Vertebral Osteomyelitis: Operative or Nonoperative Treatment?

Web survey results for: Carragee E, Errico TJ, Fardon DJ. Vertebral osteomyelitis: operative or nonoperative treatment? SpineLine. 2003;4(March-April):16-19.

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1. If this were my patient, I would recommend (select one):

5%   of respondents would recommend an instrumented posterolateral
fusion
0%    would recommend a noninstrumented posterolateral fusion

25%  would recommend another type of surgery

0%     would recommend no surgery

1. My recommendation for management of the patient described in the case presentation (not the follow-up questions) is:

20%   would recommend antibiotics only at this time

40%   would recommend antibiotics and bracing at this time

9%     would recommend operation now in addition to medical management

2.  If the patient underwent fusion, the bone graft should come from (list all that apply):

20%   chose option a only: the patient’s own iliac crest

30%   chose option b only: the bone removed from the patient’s posterior elements

30%   chose option c only: allograft or other prepared bone

10%   chose option a and b

10%   chose option b and c

0        chose option d: none of the above

2. If this patient is treated surgically, I think the approach should be:

60%  would recommend an anterior (thoraco-abdominal) approach

20%   would recommend an anterior (endoscopic) approach

20%   would recommend posterior stabilization

0        would recommend posterolateral debridement

1. If this were my patient, I would recommend:

a. 48%   would recommend medial branch blocks

b. 17%   would recommend discography of C2-3, C3-4, C4-5

c. 13%   would recommend both a and b

d. 22%   would recommend neither a or b

1. If you are the spine trauma surgeon consulted on this hypothetical patient, would you:

31%   would delay a final decision on cervical spine clearance until the patient was alert and able to cooperate regardless of imaging results.

61%   would clear the patient’s cervical spine based primarily on your advanced imaging study of choice.

8%     would clear the patient’s cervical spine based primarily on plain radiograph findings.

0         would clear the patient’s cervical spine based primarily on the current clinical examination.

2. If medical branch blocks were negative and discography was positive at C2-3 and C3-4 but normal elsewhere, I would recommend:

33%   would recommend ACDF at the two levels

38%   would recommend long-term analgesic therapy

0        would refer back to a neurologist

29%   would refer for ongoing chiropractic care

2. If you are the spine trauma surgeon consulted on an obtunded patient, do you currently utilize a specific algorithm/protocol that includes advanced imaging to allow cervical spine clearance?

64%    responded yes

36%    responded no

  DVT Prophylaxis in the Postop Patient

Web survey results for: Silber J, Fitzhenry L, Ludwig SC, Epstein O, Vacarro AR. DVT prophylaxis in the postop spine patient. SpineLine. 2003;4(September-October):19-23.

1. A 35-year-old patient is undergoing a posterior lumbar decompression and fusion with instrumentation and posterior iliac crest bone graft for an L5-S1 isthmic spondylolisthesis. Would you:

10%   use no prophylaxis

80%   use mechanical devices only

5%     use chemical prophylaxis only

5%     use both

1.  If this were your patient . . .

23%   would allow regular chiropractic care if the patient remained “active”

61%   would institute a new exercise regimen that promoted independence from health care providers

6%     would offer a surgical option

10%   don’t know or are not sure

2. A 65-year-old patient with a history of CHF and prostate carcinoma is undergoing an elective posterior cervical decompression and fusion with lateral mass screws and local bone graft. Would you:

5%       use no prophylaxis

65%     use mechanical devices only

0          use chemical prophylaxis only

30%     use both

2.  When prescribing physical therapy. . .

23%   prescribe the type and directional bias of exercise based on the history of activities that either worsen or improve the pain

30%   perform a directional biased examination and
then prescribe the physical therapy based on clinical examination

47%   write: “evaluate and treat” (leaving treatment
decisions to the therapist)

3. A 22-year-old patient sustained an L2 burst fracture requiring an anterior decompression and reconstruction as well as a posterior spinal fusion with instrumentation. Would you:

11%     use no prophylaxis

58%     use mechanical devices only

5%       use chemical prophylaxis only

26%     use both

4. A 52-year-old patient underwent an L4-5 laminotomy/partial discectomy for radiculopathy. He has a history of a DVT/PE five years previously following a total knee arthroplasty. A vena cava filter was placed at that time. Would you:

10%   use no prophylaxis

35%   use mechanical devices only

5%     use chemical prophylaxis only

50%     use both