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Typically a retroperitoneal perforation will occurafter sphincterotomy. In one, referredto as time-out from positive reinforcement(Costello, 1975), each occurrence of the tar-get disfluency was immediately followed bythe clinician saying, “Stop,” and looking awayfrom the subject for ten seconds. Many other factorshave inconsistently been reported to increase the risk of SSI after spine surgery, including asurgical indication of trauma, older age, malnutrition, American Society of Anesthesiologists(ASA) score of 2 or 3, smoking, alcohol abuse, posterior surgical approach, blood transfu-sion, perioperative hyperglycemia, and duration of surgery [15–18]

Many other factorshave inconsistently been reported to increase the risk of SSI after spine surgery, including asurgical indication of trauma, older age, malnutrition, American Society of Anesthesiologists(ASA) score of 2 or 3, smoking, alcohol abuse, posterior surgical approach, blood transfu-sion, perioperative hyperglycemia, and duration of surgery [15–18].

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