“When we allocated patients according to their reported pain relief, 27 showed no improvement (0–30% improvement on the NRS), 16 reported good improvement (31–75%) and 7 reported excellent improvement (> 75%).
“MRI features assessed in this study did, however, not show any relevant correlation with reported pain relief after facet joint infiltration.”
“Although we did not expect perfect agreement between reported pain relief and imaging findings, we were surprised to see this total lack of correlation between these two modalities!”
“If you do not assume that one of these two modalities is completely meaningless, our results can only mean, that the information provided by infiltrations and imaging are complementary.”
“We do need to point out that the patients analysed in this study were all part of the cohort of patients, where clinical presentation and imaging findings did not match. It is likely, that in a group of patients with matching symptoms and MRI or CT findings the results would have been different.”
“Our investigated collective is, however, a relevant subset of those patients presenting with chronic lumbar back pain and it is usually these patients where it is such a challenge to identify the best treatment strategy.”
“Specialists are accustomed to having some ‘gold standard’ they can refer to in their decision-making process. It is important to understand that there is no such gold standard for formulating a diagnosis and a resulting indication for surgery in chronic lumbar back pain patients.”
“Each modality—such as thorough clinical history, clinical examination, imaging techniques and local targeted infiltrations—has its strengths but also its flaws. It is the critical synopsis of all results obtained that allows one to identify the best treatment strategy for each patient.”
“To refer to the analogy mentioned above: only if you have all the tools in your toolbox available can you clearly see which problem is a nail, and which one isn’t.” — EH
Study: Intra-Wound Tobramycin Shows Promise
Researchers from Columbia University Medical Center, The Spine Hospital at New York Presbyterian have completed research in a rabbit model indicating that tobramycin does a good job of eradicating Escherichia coli (E. Coli). Their work, “Intrawound Tobramycin Powder Eradicates Surgical Wound Contamination: An In Vivo Rabbit Study,” appears in the December 15, 2017 edition of Spine.
Co-author Daniel Riew, M.D., co-chief of the spine division and director of cervical spine surgery at The Spine Hospital, commented to OTW, “We had previously published a study using a similar model and using vancomycin powder. While vancomycin is great for gram-positive organisms, it doesn’t work for gram-negatives such as E. Coli. So we thought we could do this study to determine if local tobramycin could eradicate E. Coli in a contaminated wound model.”
“We inoculated rabbits who had undergone a laminectomy and implantation of a titanium wire with E.Coli; 10 rabbits got intra-wound tobra and 10 did not. They were sacrificed on post-operative date #4. None of the rabbits who got tobra were infected whereas all of the ones without tobra got infected; 39 out of 40 culture specimens in the control and none out of 40 in the tobra group grew E. Coli.”
“This is a preliminary study and it only tells us that tobramycin is effective at eradicating E. Coli in rabbits. So, I cannot make recommendation for clinical usage yet. We are doing further studies regarding toxicity and dose. In the meantime, we do know that tobramycin impregnated cement does a nice job of treating wound infections and is not toxic. So, based on that information, I personally have used 70-140mg of intra-wound tobramycin when I was concerned about a gram-negative surgical contaminant.”
