Recent Publications and Abstracts

Postoperative Spine Dressing Changes Are Unnecessary

Ravi Bains, MD; Mayur Kardile, MD; Lance Mitsunaga, MD; Sukhraj Bains, BS; Nirmal Singh, MS; Cary Idler, MD

Spine Deform. 2017 Nov;5(6):396-400

INTRODUCTION:

There is minimal literature regarding when dressing changes should be performed. We present the dressing change protocol adopted by our institution. The purpose of this study was to provide an update of our experience with this dressing change protocol over a 15-year period.

METHODS:

Effective January 2005, we implemented our universal protocol of no dressing changes for five days after surgery. Reviewing a health system administrative database, all spine surgery cases involving instrumentation performed at our institution were captured. Surgical site infection (SSI) cases: superficial, deep, and organ space as defined by the Centers for Disease Control and Prevention (CDC), were identified by reviewing an infection control database. Fisher exact test was used to compare SSI rates in all instrumented fusion cases from January 1999 to December 2004 (prior to implementation of the dressing change protocol) to those from January 2005 to December 2013 (after the protocol was initiated).

RESULTS:

A total of 8,631 instrumented spine fusions were performed at a single institution from 1999 to 2013. Overall, after instituting our universal no-dressing-change protocol, SSI rates for all cervical, thoracic, and lumbar instrumented cases combined decreased from 3.9% (97/2473) to 0.93% (57/6158) (p < .0001). The reduction in SSI rates was most significant for posterior cervical and posterior lumbar surgeries. After our dressing change protocol was implemented, we saw an improvement in SSI rates for posterior cervical instrumented cases from 3.2% (6/186) to 0.50% (4/815) (p = .0041). Posterior lumbar instrumented fusion SSI rates dropped from 5.5% (65/1179) to 1.1% (32/2890) (p < .0001).

CONCLUSION:

Dressing changes in the immediate postoperative period are not necessary. Applying a sterile dressing in the operating room may serve as a barrier to nosocomial pathogens during hospitalization. Our data suggest this dressing change protocol may lead to reduced SSI risk. Leaving the original postoperative surgical dressing intact is safe, simple, and cost-effective.

Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Adult spine deformity; Dressing change; Pediatric spine deformity; Surgical site infection

Does chronic kidney disease affect the mortality rate in patients undergoing spine surgery?

Ravi Bains, MD; Mayur Kardile, MD; Lance Mitsunaga, MD; Y Chen, Jessica Harris, Liz Paxton, Kamran Majid, MD

J Clin Neurosci. 2017 Sep;43:208-213

The number of patients with chronic kidney disease (CKD) and their life expectancy has been increasing. With time number of patients undergoing spine surgery has also been on a rise. This study we did a retrospective review of registry data to investigate the mortality rate of chronic kidney disease patients following spine surgery using a large, multi-center spine registry. 12,276 consecutive spine-fusion patients from January 2009 to December 2012 were included and mortality rates in patients with CKD compared to those with normal kidney function following spine surgery. Logistic regression was usedto evaluate risk of mortality following spine surgery. The average age of the cohort was 59 (SD=13.4). 53% were female. Patients who had stage 3, 4 or 5 CKD were older than non-CKD patients (mean=71,SD=9.2 vs. 59, SD=13.3). After adjusting for confounding variables, patients with stage 3 or 4 CKD had higher mortality rates than patients with normal kidney function (OR 1.78, 95% CI 1.3-2.45) Hemodialysis-dependent patients (stage 5 CKD) had even higher rates of mortality compared to patients with normal function (OR 4.18, 95% CI1.87-9.34). our findings suggest that spine surgery is associated with significantly higher mortality rates in patients with CKD compared to patients with normal kidney function. Understanding the additional morbidity and mortality of spine surgery in this medically complicated group of patients is imperative for accurate preoperative risk assessment.

KEYWORDS:

Chronic renal failure; Kaplan Meir survival plot; Mortality; Spine surgery

Bone morphogenetic protein (BMP-2) usage and cancer correlation: An analysis of 10,416 spine fusion patients from a multi-center spine registry

Ravi Bains, MD; Lance Mitsunaga, MD; Mayur Kardile, MD; Y Chen, Kern Guppy, MD; Jessica Harris, Liz Paxton

J Clin Neurosci. 2017 Sep;43:214-219

Purpose: To compare the risk of developing cancer in patients who underwent spine fusion with and without the use of BMP-2 using data from a large, multi-center national spine implant registry.

Study Design: Retrospective review of registry data

Patient Sample: 10,416 consecutive spine fusion patients

Outcome Measures: Cancer risk in spine fusion patients who received BMP compared to those who did not.

Methods: An integrated health system's spine implant registry was used to identify spine fusion surgery patients between 1/09 and 6/12. Patient characteristics, BMP-2 dosage (if used), spine region and number of levels fused were extracted. Data was cross-matched with institution's Cancer Registry to identify any de novo diagnoses of cancer in these patients. Using logistic regression analysis, the risk of malignancy following spine surgery with and without BMP-2 administration was determined.

Results: Out of 10,416 spinal fusion patients, 5,987 were with BMP-2 while 4,429 were without BMP-2. De novo cancer diagnoses were found in 73 (1.2%) and 47 (1.1%) patients in the BMP-2 non-BMP group respectively (p=0.454). Average length of follow-up was 2.2 years and 1.9 years for BMP-2 and non-BMP-2 group respectively. After adjusting for age, gender, BMI, ASA score, and smoking status, we did not identify a significant effect of BMP-2 on the development of cancer (OR 1.06, 95% CI 0.58-1.92).

Conclusion: We found no evidence that the use of BMP-2 (in dosages ranging from less than 1.05 mg to more than 12 mg) was associated with an increased risk of developing cancer.

Keywords: Bone morphogenic protein 2; cancer; Spinal fusion

Congenital Scoliosis and Kyphosis - A Brief Clinical Overview

Ketan Khurjekar, Devarti Khurjekar, Shailesh Hadgaonkar, Mayur Kardile

Fibrodysplasia Ossificans Progressiva in a Four year Old Child

Mayur Kardile, Siddharth Nayak, Nagaraja HS, Abani Kanta Mishra

J Orthop Case Rep. 2012 Apr-Jun;2(2):17-20

INTRODUCTION:

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disoder characterized by bone formation within muscles tendons and ligaments. It has an incidence of one in two million. We hereby report a case of FOP in a four year male child from a tribal family in orissa.

CASE REPORT:

4 yr old male child presented with gradual development of stiffness of neck and hard nodules on his body for which his parents had sought all sort of indegenous treatment and manipulations by traditional bone setters. Patient returned to our hospital at the age of four years with widespread ossification and stiffness of neck, shoulders and back. He also had upper tibial osteochondromas and scalp nodules and valgus deformity of bilateral great toes. A diagnosis of FOP was made on clinical and radiological examination.

CONCLUSION:

Though rare, diagnosis of Myositis ossificans progressiva should be considered in a child with heterotopic bone formation and valgus deformities of great toes. Being a rare condition, treatment guidelines are not clear and this condition need further research.

KEYWORDS:

Fibrodysplasia ossificans Progressiva; scalp nodules; tibial osteochondromas

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