 0.43), width (P = 0.49), or gravimetric wear at 10 Mc (P = 0.98). VP and control groups lost 0.32 and 0.33 mg, respectively. VP may have a role in PJI prevention. A well-designed clinical study is needed.

Bilateral Facet Dislocation with Neural Compression from an Avulsed Posterior Longitudinal Ligament

Background and Importance: A review of the literature failed to show evidence of normal appearing posterior longitudinal ligament avulsion as a cause of spinal cord compression after bilateral cervical facet dislocations. We report a case of the posterior longitudinal ligament (PLL) avulsion causing spinal cord compression after bilateral cervical facet dislocation. Clinical presentation: A 93 year female presented with upper extremity numbness and bilateral C5-C6 facet dislocations. The patient was immediately taken for closed reduction and anterior cervical decompression with fusion (ACDF). After awake, closed reduction, an ACDF was immediately performed. After a complete discectomy procedure, the spinal cord could be visualized secondary to an absent PLL. A nerve hook was used to explore behind the C6 vertebral body to decompress the spinal cord. A segment of normal appearing posterior longitudinal ligament, which had avulsed from the superior aspect of C5, was found folded behind the C6 vertebra causing cord compression. There was no herniated disk material discovered. Conclusion: In addition to herniated disk material, avulsed PLL is another potential source of cord compression after closed reduction of cervical facet dislocations and surgeons must be aware of this possible source of compression while exploring and decompressing the spinal canal. This case study elucidates that the PLL is a potential cause of spinal cord compression after traumatic bilateral cervical facet dislocations.

Minimally Invasive Transforaminal Lumbar Interbody Fusion versus Lumbar Lateral Interbody Fusion: Patient-Centered Results

Introduction The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft-tissue disruption, blood loss, and shorter hospital length of stay (LOS). The various MIS techniques have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. Methods A retrospective multicentered review was performed from 2008 to 2014. All patients with one and two-level MIS TLIF and LLIF procedures were included. Total operative time, blood loss, immediate postoperative, and day of discharge VAS pain scores along with LOS were recorded. Patients were divided into two groups. Group 1 had LLIF procedures. Group 2 had TLIF procedures. Results A total of 92 patients were treated during this time period. Group 1 included 52 patients. Group 2 included 40 patients. There was no difference in BMI, number of levels fused, perioperative complications, and immediate postoperative or discharge VAS scores, between the two groups. A statistically significant benefit was observed in the LLIF group compared with the TLIF group when assessing the number of patients discharged on postoperative day (POD) 1 (48 vs. 0%, p < 0.001), overall length of stay (2.1 vs. 3.5 days, p < 0.001), mean operative time (154 vs. 265 minutes, p < 0.001), and total operative blood loss (102 vs. 206 mL, p < 0.001). Conclusion The benefits of MIS surgery continue to be validated and include decreased soft-tissue damage, blood loss, and shorter hospital LOS. The overall LOS was significantly shorter in the LLIF group. There were also a greater number of patients discharged on POD 1 in the LLIF group and total operative time and blood loss were also significantly lower in the LLIF group. Further prospective analysis is required to better delineate the benefits of one procedure over the other.