Cervical wound dehiscence following internal fixation of the cervical and thoracic spine: a report of three cases

Background

Wound dehiscence is a known postoperative complication, but in cervical spine surgery it is rare and there is a lack of documented literature. This case report discusses novel complications of wound dehiscence in three patients who were treated with spinous process ostectomies after posterior cervical surgeries.

Case Description

In total three cases are reported in these reports. Case one documents the management of a patient with full-thickness cervical wound dehiscence following a cervical paraspinal infection corrected with posterior spinal fixation and fusion. This patient was treated with resection of the prominent spinous processes. Case two documents the management of a patient with an odontoid fracture requiring revision surgery. The patient developed a full-thickness wound dehiscence and was treated with resection of the prominent spinous processes. Case three was a patient suffering from a T9 spinal cord injury who was also treated for multiple vertebral fractures. The patient eventually developed internal cervical wound dehiscence which resulted in removal of the prominent spinous processes.

Conclusions

This case report documents the successful treatment of cervical wound dehiscence which is a rare postoperative complication of cervical spinal surgery. This information is valuable as treatment strategies and research into cervical wound dehiscence are limited to a single case report.

Late Retropharyngeal and Parapharyngeal Abscess in Patients with a History of Anterior Cervical Discectomy and Fusion

OBJECTIVE

Anterior cervical discectomy and fusion is a common procedure performed by spine surgeons with rare complications and high treatment success. Late presentation of retropharyngeal abscess in patients with a history of anterior cervical discectomy and fusion is rare but can have devastating consequences. There is a paucity of data to guide medical and surgical management of retropharyngeal abscess in these patients.

METHODS

We discuss 7 patients who presented to our institution with a late retropharyngeal abscess after having a history of anterior cervical discectomy and fusion. A review and description of the current literature regarding treatment and outcomes is described.

RESULTS

Seven patients presented to our institution with a retropharyngeal abscess ranging from 10 months to 7 years after undergoing anterior cervical discectomy and fusion. All patients received at least a 6-week course of appropriate intravenous antibiotics. Only one patient had their initial ACDF instrumentation removed at the time of presentation for the abscess. Four out of the 7 patients were treated with irrigation and debridement in addition to intravenous antibiotics, whereas 3 patients were treated with no surgery and intravenous antibiotics alone. All patients were asymptomatic at final follow up.

CONCLUSIONS

Late retropharyngeal abscess after anterior cervical discectomy and fusion is a rare complication. Surgical management should be considered along with long term antibiotics. Removal of implants may not be necessary for infection resolution. Antibiotic treatment alone may be indicated for patients who are not septic, do not have airway compromise, or and can be considered for poor surgical candidates.

Beyond the dermis-high-risk invasive squamous cell carcinoma: a retrospective review

OBJECTIVE

Most cutaneous squamous cell carcinomas (cSCC) are low risk and can be treated with simple excision or ablation. High-risk cSCC require invasive treatment, including radical surgery. We present our experience in treating invasive cSCC of the pelvis and extremities.

METHOD

A retrospective review of the data of patients with invasive cSCC, indicated for surgery between 2014 and 2018, from a single institution was carried out.

RESULTS

A total of 19 patients (nine men, 10 women) were included in the study. Mean age was 62 years; mean tumour size was 8.6cm). Of the 19 patients, five patients with paraplegia with cSCC arising from hard-to-heal ulcers died of infection or bleeding after surgery or systemic therapy. Also, nine patients with localised cSCC underwent margin-negative resection with or without radiation; one patient experienced disease relapse. Of the participants, two patients with previous transplants and multifocal aggressive cSCC underwent numerous resections but succumbed to disease, and two patients who presented with locally recurrent disease after previous positive margin resection and radiation underwent re-resection but developed recurrent disease.

CONCLUSIONS

Prognosis for invasive cSCC largely depends on clinical setting. Tumours arising from ulcers in patients with paraplegia have a poor prognosis regardless of treatment. Invasive cSCC in transplant patients are often multifocal and often recur. Debulking procedures are associated with local recurrence despite radiation. Patients presenting with localised disease have a favourable prognosis with wide resection, flap coverage and adjuvant therapy.

Radiographic Evaluation of Minimally Invasive Instrumentation and Fusion for Treating Unstable Spinal Column Injuries

STUDY DESIGN

Retrospective cohort.

OBJECTIVE

Facet fusion in minimally invasive spine surgery (MISS) may reduce morbidity and promote long-term construct stability. The study compares the maintenance of correction of thoracolumbar (TL) trauma patients who underwent MISS with facet fusion (FF) and without facet fusion (WOFF) and evaluates instrumentation loosening and failure.

METHODS

TL trauma patients who underwent MISS between 2006 and 2013 were identified and stratified into FF and WOFF groups. To evaluate progressive kyphosis and loss of correction, Cobb angles were measured at immediate postoperative, short-term, and long-term follow-up. Evidence of >2 mm of radiolucency on radiographs indicated screw loosening. If instrumentation was removed, postremoval kyphosis angle was obtained.

RESULTS

Of the 80 patients, 24 were in FF and 56 were in WOFF group. Between immediate postoperative and short-term follow-up, kyphosis angle changed by 4.0° (standard error [SE] 1.3°) in the FF and by 3.0° (SE 0.4°) in the WOFF group. The change between immediate postoperative and long-term follow-up kyphosis angles was 3.4° (S.E 1.1°) and 5.2° (S.E 1.6°) degrees in the FF and WOFF groups, respectively. Facet fusion had no impact on the change in kyphosis at short term (P = .49) or long term (P = .39). The screw loosening rate was 20.5% for the 80 patients with short-term follow-up and 68.8% for the 16 patients with long-term follow-up. There was no difference in screw loosening rate. Fifteen patients underwent instrumentation removal-all from the FF group.

CONCLUSION

FF in MISS does not impact the correction achieved and maintenance of correction in patients with traumatic spine injuries.

CT Prediction Model for Major Arterial Injury after Blunt Pelvic Ring Disruption

Purpose To develop and test a computed tomography (CT)-based predictive model for major arterial injury after blunt pelvic ring disruptions that incorporates semiautomated pelvic hematoma volume quantification. Materials and Methods A multivariable logistic regression model was developed in patients with blunt pelvic ring disruptions who underwent arterial phase abdominopelvic CT before angiography from 2008 to 2013. Arterial injury at angiography requiring transarterial embolization (TAE) served as the outcome. Areas under the receiver operating characteristic (ROC) curve (AUCs) for the model and for two trauma radiologists were compared in a validation cohort of 36 patients from 2013 to 2015 by using the Hanley-McNeil method. Hematoma volume cutoffs for predicting the need for TAE and probability cutoffs for the secondary outcome of mortality not resulting from closed head injuries were determined by using ROC analysis. Correlation between hematoma volume and transfusion was assessed by using the Pearson coefficient. Results Independent predictor variables included hematoma volume, intravenous contrast material extravasation, atherosclerosis, rotational instability, and obturator ring fracture. In the validation cohort, the model (AUC, 0.78) had similar performance to reviewers (AUC, 0.69-0.72; P = .40-.80). A hematoma volume cutoff of 433 mL had a positive predictive value of 87%-100% for predicting major arterial injury requiring TAE. Hematoma volumes correlated with units of packed red blood cells transfused (r = 0.34-0.57; P = .0002-.0003). Predicted probabilities of 0.64 or less had a negative predictive value of 100% for excluding mortality not resulting from closed head injuries. Conclusion A logistic regression model incorporating semiautomated hematoma volume segmentation produced objective probability estimates of major arterial injury. Hematoma volumes correlated with 48-hour transfusion requirement, and low predicted probabilities excluded mortality from causes other than closed head injury. ^© RSNA, 2018 Online supplemental material is available for this article.

First Report of Tomato torrado virus Infecting Tomato in Italy

In 2009 and 2010, approximately 2% of plants had disease symptoms, including initial leaflet chlorosis that later developed into necrotic spots and general necroses along the leaflet. Fruit production on affected plants was substantially reduced and necroses were also present. Total RNA was extracted from five symptomatic plant samples using the RNeasy Plant Mini Kit (Qiagen, Hilden, Germany) and analyzed by reverse transcription (RT)-PCR with specific primer pair: TR2F (5' GAAGGACGAAGAGCGACTG 3'), and TR2R (5' AAGGTAGGTATGCGTTTGC 3') (1). The primers amplified a 575-bp fragment within the coat protein Vp23 of Tomato torrado virus (ToTV). No RT-PCR products were observed when water or asymptomatic tomato plants were used as controls. The RT-PCR products were purified and directly sequenced in both directions. Pair-wise similarity analysis confirmed the presence of ToTV with 99% similarity to isolate PRI-ToTV0301 (GenBank Accession No. DQ388880) and 98% similarity to isolate Kra (Accession No. EU652402). A representative sequence was deposited with GenBank (Accession No. GU903899). To further confirm the presence of ToTV, dsRNA analysis was conducted on all five symptomatic plants and one healthy tomato plant (2). Electrophoresis of dsRNA showed two bands of approximately 5,400 and 7,800 nucleotides long, typical of ToTV in all samples, while a third band between the other two (approximately 6,400 nt) was detected. Serological testing using double-antibody sandwich-ELISA was also conducted on the five symptomatic and 25 additional plants from the same greenhouse that displayed typical Pepino mosaic virus (PepMV) symptoms only. Antibodies used for serological testing screened for the presence of PepMV, Tomato spotted wilt virus, Cucumber mosaic virus, and Tomato mosaic virus (Loewe Biochemica, Sauerlach, Germany). These tests detected PepMV in all samples with disease symptoms typical of PepMV, and in three of the five samples with the newly described symptoms. To our knowledge, this is the first report of ToTV in Italy, and in some plants, co-infection with PepMV was likely. All ToTV-infected tomato plants in the greenhouse were destroyed. References: (1) H. Pospieszny et al. Plant Dis. 91:1364, 2007. (2) J. Sambrook et al. Molecular Cloning. A Laboratory Manual. 2nd ed. Cold Spring Harbor Laboratory Press, Woodbury, NY, 1989.

Influence of the second amino acid on recombinant protein expression

Factors affecting protein expression have been intensely studied to the benefit of recombinant protein production. Through mutational analysis at the +2 amino acid position of recombinant Igα, we examined the effect of all 20 amino acids on protein expression. The results showed that amino acids at the +2 position affected 10-fold in the recombinant protein expression. Specifically, Ala, Cys, Pro, Ser, Thr, and Lys at the +2 position resulted in significantly higher expression of recombinant Igα than other amino acids, while Met, His and Glu resulted in greatly reduced protein expression. This expression difference depended on the amino acid instead of their codon usage. Consistent with the mutational results, a statistically significant enrichment in Ala and Ser at the +2 position was observed among highly expressed Escherichia coli genes. This work suggests a general approach to enhance protein expression by incorporating an Ala or Ser after the initiation codon.

Fabrication and Characterization of a Surface-Acoustic-Wave Biosensor in CMOS Technology for Cancer Biomarker Detection

Design, fabrication, and characterization of a novel surface acoustic wave (SAW) biosensor in complementary metal-oxide semiconductor (CMOS) technology are introduced. The biosensor employs a streptavidin/biotin-based five-layer immunoassay for detecting a prominent breast cancer biomarker, mammoglobin (hMAM). There is a growing demand to develop a sensitive and specific assay to detect biomarkers in serum that could be used in the early detection of breast cancer, determining prognosis and monitoring therapy. CMOS-SAW devices present a viable alternative to the existing biosensor technologies by providing higher sensitivity levels and better performance at low costs. Two architectures (circular and rectangular) were developed and respective tests were presented for performance comparison. The sensitivities of the devices were analyzed primarily based on center frequency shifts. A frequency sensitivity of 8.704 pg/Hz and a mass sensitivity of 2810.25 m(2) /kg were obtained. Selectivity tests were carried out against bovine serum albumin. Experimental results indicate that it is possible to attach cancer biomarkers to functionalized CMOS-SAW sensor surfaces and selectively detect hMAM antigens with improved sensitivities, lowered costs, and increased repeatability of fabrication.

Blocking internalization of pBP1, a secreted homeoprotein, kills breast cancer cells but not normal breast epithelial cells

Abstract #3068

Background: BP1 is a member of the homeobox gene family, a highly conserved family of transcription factor genes. pBP1 is a homeotic protein that is upregulated in 80% of invasive ductal breast tumors. We have previously shown that the percentage of pBP1 positive breast cancer cases increases with the extent of cellular proliferation and carcinogenesis. BP1 expression is associated with aggressive tumors: 100% of ER negative tumors were BP1 positive, compared with 73% of ER positive tumors. pBP1 is secreted by MCF-7 cells, T47D cells, and MDA-MB-231 breast cancer cells, but not by MCF10A or H16N2 normal breast epithelial cells. In all cell lines tested, secreted pBP1 is internalized, resulting in stimulation of growth. Moreover, incubation of MCF-7 or MCF10A cells in recombinant pBP1 results in stimulation of several oncogenes, including bcl-2, Twist, and Met. These results led us to ask whether we could abrogate mitogenic stimulation by addition of anti-pBP1 antibody.
 Materials and Methods. Cells were incubated in 10 µg/ml anti-BP1 Ab (Novus) or 10 µg/ml IgG for three days. Growth was measured using MTT assays and apoptosis was assessed by flow cytometry after staining with Annexin V (Trevigen).
 Results. Addition of anti-BP1 Ab to the growth medium of MCF-7 cells, T47D cells, and MDA-MB-231 cells caused significant growth inhibition and apoptosis. In contrast, addition of anti-BP1 Ab to the growth medium of MCF10A and H16N2 cells did not lead to significant growth inhibition or apoptosis.
 Discussion. Our novel finding that pBP1 is secreted by breast cancer cells but not normal breast epithelial cells was the impetus to test the effect of adding anti-BP1 Ab to the growth media of both types of cells. Remarkably, anti-BP1 Ab kills only the breast cancer cells, suggesting they may be BP1-dependent. Our data indicate it may be possible to specifically target BP1 positive breast cancer cells in the 80% of women with BP1 positive tumors.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3068.