European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Surgical site infections represent a major complication of spinal surgery. The application of lyophilised vancomycin into the wound is reported to significantly decrease infection rates. As concentrations applied locally can exceed the minimal bacterial inhibitory concentration for more than a 1000-fold, toxic side effects on local tissue may be possible. ⋯ As bone remodelling requires the immigration, proliferation and differentiation of osteoblasts at the fusion site, high dosages of intrawound vancomycin might interfere with regenerative processes and increase the risk of non-union. To allow an appropriate balance of infection risk and the risk of non-union, the minimal local concentration required should be determined by controlled in vivo studies.
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The clinical features and etiology of low back pain and buttock pain remain poorly understood. We report ten patients with buttock pain who underwent gluteus medius muscle (GMeM) decompression under local anesthesia. ⋯ In patients with buttock pain, pain around the GMeM should be considered as a causative factor. Less invasive surgery with cutting and opening of the tight gluteal aponeurosis over the GMeM under local anesthesia yielded excellent clinical outcomes.