Background and Aim: Surgical Site Infection (SSI) is one of the most important complications after spine surgeries. Different methods have been proposed to prevent this type of infection. The present study was performed to evaluate the effect of applying topical vancomycin powder on prevention of SSI in patients undergoing spinal surgery using implants in Al-Zahra Hospital, Isfahan, Iran from February 2015 to June 2016.
Methods and Materials/Patients: In this clinical trial, 100 patients candidate for spinal surgery with implants were divided into two groups using randomization technique including 50 patients in each group. Vancomycin powder solved in 20cc N/S serum was flushed over all layers of the surgical wound in the case group and in the control group sterile normal saline solution was used. Patients were examined at discharge and three months after surgery for ruling out surgical site infection. SSIs following spine surgery can be superficial, characterized by obvious wound drainage and erythema or it can be deep infections disseminating under the fascia which may lead to discitis, epidural abscess, and spondylitis.
Results: One case of SSI was observed in the control group who was 83 years old. The mean age of all patients was 51.9±14.5 years old. The duration of surgery in this patient was 5 hours. The mean duration of surgery was 3.41±0.73 hours. The length of implant, BMI, sex, underlying diseases and other risk factors (diabetes and hypertension) did not affect the rate of infection.
Conclusion: Even though topical antibiotics seem to be effective on controlling SSI but our finding did not support this hypothesis. The authors would like to suggest that keeping routine strict sterility strategies during spine operations is effective enough in preventing surgical site infection.

Background and Aim: Although operation is the most appropriate treatment for Cauda Equina Syndrome, the effectiveness of operation on clinical symptoms is still under discussion. This study aimed to determine the prognosis of Cauda Equina Syndrome in patients with lumbar disk surgery in Al-Zahra Hospital of Isfahan City, Iran, from 2013 to 2015.
Methods and Materials/ Patients: In This prospective study, patients diagnosed with Cauda Equina Syndrome who underwent operation in Al-Zahra Hospital of Isfahan from 2013 to 2015 were followed up for two years and the effect of the surgery on the improvement of their clinical symptoms was investigated.
Results: In this study, 33 patients with Cauda Equina Syndrome were evaluated. About 24-month follow-up of patients showed muscle weakness improvement in 26(78.8%) of them. Of all 19 patients with urinary dysfunction, 18(94.7%) recovered. Six (33.3%) cases improved the day after surgery, 6(33.3%) cases in one month, 4(22.2%) cases in six months, and 2(11.1%) cases within 24 months after the surgery. All 4(100%) patients with bowl disorder also recovered during the study. One (25%) of them improved the day after operation, 1(25%) one month after the operation and 2(50%) within 24 months following the operation.
Conclusion: According to the results of this study, operation of the lumbar disks leads to improvement of Cauda Equina Syndrome, including recovery of sphincter disorders and muscle weakness, but considering the limitations of our investigation (including a small sample size), further studies are recommended in this area.

Case Presentation: Herein, we reported a 45-year-old woman with chronic pain in the lumbar area and radicular pain in her left leg, aggravating gradually during the previous six months before the operation. She also suffered from progressive muscle weakness in her left lower extremity. The

patient was operated for prolapsed disc herniation. Macroscopically, no abnormality of the skin, muscles, or ligaments was observed during surgery. After incision of the annulus in level L3-L4, surprisingly the excised nucleus pulposus was black. The alkaptonuria was diagnosed after histopathological examination of the black disc material and confirmed by urinalysis.
Conclusion: The postoperative course was uneventful and the patient was free from low back pain and leg pain after surgery. In patients without any manifestations of alkaptonuria or ochronosis such as our case, timely diagnosis of this pathologic condition is momentous for investigation, treatment, and prevention of other organs’ involvement.