Complication Of Spinal Surgery Research Articles

Use of TachoSil for durotomy repair in spine surgery: a single-center retrospective review.

A significant complication of spine surgery is persistent postoperative CSF leak secondary to intentional or incidental durotomy. Traditionally, the gold standard for repair of simple durotomy has been primary surgical repair; however, this technique alone may not be possible for more complex durotomy and is often supplemented with sealants or fibrin glues. The authors add to the literature the largest series of spine surgery patients treated with TachoSil, a synthetic collagen patch containing human fibrinogen and human thrombin, for the management of incidental or intentional durotomy. The authors identified all patients who underwent a spinal operation and were billed for operative use of TachoSil at their institution between January 1, 2023, and November 3, 2023. Demographic, clinical, and outcome variables were collected and analyzed using standard statistical methods. Categorical variables were reported as number (%), and continuous variables were reported as median (range). The authors retrieved 55 patients meeting their inclusion criteria. The population consisted of 29 (52.7%) females, had a median age of 52 years, and had a median BMI of 28.3 kg/m2. Of the repaired durotomies, 37 (67.3%) were intentional to the operation and 18 (32.7%) were incidental or secondary to trauma. Abnormal residual fluid collections were appreciated in 1 (1.8%) patient. Wound breakdown was observed in 2 (3.6%) patients. Thirty-day readmission was observed in 6 (10.9%) patients, and 30-day reoperation was necessary in 2 (3.6%) patients. Ninety-day readmission was observed in 7 (12.7%) patients and 90-day reoperation was necessary in 3 (5.5%) patients. One (1.8%) case of 30-day readmission was related to CSF leak, and no cases of 30-day or 90-day reoperation were related to dural closure failure. This study is a brief examination of the demographic characteristics, surgical variables, and outcomes of durotomy repair in spine surgery with TachoSil and provides encouraging results for the continued use of the material in this context. This study provides the impetus for examination of TachoSil in larger, multi-institutional studies to establish it as a standard of care in spinal dural repair.

Trends in Medicare procedural and reimbursement rates for spinal CSF leak repair (2000-2021).

CSF leaks are a common complication of spinal surgery, occurring in 3%-16% of elective cases and up to 12% of operatively managed traumatic spinal injuries. They can also occur following lumbar puncture. However, there are limited data on utilization and reimbursement trends within Medicare for CSF leak repairs. Characterizing the economic burden and market of spinal CSF leak repair has implications for optimizing effective management strategies. This study evaluates reimbursement and utilization trends for both surgical repair and epidural blood patch (EBP) management of spinal CSF leaks between the years 2000 and 2021. The 2000-2021 provider utilization and payment files from the Centers for Medicare & Medicaid Services was queried to identify all spinal CSF leak repair procedures billed to Medicare part B. For each management strategy, the number of procedures, total charges submitted by providers, and total Medicare reimbursements were extracted. Monetary data were adjusted to 2021 US dollars using changes to the Consumer Price Index. Spearman rank correlation coefficients were used to analyze trends in reimbursement and utilization. From 2000 to 2021, 62,826 open surgical repairs were reported with $37,082,407 paid in reimbursement (45.9% repaired without additional laminectomy, 28.8% with laminectomy, and 25.3% requiring a spinal dural graft). An additional 63,227 EBPs were reported for CSF leak repair with $7,567,776 in reimbursement. Reimbursement for CSF leak repair without laminectomy totaled $15,707,094; repairs with laminectomy, $12,429,690; and use of spinal dural grafts, $8,945,444. Both a significant 162% increase in the utilization of spinal dural grafts (333 to 872, p < 0.001) and a decrease in reimbursement ($671 to $496, p = 0.02) was observed from 2000 to 2021. There was a significant 31% decrease in reimbursement for EBP ($148 to $102, p < 0.001). Significant variability exists in the management strategy and rates of utilization and reimbursement for treating spinal durotomy. Despite increasing utilization of spinal dural grafts, reimbursement has declined between the years 2000 and 2021. Further studies are required to optimize both the cost effectiveness and efficacy of spinal durotomy repair techniques.

Prevalence of metal hypersensitivity in pediatric spine surgery.

Delayed metal hypersensitivity reactions can cause complications in spine surgery. Currently, there is no information on the prevalence of metal hypersensitivity in pediatric patients undergoing spine surgery. The objective of this study is to determine the prevalence of metal hypersensitivity in pediatric patients undergoing spinal instrumentation. Retrospective chart review of patients who underwent spinal instrumentation with or without fusion at a single institution, from January 1, 2014, to December 31, 2020, was performed. Patients were pre-screened for history of allergic diseases, including previous reaction to metals, prior to surgery. Patch metal allergy testing (PMAT) for metal hypersensitivity was also performed. Of the 796 pediatric patients who underwent spinal instrumentation procedures from 2014 to 2020, 118 (15%) screened positive for metal hypersensitivity. However, the number of patients with documented evidence of metal hypersensitivity diminished to 26 (3%) after PMAT verification. Nickel hypersensitivity was most prevalent, with 20 patients (16.9% of positive screening; 2.5% of all instrumented patients) demonstrating positive skin patch tests. The other most prevalent metal hypersensitivities included cobalt in 9 patients (7.6%; 1.1%), manganese in 3 patients (2.5%; 0.4%), and copper in 1 patient (0.8%; 0.1%). with a number needed to treat (NNT) of 5. This study suggests that routine pre-operative PMAT is not necessary in all pediatric spine patients yet should be considered if patients report a history of prior metal hypersensitivity reactions.

INCIDENTAL DUROTOMY IN DEGENERATIVE SPINAL SURGERY

Background. Incidental durotomy is a common complication in degenerative spine surgery and according to the literature occurs in 1 to 17%. Different clinical cases with severe complications are described and which are resulted in wrong tactics for dural lesion treatment.Objective. To evaluate frequency, treatment methods and possible complications of incidental durotomy in spinal degenerative disease surgery.Material and Methods. A retrospective analysis of the data of 859 patients who underwent surgery in spinal department since 2018 till 2021.Results. 22 cases of incidental durotomies were found. One during anterior cervical discectomy (ACD), one during lumbar laminectomy with posterior instrumentation, six during microdiscectomy and fourteen during lumbar minimally invasive unilateral decompression. Three patients repeated revision surgery due to complication: liquorrhea, wound infection. Maximum follow-up period was 24 months. Positive results were achieved in all cases. The frequency of incidental durotomies depends on whether the operation is revision: 18.8% (9 injuries out of 48 revision operations) vs. 1.6% (13 injuries out of 811 primary operations). p&lt;0.001. The risk of durotomy during revision surgery is 10 times higher (RR = 10,0; 95%, CI: 4,5–22,4).Conclusion. A statistically significant relationship was revealed between the incidence of durotomy and the type of surgery. During minimally invasive unilateral decompression for bilateral stenosis the risk of incidental durotomy is significantly higher. Primary repair of the incidental durotomy is recommended to prevent complications. If wound liquorrhea is detected, lumbar drainage system is recommended. The liquorrhea lasting more than 48 hours is an indication for revision surgery. In our study the VAS back and limb score and ODI did not differ from similar data of patients without incidental durotomy. If primary repair of durotomy is performed and liquorrhea is eliminated, the results of treatment of this patients are good. No consequences are noted when primarily dural repair is performed.

Risk factors of acute urinary retention after spine surgery.

Acute postoperative urinary retention (APOUR) is 1 of the most common complications of spinal surgery, impacting both postoperative care and the patients' quality of life. This study is designed to investigate the risk factors and the incidence of APOUR after spinal surgery in Taiwan. We conducted a retrospective analysis using the Taiwanese National Health Insurance Research Database (NHIRD), a nationwide cohort of patients who underwent spinal surgery from the year 2000 to 2013. Patients suffering from APOUR were collected and perioperative parameters were recorded. The risk factors related to APOUR after spinal surgery were examined using multivariate logistic regression analysis. A total of 16,160 patients who underwent spinal surgery were retrieved from NHIRD. Among them, 432 (2.67%) suffered from acute urinary retention after surgery. Multivariate logistic regression analysis revealed that age (adjusted odds ratio [OR] = 1.02, 95% CI = 1.01-1.02), male gender (adjusted OR = 1.35, 95% CI = 1.10-1.60) and undergoing spinal surgery more than 2 times (adjusted OR = 4.78, 95% CI = 2.49-9.20) were statistically significant risk factors for APOUR after spinal surgery. The results of this retrospective cohort study suggest that patients undergoing spinal surgery more than 2 times, male gender and advanced age are significantly associated with an increased risk of APOUR after spinal surgery. This information may assist surgeons to identify patients who have a high risk of APOUR after spinal surgery and proactively provide them with early intervention.

The use of the psoas-to-lumbar vertebrae index and modified frailty index in predicting postoperative complications in degenerative spine surgery: can sarcopenia or frailty be underestimated?

Degenerative spine disease (DSD) is increasingly prevalent due to aging populations, leading to higher surgical interventions and associated complications. This necessitates a comprehensive preoperative assessment, evaluating frailty through tools such as the modified Frailty Index 5 and modified Frailty Index 11 (mFI-5 and mFI-11). Despite the utility of mFI-5 and mFI-11 in predicting postoperative complications, these indices do not account for sarcopenia, a syndrome related to but distinct from frailty, which is associated with higher complication rates. This paper aims to retrospectively evaluate the influence of sarcopenia and frailty on postoperative adverse events in a cohort of patients who underwent posterior spine fusion for degenerative disease of the lumbar spine. A retrospective review of 286 patients who underwent posterior lumbar spine fusion for DSD was conducted. Frailty was measured using mFI-5 and mFI-11, while sarcopenia was assessed through Psoas to Lumbar Vertebral Index (PLVI) on magnetic resonance images. Primary outcomes included postoperative complications within 30 days. Statistical analysis involved univariate and multivariate models to determine the predictors of complications. Higher frailty scores were significantly associated with increased postoperative complications (p < .05). However, sarcopenia showed no significant correlation with postoperative complications rates, except for pneumological complications (p = .031). Multivariate analysis confirmed frailty as a strong independent predictor of postoperative complications, while sarcopenia had limited impact. Frailty is a robust predictor of postoperative complications in DSD surgeries, while sarcopenia, appears to play a lesser role. The findings suggest that frailty alone provide a more comprehensive assessment of risk than sarcopenia.

Management of subarachnoid-pleural fistula following anterior transthoracic approach for the ossification of posterior longitudinal ligament in the thoracic spine.

Subarachnoid-pleural fistula is an abnormal communication between the subarachnoid and pleural spaces that can arise from blunt or penetrating trauma or as a complication of spinal surgery via the transthoracic approach. Uncontrolled cerebrospinal fluid (CSF) leakage with a fistulous condition after transthoracic spinal surgery could be more problematic than that after spinal surgery via the conventional posterior approach because of the negative pressure in the pleural cavity. The authors reported subarachnoid-pleural fistula management using chest and lumbar spinal drainage in five patients with several troublesome complications, such as intracranial subdural hematoma or severe respiratory dysfunction. Chest drainage was managed for 2-3 days by continuous low negative pressure, whereas lumbar spinal drainage was managed for 5-7 days, aiming at an output volume of 150-200 ml/day and higher than that of chest drainage. Additionally, when examining changes in the accumulated pleural fluid were examined by standing chest X-ray immediately before operation and 1 month after operation, the pleural effusions in four of the five patients were assimilated 1 month postoperatively. Compared with CSF management following standard posterior spinal surgery, management after the anterior transthoracic approach could be more troublesome because of intrapleural negative pressure. When chest and lumbar spinal drainage are used, it is important to consider that over-drainage of CSF could potentially cause severe respiratory dysfunction and intracranial subdural hematoma.

Prior Antidepressant Prescription is Associated with Greater Opioid Prescriptions and Complications in Cervical Spine Surgery: A Propensity Matched Cohort Study.

Retrospective cohort study of national database. This study evaluates the impact of antidepressant prescriptions on postoperative outcomes and complications in cervical spine surgery. Patients who underwent cervical spine surgery often receive antidepressant prescriptions (ADP) to address concurrent mental health issues such as depression and anxiety. However, the use of antidepressants can affect bone metabolism. Yet, there is an opacity in the literature regarding the effects of ADP on outcomes of cervical spine surgery. Utilizing the TriNetX database, ACDF and Cervical Arthroplasty patients were matched on a 1:1 basis according to ADP status. Outcome variables such as emergency department visits, hospital readmissions, opioid prescription, and misuse, pseudoarthrosis, adjacent segment disease, and hardware failure were evaluated over follow-up periods ranging from 2 to 24 months. In a matched sample of 12,838 patients, those with ADP exhibited significantly higher rates of opioid prescriptions at 2 weeks (OR 1.34, P<0.0001), 6 months (OR 1.36, P<0.0001), 12 months (OR 1.36, P<0.0001), and 24 months (OR 1.33, P<0.0001). Emergency Department visits were significantly higher at 6 months (OR 1.11, P=0.0082) and 24 months (OR 1.083, P=0.014). Opioid abuse is notably higher by 24 months (OR 1.37, P=0.0033). Hospitalization rates were significantly increased at 12 months (OR 1.16, P=0.0013) and 24 months (OR 1.18, P<0.0001). Adjacent segment disease (OR 1.54, P<0.0001 at 24mo), hardware failure (OR 1.42, P=0.013 at 24mo), and pseudarthrosis (OR 1.48, P<0.0001 at 24mo) were also significantly higher in the ADP group. Patients with ADP undergoing cervical spine surgery experience higher risks of opioid use and abuse, increased hospital readmissions, emergency department visits, and a higher rate of mechanical complications. III.

Phrenic Nerve Palsy After Posterior Cervical Fusion: A Case Report and Review of Literature.

Cervical nerve palsies, most commonly C5, are relatively common following posterior cervical decompression and fusion (PCDF) for the management of cervical myelopathy. However, phrenic nerve palsy following PCDF is a rare complication documented in only one previous case report. The authors present a case of phrenic nerve palsy following PCDF. The patient is a 51-year-old male who presented with cervical myelopathy and radiculopathy as well as cervicalgia of 1 year's duration. The patient underwent C3-C6 posterior cervical decompression and fusion (PCDF). On postoperative day 5, he was found to have a right C5 nerve palsy, which improved with steroid use and physical therapy. When he returned at 7 weeks postoperatively, the patient had progressive dyspnea. A fluoroscopic exam by pulmonology revealed a right-sided phrenic nerve palsy was the cause of the dyspnea. Phrenic nerve palsy causing hemi-diaphragmatic paralysis is a rare complication of cervical spine surgery that requires a high degree of suspicion due to the nonspecific signs and symptoms. Our clinical case suggests that surgeons should bear in mind phrenic nerve palsy as a potential complication in patients with respiratory distress following cervical laminectomy.

Open vs tubular rate of re-operation for incidental durotomies after lumbar microdiscectomies: a propensity matched analysis.

Incidental durotomy (ID) is a common complication in spine surgery and can lead to increase in length of stay, decreased satisfaction with surgery and pseudomeningocele formation. Here, we describe a retrospective study comparing ID occurrences and repairs between patients receiving traditional open versus tubular minimally invasive spine (MIS) microdiscectomy. A retrospective comparative cohort-matched analysis was performed to study ID and its complications in MIS versus open lumbar microdiscectomies. The study included 192 patients in the tubular MIS cohort and 2902 patients in the open microdiscectomy cohort. Propensity scores were estimated by age and Elixhauser comorbidity score. After cohort matching, 156 patients were included in the open cohort. The difference in proportion for incidental durotomies, re-operation for pseudomeningocele, and levels were calculated using a Fisher's exact test. The total incidence of durotomy in our cohort of 348 patients was 3.1% (n = 11), 5 (3.2%) in the open cohort and 6 (3.1%) in the tubular cohort. Various ID repair techniques were used including primary repair and dural sealants. One patient in the open cohort required re-operation for pseudomeningocele formation while none required re-operation in the MIS cohort. This result was not significant (p = 0.45). Pseudomeningocele formation after ID is rare. The rates of ID were similar between cohorts. We found no significant difference between re-operation rate for pseudomeningocele between the two cohorts. Larger, cohort-matched, prospective studies are needed to determine the true difference between rates of re-operation for pseudomeningocele formation after lumbar microdiscectomies.

A Comparative Study of Post-Operative Outcomes with and without Using Intraoperative Neurophysiological Monitoring in Intra Medullary Spinal Cord Tumors Surgeries; A Systematic Review

Abstract Background Although relatively infrequent, neurological injury is a much dreaded complication in spine surgery and has the potential to result in serious postoperative motor and sensory deficits. As a result of these surgical challenges, intraoperative neuromonitoring (IONM) has gained favorable grounds in facilitating maximal tumor resection and minimizing neurologic morbidity. Aim and Objectives to review the efficacy of intraoperative neurophysiological monitoring (IONM) on post operative outcomes preventing neurological injury, predicting post operative neurological deficit and its effect on intraoperative surgeon’s decision making, and to know if it is beneficial or not in intramedullary spinal cord tumors surgeries in adults. Subjects and Methods This was observational studies and non randomized controlled studies. our patients were followed up according to this schedule (immediate post operative, first day, three days, first month, three months, six months, one year post operative) and the assessment were done by using Oxford grading system. Result Regarding neurological status by clinical examination at last follow up, Improved in 72, transient worsening in no cases, no change in 12 cases and progression in 17 cases, Conclusion. Conclusion our systematic review of the literature indicates that there is strong evidence that multimodality neuromonitoring is sensitive and specific for detecting intraoperative neurologic injury during spine surgery. Although the level of evidence supporting the conclusion that intraoperative neuromonitoring reduces the rate of new or worsening neurologic deficits is low, the available evidence does consistently support this conclusion.

Vertebral bone quality score as a new tool for osteoporosis diagnosis in patients undergoing lumbosacral fusion surgery: a single center cohort study.

Osteoporosis, a common bone disorder, increases fracture and spinal surgery complications risk. This study evaluates the potential of the Magnetic Resonance Imaging (MRI)-based Vertebral Bone Quality (VBQ) score as an alternative for assessing bone density in lumbosacral fusion surgery patients. In a prospective cohort study from April 2021 to November 2022, 134 patients with lumbar degenerative diseases underwent lumbar Dual-Energy X-ray Absorptiometry (DXA) and lumbosacral non-contrast T1-weighted MRI. VBQ scores were calculated and analyzed using IBM SPSS Statistics and MedCalc software. Osteopenia/Osteoporosis patients exhibited significantly higher VBQ scores than normal bone mineral density patients (3.37 ± 0.51 vs. 2.99 ± 0.44, P<0.001). VBQ correlated significantly with lumbar DXA T scores (r value= -0.415, p<0.001). Receiver Operating Characteristic (ROC) analysis showed VBQ AUC values of 0.730 (CI 95% 0.647-0.803, P<0.001) and 0.839 (CI 95% 0.765-0.897, P<0.001) for Osteopenia/Osteoporosis and osteoporosis diagnosis, respectively. The study suggests MRI-derived VBQ scores may benefit pre-lumbosacral fusion surgery bone density assessment, potentially improving patient care and aiding osteoporosis detection in spinal surgery candidates.

Prolonged operative time significantly impacts on the incidence of complications in spinal surgery

BackgroundIn spinal surgery adverse events (AE) and surgical complications (SC) significantly affect patient’s outcome and quality of life. The duration of surgery has been investigated in different surgical field as risk factor for complications. The aim of this study is to analyze the correlation between operative time and adverse events in spinal surgery.MethodsWe retrospectively analyzed data collected prospectively in a cohort of 336 patients surgically treated for spinal diseases of oncological and degenerative origin in a single center, between January 2017 to January 2018. Demographics and clinical data were collected. Adverse events were classified using Spinal Adverse Events Severity System version 2 (SAVES-V2) capture system. Focusing on degenerative patients, bivariate analysis and univariate logistic regression were used to determine the association between operative time and complications.ResultsA total of 105/336 patients experienced an AE related to surgery, respectively 38% in the oncological group and 28% in the degenerative group. The average age at surgery was 60.3 years (SD 17.1) and the mean operative time was 164.8 ± 138 min. A total of 206 adverse events (30 intraoperative, 135 early postoperative and 41 late postoperative AEs) were recorded. Early post-operative complications accounted for the most recorded AEs (55.5% in the oncological group and 73.2% in the degenerative group). Univariate logistic regression analyses confirmed that operative time correlated with increased risk of intra-operative (p-value = 0.0008), early post-operative (p-value < 0.001) and late post-operative (p-value < 0.001) adverse events.ConclusionsThis study highlights the strong correlation between the occurrence of adverse events in spinal surgery and prolonged operative time and suggests that efforts should be made to minimize the duration of surgical procedures while prioritizing patient’s safety, without compromising the technical achievement of the procedure.

Preoperative Serum Albumin and TLC as Predictors of Postoperative Complications in Spine Surgery.

Narrative review. To investigate the state of literature regarding serum albumin and total lymphocyte count and their associations with postoperative complications after spine surgery. Comprehensive search of the PubMed database was performed to find relevant articles addressing preoperative serum albumin, total lymphocyte count, or their respective composite scores and their associations with postoperative complications after spine surgery. Serum albumin level is frequently cited as a marker of patient nutritional status. Total lymphocyte count has more recently gained attention in the literature for similar reasons. Identification of modifiable preoperative patient risk factors for postoperative complications such as malnutrition may help minimize the incidence of postoperative complications. Review of the literature revealed 10 studies that discussed the association between preoperative hypoalbuminemia and postoperative complications. Five studies examined the relationship between either prognostic nutritional index (PNI), controlling nutritional status (CONUT), or both and postoperative complications after spine surgery. Preoperative hypoalbuminemia, low PNI, and high CONUT scores were associated with increased risk of postoperative complications after spine surgery. Preoperative malnourishment is a modifiable patient factor that is associated with an increased risk of postoperative complications after spine surgery.

Effect of the cone-beam CT acquisition trajectory on image quality in spine surgery: experimental cadaver study

BACKGROUNDIntraoperative 3D imaging with cone-beam CT (CBCT) improves assessment of implant position and reduces complications in spine surgery. It is also used for image-guided surgical techniques, resulting in improved quality of care. However, in some cases, metal artifacts can reduce image quality and make it difficult to assess pedicle screw position and reduction. PURPOSEThe objective of this study was to investigate whether a change in CBCT acquisition trajectory in relation to pedicle screw position during dorsal instrumentation can reduce metal artifacts and consequently improve image quality and clinical assessability. STUDY DESIGNExperimental cadaver study. METHODSA human cadaver was instrumented with pedicle screws in the thoracic and lumbar spine region (Th11 to L5). Then, the acquisition trajectory of the CBCT (Cios Spin, Siemens, Germany) to the pedicle screws was systematically changed in 5° steps in angulation (−30° to +30°) and swivel (−25° to +25°). Subsequently, radiological evaluation was performed by 3 blinded, qualified raters on image quality using 9 questions (including anatomical structures, implant position, appearance of artifacts) with a score (1–5 points). For statistical evaluation, the image quality of the different acquisition trajectories was compared to the standard acquisition trajectory and checked for significant differences. RESULTSThe angulated acquisition trajectory significantly increased the score for subjective image quality (p<.001) as well as the clinical assessability of pedicle screw position (p<.001) with particularly strong effects on subjective image quality in the vertebral pedicle region (d=1.61). Swivel of the acquisition trajectory significantly improved all queried domains of subjective image quality (p<.001) as well as clinical assessability of pedicle screw position (p<.001). CONCLUSIONSIn this cadaver study, the angulation as well as the swivel of the acquisition trajectory led to a significantly improved image quality in intraoperative 3D imaging (CBCT) with a constant isocenter. The data show that maximizing the angulation/swivel angle towards 30°/25° provides the best tested subjective image quality and enhances clinical assessability. Therefore, a correct adjustment of the acquisition trajectory can help to make intraoperative revision decisions more reliably. CLINICAL SIGNIFICANCEThe knowledge of enhanced image quality by changing the acquisition trajectory in intraoperative 3D imaging can be used for the assessment of critical screw positions in spine surgery. The implementation of this knowledge requires only a minor change of the current intraoperative imaging workflow without additional technical equipment and could further reduce the need for revision surgery.

Comparison of Surgical Site Infection After Instrumented Spine Surgery in Patients With High Risk of Infection According to Different Antibiotic Prophylaxis Protocols: A Cohort Study of 132 Patients With a Minimum Follow-Up of 1 year.

Observational Study. Surgical site infections (SSIs) are one of the major complications in spine surgery. Numerous factors that increase the risk of SSI have been widely described. However, clinical guidelines on antibiotic prophylaxis are usually common for all patients. There are no specific guidelines for patients with a high risk of infection. The aim of this paper is to create a specific protocol for patients at high risk of SSI. This is a three-cohort study using a prospective database. Risk patients are those who meet at least two of the following criteria: obesity, diabetes, reoperation and immunosuppression. Between October 2021 and April 2023, 132 patients were recruited.They were divided into three cohorts: cohort A, 46 patients, standard prophylaxis with cefazolin 2g/8h for 24h; cohort B, 46 patients, cefazolin 2g/8h and amikacin 500mg/12h for 24h; cohort C, 40 patients, cefazolin 2g/8h and amikacin 500mg/12h for 72h. There was a significant decrease in the infection rate depending on the prophylaxis (23.9% in cohort A, 8.7% in cohort B, and 2.5% in cohort C). When logistic regression models were applied and cohorts B and C were compared with A, the following results were obtained: OR of 0.30 (CI: 0.08 - 0.97; P = 0.057) and 0.08 (IC: 0.00 - 0.45; P = 0.019), respectively. Prophylaxis with prolonged double antibiotic therapy with cefazolin and amikacin is associated with a statistically significant decrease in the rate of SSI in patients with a high risk of infection.

Post-Operative Complications of Traumatic Thoracolumbar Spine Surgery: Experience of the P11 Neurosurgical Emergency Department—CHU Ibnou Rochd Casablanca (2018–2022)

This retrospective study focuses on 110 cases of thoracolumbar trauma operated on between 2018 and 2022 in the neurosurgical emergency department. The objective is to analyze the complication rates of surgery for traumatic thoracolumbar spine pathology, identify high-risk patients and understand these complications in order to improve preoperative planning and advice to patients for better care. The results show that the frequency of complications of thoracolumbar spine surgery in this department was 28.18%. The average age of patients with complications was 41.5 years, with a male predominance (65%). The main complications were post-operative infections (38.70%) and discharge of pus through the surgical wound with infectious syndrome (32.35%). The most frequent pathological histories in patients were toxic habits (alcohol and chronic smoking), diabetes and psychiatric disorders.

Does hydrogen peroxide help mitigate the incidence of Cutibacterium acnes in cervical spine surgeries?

Background: Surgical site infection (SSI) is a common yet serious complication of cervical spine surgery. While initially thought to be clinically insignificant, Cutibacterium acnes (C. acnes) is an important cause of infection. The purpose of this study was to investigate the ability of an hydrogen peroxide (H2O2) application during standard pre-surgical skin preparation to reduce the burden of C. acnes in patients undergoing cervical spine surgery. Methods: This was a retrospective review of prospectively collected data. Subjects were randomly assigned to either standard surgical preparation plus H2O2 (experimental) or without H2O2 (control). Pre-scrub, post-scrub, and dermal cultures were obtained to assess the C. acnes burden after cultures on an aerobic and anaerobic growth medium were held for 21 days. Multivariate analysis was conducted to determine factors associated with presence of C. acnes. Outcome measures included the results of intraoperative cultures and the development of a SSI within 90 days post-operatively. Results: Patients (n=86) undergoing elective two- or three-level fusion via anterior approach were included. Prior to application of the antiseptic solution, 65% (28/43) of the experimental cohort and 77% (33/43) of the control cohort had positive C. acnes cultures (p=0.34). Following application of antiseptic solution, there were no differences in positive C. acnes culture rates between the experimental and control cohorts in the epidermal (30% versus 28%, p=1.00) or dermal (40% versus 42%, p=1.00) cultures. No differences in the rates of C. acnes eradication from pre-antiseptic to post-antiseptic application occurred for epidermal (p= 1.00) or dermal (p= 1.00) skin layers. None of the factors were associated with positive C. acnes epidermal cultures on multivariable logistic regression analysis (p> 0.05). Conclusions: While there is potential for H2O2 to reduce the positive culture rate of C. acnes in cervical spine patients, no difference was seen when compared to standard surgical skin preparation.

Evaluation of ERAS protocol implementation on complex spine surgery complications and length of stay: a single institution study

BACKGROUND CONTEXTWith the goal of improving patient outcomes, the Integrated Spine Center at UT Southwestern Medical Center implemented an enhanced recovery after surgery (ERAS) protocol which includes pre- and postsurgery guidelines. Numerous studies have shown benefit of implementation of ERAS protocols to standardize perioperative care in line with best practices; however, the literature on complication rates, LOS, and readmissions shows mixed results. PURPOSEThe goal of this study was to investigate the impact of the ERAS protocol implementation on complication rates in the perioperative period, as well as hospital and ICU length of stay and hospital re-admission rates. STUDY DESIGN/SETTINGA retrospective cohort study was performed on all patients who underwent spine surgery between September 2016 and September 2021 at a single institution. Patients who met inclusion criteria were divided into non-ERAS and ERAS groups, and comparative statistics were used to evaluate ERAS protocol effectiveness. PATIENT SAMPLEAll patients who underwent spine surgery at UT Southwestern between September 2016 and September 2021 were evaluated for inclusion in the study. The patient sample was further refined to include only complex patient cases which were able to receive the full ERAS protocol (nonemergent admissions). OUTCOME MEASURESPresence of absence of postoperative complications including surgical site infection, AKI, DVT, MI, sepsis, pneumonia, PE, stroke, shock, and other complications were compared between groups, as were hospital and ICU length of stay, and 7, 30, and 90 day readmissions. Self-reported or functional measures were not used in outcome evaluation. METHODSA database of patient and surgery characteristics was built using an EMR query tool with spot checks performed by the authors. Control and treatment groups were matched for gender, age, BMI, ASA score, and surgery type. Total number of complication rates was compared between ERAS and non-ERAS groups, and comparative statistics were used to determine significance. RESULTSSignificant differences between ERAS versus non-ERAS groups were found in rates of UTI (6.8% vs 3.1%, respectively; p=.031), constipation (20.6% vs 11.4%, respectively; p=.001), and any complications (31.4% vs 19.4%, respectively; p<.001). There was no significant difference in the rates of other complications, in length of hospital or ICU stay, or readmissions at 7, 30, and 90 days. CONCLUSIONSImplementation of the ERAS protocol did not decrease complication rates or length of stay, and ERAS patients had significantly higher rates of UTI, constipation, and any complications. There may have been confounding factors due to the impact of COVID-19 on delivery of care, as well as misalignment between ERAS goals and outcome measures.

Does obesity and varying body mass index affect the clinical outcomes and safety of biportal endoscopic lumbar decompression? A comparative cohort study

BackgroundEndoscopic spine surgery has recently grown in popularity due to the potential benefits of reduced pain and faster recovery time as compared to open surgery. Biportal spinal endoscopy has been successfully applied to lumbar disc herniations and lumbar spinal stenosis. Obesity is associated with increased risk of complications in spine surgery. Few prior studies have investigated the impact of obesity and associated medical comorbidities with biportal spinal endoscopy.MethodsThis study was a prospectively collected, retrospectively analyzed comparative cohort design. Patients were divided into cohorts of normal body weight (Bone Mass Index (BMI)18.0–24.9), overweight (BMI 25.0–29.9) and obese (BMI > 30.0) as defined by the World Health Organization (WHO). Patients underwent biportal spinal endoscopy by a single surgeon at a single institution for treatment of lumbar disc herniations and lumbar spinal stenosis. Demographic data, surgical complications, and patient-reported outcomes were analyzed. Statistics were calculated amongst treatment groups using analysis of variance and chi square where appropriate. Statistical significance was determined as p < 0.05.ResultsEighty-four patients were followed. 26 (30.1%) were normal BMI, 35 (41.7%) were overweight and 23 (27.4%) were obese. Patients with increasing BMI had correspondingly greater American Society of Anesthesiologist (ASA) scores. There were no significant differences in VAS Back, VAS Leg, and ODI scores, or postoperative complications among the cohorts. There were no cases of surgical site infections in the cohort. All cohorts demonstrated significant improvement up to 1 year postoperatively.ConclusionsThis study demonstrates that obesity is not a risk factor for increased perioperative complications with biportal spinal endoscopy and has similar clinical outcomes and safety profile as compared to patients with normal BMI. Biportal spinal endoscopy is a promising alternative to traditional techniques to treat common lumbar pathology.