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1.  Antibiotic Microbial Prophylaxis for Spinal Surgery: Comparison between 48 and 72-Hour AMP Protocols 
Asian Spine Journal  2010;4(2):71-76.
Study Design
This is a prospective randomized cohort study.
Purpose
We intended to evaluate the efficacy of a 48 hour antibiotic microbial prophylaxis (AMP) protocol as compared with a 72 hour AMP protocol.
Overview of Literature
The current guideline for the prevention of surgical site infection (SSI) suggests the AMP should not exceed 24 hours after clean surgery like spinal surgery. But there exist some confusion in real clinical practice about the duration of postoperative antibiotic administration because the evidence of the guideline was not robust.
Methods
The subjects were 548 patients who underwent spinal surgery at our department from April 2007 to December 2008. The patients were classified into two groups according to the prophylaxis protocol: group A, for which AMP was employed for 72 hours postoperatively and group B, for which AMP was employed for 48 hours postoperatively. Five hundred two patients out of 548 patients were followed until 6 months postoperatively. The incidence of SSI in the two groups was analyzed.
Results
The overall infection rate was 0.8%. There was no significant difference in infection rate between the two groups. The overall infection rate for the patients who underwent instrumented fusion was 0.9%. There was no significant difference in the infection rate between the patients of the two groups who underwent instrumented fusion.
Conclusions
AMP for 48 hours is as efficient as AMP for 72 hours.
doi:10.4184/asj.2010.4.2.71
PMCID: PMC2996630  PMID: 21165308
Spine; Surgical site infection; Anti-bacterial agents
2.  Multiple Levels of Lumbar Spondylolysis - A Case Report - 
Asian Spine Journal  2009;3(1):35-38.
We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery.
doi:10.4184/asj.2009.3.1.35
PMCID: PMC2852035  PMID: 20404945
Lower back pain; Multiple spondylolysis; Fusion
3.  Risk Factors Associated with the Halo Phenomenon after Lumbar Fusion Surgery and its Clinical Significance 
Asian Spine Journal  2008;2(1):22-26.
Study Design
Retrospective study.
Purpose
First, to examine the association between bone mineral density (BMD) and the halo phenomenon, and second, to investigate risk factors predisposing to the halo phenomenon and its correlation with clinical outcomes.
Overview of Literature
The few in vivo studies regarding the relationship between pedicle screw stability and BMD have shown conflicting results.
Methods
Forty-four female patients who underwent spine fusion surgery due to spinal stenosis were included in this study. The halo phenomenon and fusion state were evaluated through plain radiographs performed immediately after surgery and through the final outpatient follow-up examination. BMD, osteoarthritis grade in the hip and knee joints, and surgical outcome were also evaluated.
Results
BMD was not related to the halo phenomenon, but age, absence of osteoarthritis in the knee, and non-union state were found to be significant risk factors for the halo phenomenon. However, the radiological halo phenomenon did not correlate with clinical outcome (visual analogue scale for back pain and leg pain).
Conclusions
The halo phenomenon is a simple phenomenon that can develop during follow-up after pedicle screw fixation. It does not influence clinical outcomes, and thus it is thought that hydroxyapatite coating screws, expandable screws, cement augmentation, and additional surgeries are not required, if their purpose is to prevent the halo phenomenon.
doi:10.4184/asj.2008.2.1.22
PMCID: PMC2857487  PMID: 20411138
Halo phenomenon; Pedicle screw; Bone mineral density

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