Lumbar Spinal Fusion Surgery Research Articles

Lumbar Spinal Steroid Injections and Infection Risk after Spinal Surgery: A Systematic Review and Meta-Analysis.

Lumbar spinal steroid injections (LSSI) are universally used as preferred diagnostic or therapeutic treatment options before major spinal surgeries. Some recent studies have reported higher risks of surgical-site infection (SSI) for spinal surgeries performed after injections, while others have overlooked such associations. The purpose of this study is to systematically review the literature and perform a meta-analysis to evaluate the associations between preoperative LSSI and postoperative infection following subsequent lumbar decompression and fusion procedures. Three databases, namely PubMed, Scopus, and Cochrane Library, were searched for relevant studies that reported the association of spinal surgery SSI with spinal injections. After the comprehensive sequential screening of the titles, abstracts, and full articles, nine studies were included in a systematic review, and eight studies were included in the meta-analysis. Studies were critically appraised for bias using the validated MINOR (methodological index for non-randomized studies) score. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Subgroup analysis was performed according to the time between LSSI and surgery and the type of lumbar spine surgery. Meta-analysis showed that preoperative LSSI within 30 days of lumbar spine surgery was associated with significantly higher postoperative infection compared with the control group (OR,1.79; 95% CI, 1.08-2.96). Based on subgroup analysis, lumbar spine fusion surgery within 30 days of preoperative LSSI was associated with significantly high-infection rates (OR, 2.67; 95% CI, 2.12-3.35), while no association was found between preoperative LSSI and postoperative infection for lumbar spine decompression surgeries. In summary, given the absence of high-level studies in the literature, careful clinical interpretation of the results should be performed. The overall risk of SSI was slightly higher if the spinal surgery was performed within 30 days after LSSIs. The risk was higher for lumbar fusion cases but not for decompression-only procedures.

467 Cost Effectiveness of Using a New Autograft Harvesting Technology in Adult Posterior Lumbar Spine Fusion Surgery

INTRODUCTION: Autograft in the form of the patient’s own bone dust can be harvested during surgery and used to facilitate fusion, or allograft can be purchased at a cost and used as an alternative. METHODS: We compared allograft use to the upfront investment of a new autograft harvesting technology (Bone Collector), enrolling 107 patients. In 81 patients, Bone Collector was used to collect autologous graft. We compared the allograft requirement and allograft cost to similar variables in a control group of 26 patients where the Collector was not utilized. Quality Adjusted Life Years (QALYs) were calculated as the effectiveness parameter for both groups. EQ-5D scores were used to calculate quality of life utilities pre-operatively and at 3 months, 1 year and 2 years post-operatively. The cost-effectiveness study was performed from a societal perspective with a 2-year horizon for US populations. RESULTS: Of the 81 patients for whom the Bone Collector was used, 58% patients required autograft only. Forty-Two percent required allograft supplementation with the harvested autograft. In the 26 patients where the bone collector was not utilized, 35% required autograft only, while 66% required both autograft and allograft. The mean allograft requirement for the Bone Collector group was 4cc, while that of the group not utilizing the Bone Collector was 7.5cc. The cost of Allograft ranged from $100 to $4000. The cost of the 2 different Bone Collectors that were used in this study ranged from $400 to $1000. Preoperative ODI and EQ-5D scores for the entire cohort improved at 3 months, one year and 2 years postoperatively. Our decision analysis revealed that using the Bone collector was dominant (cost saving and more effective) compared to non-use, saving $326 and gaining 0.04 QALYs. Results were robust in multiple sensitivity analyses, with Bone Collector remaining dominant unless its cost is >$2900. CONCLUSION: Our cost-effectiveness analysis revealed that Bone Collector would be cost saving and more effective in most plausible scenarios.

The Rise and Fall of Bone Morphogenetic Protein 2 Throughout the United States.

Retrospective Database Study. Investigate utilization of bone morphogenetic protein (BMP-2) between 2004 and 2014. The utilization, particularly off-label utilization, of BMP-2 has been controversial and debated in the literature. Given the concerns regarding cancer and potential complications, the risk benefit profile of BMP must be weighed with each surgical case. The debate regarding the costs and potential side effects of BMP-2 compared with autologous iliac crest bone harvest has continued. The National Inpatient Sample (NIS) database was queried for the use of BMP-2 (ICD-9-CM 84.52) between 2004 and 2014 across 44 states. The NIS database represents a 20% sample of discharges, weighted to provide national estimates. BMP-2 utilization rates in spine surgery fusion procedures were calculated as a fraction of the total number of thoracic, lumbar, and sacral spinal fusion surgeries performed each year. Between 2004 and 2014, BMP-2 was utilized in 927,275 spinal fusion surgeries. In 2004, BMP-2 was utilized in 28.3% of all cases (N=48,613). The relative use of BMP-2 in spine fusion surgeries peaked in 2008 at 47.0% (N=112,180). Since then, it has continued to steadily decline with an endpoint of 23.6% of cases in 2014 (N=60,863). Throughout the United States, the utilization of BMP-2 in thoracolumbar fusion surgeries increased from 28.3% to 47.0% between 2004 and 2008. However, from 2008 to 2014, the utilization of BMP-2 in thoracolumbar spine fusion surgeries decreased significantly from 47.0% to 23.4%. While this study provides information on the utilization of BMP-2 for the entire United States over an 11-year period, further research is needed to the determine the factors affecting these trends.

Acute normovolemic hemodilution in combination with tranexamic acid is an effective strategy for blood management in lumbar spinal fusion surgery

BackgroundThe retrospective study was designed to compare the effectiveness and safety of acute normovolemic hemodilution (ANH), tranexamic Acid (TXA), and a combination of ANH and TXA in lumbar spinal fusion surgery.MethodsData of 120 patients underwent multi-level posterior spinal fusion for treating degenerative lumbar disease between June 2013 and December 2017 was collected, retrospectively. Four treatment strategies were enrolled, including ANH, TXA, a combination of ANH and TXA, and without any patient blood management. Intraoperative blood loss, hemoglobin and PCV at the end of surgery and at the postoperative first day, and postoperative drain collection, and intraoperative and postoperative transfusion and rate of transfusion were also collected.ResultsIntraoperative blood loss and postoperative drain collection of the TXA group, ANH combined with TXA group were statistically lower than those in the control group and ANH group (P < 0.05). Intraoperative and postoperative transfusion amount and rate of intra-operative allogenic transfusion of the ANH group, TXA group, and ANH combined with TXA group were statistically lower than those of the control group (P < 0.05). Hemoglobin and PCV at postoperative the first day in the ANH group, TXA group, and ANH combined with TXA group were significant higher than those in the control group (P < 0.05). The combination of TXA and ANH group achieved the lowest intraoperative blood loss, postoperative drain collection and allogenic transfusion rate.ConclusionA combination of TXA and ANH might be an effective strategy for reducing the rate of transfusion and blood loss in patients underwent lumbar spinal fusion surgery.

Efficacy of bilateral erector spinae block for postoperative pain control in patients of lumbar spine fusion surgery

BackgroundControlling postoperative pain after posterior lumbar spine surgeries is necessary to achieve patient satisfaction and good outcome after successful surgical intervention. Preoperative erector spinae block (ESB) technique is considered a recently evolved tool to achieve these goals.PurposeThe aim of this study was to evaluate the efficacy of the bilateral ESB technique in pain management after lumbar spinal fusion surgery for degenerative spine diseases.Patients and methodsPatients who underwent lumbar spinal fusion surgery for degenerative pathologies in 2019and 2020 were enrolled in the study. The patients were assessed according to pain score experienced postoperatively at different times till the end of the first postoperative day by numeric rating scale, amount of analgesics received, and drug-related complications noticed in the first postoperative day.ResultsThe data of 60 patients who had lumbar spinal fusion surgery were collectively analyzed. Of these, 30 received only general anesthesia (group A), whereas the other 30 patients received the ESB in addition to general anesthesia (group B). The numeric rating scale pain scores and the amount of intravenous postoperative analgesia received were lower in group B than in group A at all the measured time points (P < 0.05). There was no significant difference in the incidence of complications between the two groups.ConclusionBilateral ESB is an effective tool in controlling postoperative pain after posterior spinal fusion surgeries in both pain intensity and postoperative-received analgesics.

The association between lumbar bone mineral density and advanced glycation end products derived from confocal fluoresce01. Basic science: Biologynce microscopy: A prospective investigation of bone biopsies in patients undergoing lumbar spinal fusion surgery

The association between lumbar bone mineral density and advanced glycation end products derived from confocal fluoresce01. Basic science: Biologynce microscopy: A prospective investigation of bone biopsies in patients undergoing lumbar spinal fusion surgery

The association between advanced glycation end products derived from confocal fluorescence microscopy of bone biopsies and dermal ultrasound echogenicity in patients undergoing lumbar spinal fusion surgery

The association between advanced glycation end products derived from confocal fluorescence microscopy of bone biopsies and dermal ultrasound echogenicity in patients undergoing lumbar spinal fusion surgery

A Novel Method of Ultrasound-guided Modified Thoracolumbar Interfascial Plane Block for Perioperative Pain Control in Lumbar Spine Fusion Surgery: Experience Based on Two Cases

Thoracolumbar Interfascial Plane Blocks (TLIP) is commonly used for pain management after spine surgeries. It involves blocking the dorsal rami of the thoracolumbar nerves in the fascial plane between the multifidus and longissimus muscles. The clinical efficacy of the conventional TLIP block is well documented in the postoperative pain management for lumbar spinal surgeries. The novel ultrasound-guided modified TLIP block described here is relatively safe and easier to perform by the trainee Anaesthesiologists. Besides, the relevant sonoanatomic landmarks of the novel technique and its perioperative analgesic efficacy in patients undergoing lumbar spine fusion surgery are described here. Further ultrasound- anatomy correlation studies are required to investigate this novel approach TLIP block.

Fatal Pulmonary Fat Embolism Occurring in Lumbar Spinal Fusion Surgery: Case Report and Review of Literature

Fat embolism system is one of the serious complications of orthopedic surgery, which is common seen in cases of severe trauma with long bone fractures. However, in clinical medical practice, it is rarely seen for Fat embolism system in orthopaedic lumbar fusion surgery. This paper report a case of sudden shock and death during lumbar fusion due to lumbar intervertebral disc disease. By forensic pathological examination, the pulmonary and brain fat embolism were observed in tissue sections, and the patient was diagnosed as FES. Based on the review of relevant literature and the pathological findings of this case, the clinical characteristics, diagnosis and treatment of FES in lumbar fusion are commentated in this paper. At the same time, it is emphasized that the clinical practise should strengthened the understanding and attention of non-traumatic fat embolism cases in order to timely identify, diagnose and treat the disease, improve the effectiveness of treatment, and reduce the corresponding medical disputes.

Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial

BackgroundContinuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated. ObjectivesThe aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries. MethodsIn this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test. ResultsMean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications. ConclusionContinuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.

Outcomes of anterior vs. posterior approach to single-level lumbar spinal fusion with interbody device: An analysis of the nationwide inpatient sample

BackgroundInterbody devices have revolutionized lumbar spinal fusion surgery by improving mechanical stability and maximizing fusion potential. Several approaches for interbody fusion exist with two of the most common being anterior lumbar interbody fusion (ALIF) and posterior lumbar interbody fusion (PLIF). This study aims to compare patient data, hospital outcomes, and post-operative complications between an anterior vs. posterior approach to lumbar interbody fusion. MethodsThis retrospective cohort study utilized the Nationwide Inpatient Sample (NIS) and International Classification of Diseases, 10th edition (ICD10) codes to identify patients (18 +) from 2016 to 2018 who underwent lumbar interbody fusion under an anterior or posterior approach. Patients missing identifiers were excluded from this study. Patients were further investigated by demographic data and the presence of comorbidities. Hospital outcome data was investigated by length of stay (LOS), total hospital charges, mortality, and post-operative complications. Results373,585 patients were included in this study. 257,975 (69%) underwent fusion via a posterior approach, and 115,610 (31%) via an anterior approach. Patients undergoing posterior approach were found to have a greater number of comorbidities than anterior (3.5 vs. 2, respectively, p = <0.001). The posterior approach was associated with decreased LOS (3.59 vs 4.19 days, p = <0.0001) and decreased total hospital charges ($141,700 vs $211,015, p = <0.0001). A posterior approach was found to have lower rates of post-operative complications. For the anterior approach cohort, tobacco dependence (OR=1.31 [1.20–1.42, p = <0.001], diabetes (OR=2.41 [2.33–2.49, p = <0.001], and osteoporosis (OR=1.42 [1.30–1.54, p = <0.001] were found to be significant independent predictors of post-operative pseudoarthrosis. Obesity (OR=1.28 [1.14–1.42, p = <0.001], tobacco dependence (OR=1.48 [1.40–1.56, p = <0.001], diabetes (OR=2.21 [2.10–2.32, p = <0.001], congestive heart failure (OR=1.20 [1.01–1.39, p = 0.04], and osteoporosis (OR=1.65 [1.55–1.75, p = <0.001], were found to be independent predictors of post-operative pseudoarthrosis in the posterior cohort. ConclusionsPatients who underwent the anterior approach suffered from increased hospital charges, length of stay, and increased risk of post-operative complications including mortality, wound dehiscence, hematoma/seroma, and pseudoarthrosis. Comorbid disease plays a significant role in the outcome of successful fusion with variable effect depending on the surgical approach. Increasing due diligence in patient selection should be considered when choosing an approach in pre-operative planning.

Lumbar spinal fusion surgery outcomes in a cohort of injured workers in the Victorian workers' compensation system.

Lumbar spinal fusion (LSF) outcomes for workers' compensation patients are worse than for the general population. The objectives were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes. Retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers' compensation system. WorkSafe Victoria's claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses. Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had substantial work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment. Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation and common law or impairment benefit lodgement before surgery. An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers' compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.

Qualitative analysis of the patient journey following lumbar spinal fusion surgery in real-time as lived: Insights to inform rehabilitation

Purpose: Approximately 4500 NHS lumbar spinal fusion surgery (LSFS) procedures are performed annually, at an estimated annual cost of £26 million. Low-level evidence suggests inconclusive/variable outcomes for LSFS. However, meta-analyses of data from observational studies have demonstrated clinically relevant improvement in leg pain, back pain and disability long-term. UK surveys investigating physiotherapy/surgeon practice have identified that decisions regarding surgery and rehabilitation should be patient-specific owing to considerable clinical heterogeneity.

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

This Month in Anesthesiology

This Month in Anesthesiology

Usefulness of Preoperative Planning by Three-Dimensional Planning Software for Pedicle Screw Placement in Thoracolumbar Surgeries: Misplacement Rate and Associated Risk Factors.

Introduction A number of imaging technologies have been developed to reduce the risk of pedicle screw (PS) misplacement. For example, preoperative three-dimensional (3D) planning can reportedly enhance implant placement accuracy in some orthopedic surgeries. However, no study has investigated the effect of preoperative 3D planning on PS placement without intraoperative 3D navigation. Thus, in this study, we aim to examine the accuracy of PS placement and identify the risk factors for PS misplacement in thoracolumbar surgeries performed using preoperative 3D planning software with intraoperative fluoroscopic guidance in a retrospective study. Methods In total, 25 consecutive patients (197 PSs) underwent thoracic or lumbar spinal fusion surgeries using preoperative 3D planning with intraoperative fluoroscopic guidance. PS misplacement was graded based on the degree of perforation (Grade 0, no perforation; Grade 1, <2 mm; Grade 2, 2-4 mm; Grade 3, >4 mm) observed in postoperative computed tomography (CT). Deviations between planned and actual PSs were evaluated by matching preoperative and postoperative CT volume images for each vertebra. Results The overall PS misplacement rate was 6.6% (Grade 1: 4.0%, Grade 2: 1.5%, Grade 3: 1.0%). The median linear deviations of PS entry points between planned and actual locations were determined to be 3.3 mm and 3.3 mm for the horizontal and vertical axes, respectively. The median angular deviations of the PS axis were 6.2° and 4.5° for the transverse and sagittal planes, respectively. Multivariate analysis revealed that horizontal deviation of the PS entry point was the sole factor associated with Grade ≥1 PS misplacement (odds ratio=2.47, p<0.001). Conclusions Preoperative 3D planning software without intraoperative 3D navigation was able to achieve a relatively low PS misplacement ratio among the reported ratio of conventional techniques without navigation. Surgeons should carefully ensure that the entry point is consistent with preoperative planning, especially in the mediolateral direction to avoid misplacement in this method.

Prognostic factors for outcome following lumbar spine fusion surgery: a systematic review and narrative synthesis.

The objective of this study was to identify and evaluate the value of prognostic factors related to disability, pain and quality of life (QoL) for adult patients undergoing lumbar spine fusion surgery (LSFS). Two reviewers independently searched the literature, assessed eligibility, extracted data and assessed risk of bias and certainty of evidence. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. LSFS] to 20/9/2020; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with ≥ 12-month follow-up after LSFS were included. Narrative synthesis was based on recommendations by Cochrane Consumers and Communication Review Group. The GRADE tool enabled assessment of certainty of evidence. Prognostic factors and outcome were analysed and summarised when examined in ≥ 2 studies and when results pointed in the same direction in ≥ 75% of studies. Sixteen studies (n = 8388, 2 low and 14 high risk of bias) were included with 39 prognostic factors identified. There is low certainty evidence that higher pre-operative severity of leg pain predicts greater improvement of leg pain and that pre-operative working predicts less post-operative disability both at 1-2-year follow-up. Other found associations were of very low certainty evidence. No moderate to high certainty evidence exists. Use of leg pain and pre-operative working may be valuable predictors of outcome to inform clinical decision-making and advice regarding LSFS surgery. There is need for adequately powered low-risk-of-bias prospective observational studies to further investigate candidate prognostic factors.

Presenteeism and absenteeism before and after single-level lumbar spine surgery

Background ContextHealth can impact work performance through absenteeism, time spent away from work, and presenteeism, inhibited at-work performance. Low back pain is common and costly, both in terms of direct medical expenditures and indirect reduced work performance. PurposeSurgery for lumbar spinal pathology is an important part of treatment for patients who do not respond to nonsurgical management. While the indirect costs of return to work and absenteeism among employed patients undergoing lumbar spine surgery have been studied, little work has been done to quantify presenteeism before and after lumbar spine surgery. Study Design/SettingProspective cohort study at a single high-volume urban musculoskeletal specialty hospital. PATIENT SAMPLEPatients undergoing single-level lumbar spinal fusion and/or decompression surgery. Outcome MeasuresPresenteeism and absenteeism were measured using the World Health Organization's Health and Work Performance Questionnaire before surgery, as well as 6 weeks, 6 months, and 12 months after surgery. MethodsAverage presenteeism and absenteeism were evaluated at pre-surgical baseline and each follow-up timepoint. Monthly average time lost to presenteeism and absenteeism were calculated before surgery and 12 months after surgery. Study data were collected and managed using REDCap electronic data capture tools with support from Clinical and Translational Science Center grant, UL1TR002384. One author discloses royalties, private investments, consulting fees, speaking/teaching arrangements, travel, board of directorship, and scientific advisory board membership totaling >$300,000. ResultsWe enrolled 134 employed surgical patients, among whom 115 (86%) responded at 6 weeks, 105 (78%) responded at 6 months, and 115 (86%) responded at 12 months. Preoperatively, mean age was 56.4 years (median 57.5), and 41.0% were women; 68 (50.7%) had only decompressions, while 66 (49.3%) had fusions. Among respondents at each time point, 98%, 92%, and 92% were still employed, among whom 76%, 96%, and 96% had resumed working, respectively (median 29 days). Average at-work performance among working patients (who responded at each pair of timepoints) moved from 75.4 to 78.7 between baseline and 6 weeks, 71.8 to 85.9 between baseline and 6 months, and 73.0 to 88.1 between baseline and 12 months. Gains were concentrated among the 52.0% of patients whose at-work performance was declining (and low) leading up to surgery. Average absenteeism was relatively unmoved between baseline and each follow-up. Before surgery, the monthly average time lost to presenteeism and absenteeism was 19.8% and 18.9%, respectively; 12 months after surgery, these numbers were 9.7% and 16.0%; changes represent a mitigated loss of 13.0 percentage points of average monthly value. ConclusionsPresenteeism and absenteeism contributed roughly evenly to preoperative average monthly lost time. Although average changes in absenteeism and 6-week at-work performance were small, average changes in at-work performance at 6 and 12 months were significant. Cost-benefit analyses of lumbar spine surgery should therefore consider improved presenteeism, which appears to offset some of the direct and indirect costs of surgical treatment.

Enhanced Recovery After Surgery Protocol for Lumbar Spinal Surgery With Regional Anesthesia: A Retrospective Review.

BackgroundIn the USA, spinal fusion surgery incurs the highest hospital cost. Despite the recent advances in the application of enhanced recovery after surgery (ERAS) protocols in these surgeries, the efficacy of these protocols in improving the perioperative outcomes remains unclear. We conducted a retrospective review as a quality improvement (QI) project to analyze the efficacy of the ERAS protocol with intraoperative modified thoracolumbar interfascial plane (mTLIP) block to determine whether these interventions reduce the length of stay (LOS) and opioid requirements during the postoperative period.MethodsRetrospective reviews of adult patients (>18 yrs) who underwent elective lumbar spinal fusion or laminectomy at our institute were reviewed. Patients were administered oral gabapentin and acetaminophen preoperatively. Prior to incision, an mTLIP block was performed using liposomal bupivacaine. Intraoperatively, ketamine, ketorolac, and tranexamic acid were administered. Postoperative, pain control was treated with scheduled acetaminophen, ketorolac, and low-dose ketamine infusion. Hydromorphone and oxycodone were administered for breakthrough pain. Patients who underwent a similar procedure without ERAS protocol were chosen as controls to assess the efficacy of ERAS protocol. Data pertaining to patient demographics, operative and perioperative use of analgesics, LOS, 90-day readmissions, and morbidity were collected. Patients who underwent laminectomy and spinal fusion surgery were analyzed separatelyResultsA total of 65 patients were identified; laminectomy (n- 24), spinal fusion surgery (n-41). In the laminectomy patients, treatment group (n-12) and the control group (n-12). Treatment group receiving the ERAS protocol with the regional anesthesia via the mTLIP (n= 12) opioid requirement was reduced by 51.42% [P = 0.03], and LOS was reduced by 2.04 days [P = 0.01] [0.75 days vs. 2.79 days]). In the spinal fusion patients, treatment group (n-15) and control group (n-26). Treatment group receiving the ERAS protocol with the use of regional anesthesia via the mTLIP group (n= 15), opioid requirement was reduced by 38.33% [P = 0.04]. No difference in LOS was observed at 5.4 days vs. 4.88 days (P = 0.28).ConclusionERAS protocol in patients undergoing lumbar spinal surgery incorporated the use of regional anesthesia via the mTLIP block, we observed there is a statistically significant reduction in the LOS for lumbar laminectomy and a significant reduction in opioid administration for lumbar laminectomies and spinal fusion surgery.

The effects of volume-controlled ventilation versus pressure-controlled ventilation on hemodynamic and respiratory parameters in patients undergoing lumbar spine fusion surgery: a randomized controlled trial.

Hypotension is a common event in patients under general anesthesia during lumbar spine fusion surgery. The reduction of venous drainage followed by the postural changes is the main reason. The venous return reduced when the intrathoracic pressure is positive. Volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) are two traditional ventilation modes in operating room, with different respiratory mechanics. The two ventilation modes have different influences on intrathoracic pressure and consequently venous return. A double-blinded, randomized, parallel group controlled clinical trial was conducted to examine the hemodynamic and respiratory effects of two different ventilation modes in lumbar spine fusion surgery. Forty-eight patients scheduled for posterior lumbar spine fusion surgery at Zhongda Hospital, Southeast University were randomly allocated into two groups to receive either the VCV mode or PCV mode [vital volume (VT) 8 mL/kg, and partial pressure of end-tidal carbon dioxide (PETCO2) 35-45 mmHg]. The respiratory mechanics [peak airway pressure (Ppeak) and dynamic compliance (Cdyn)] and hemodynamic changes were measured every 10 min for 120 min. All participants and relevant staff were blinded to the randomization. The data of 19 of 22 patients in the VCV group and 18 of 20 in the PCV group were analyzed. Compared to VCV group, cardiac output (CO) and central venous pressure (CVP) in the PCV group were higher; however, the difference was not significant. There's no statistically difference in systemic vascular resistance index (SVRI) values of both the groups. The mean blood pressure (MBP) of the PCV group was higher than that of the VCV group from 90 min after the patients were turned to the prone position until the endpoint. The Cdyn and Ppeak of the PCV group were higher than those of the VCV group. Additionally, there was a positive correlation between Cdyn and CO (r=0.744, P=0.006). With better respiratory mechanic and hemodynamic stability, PCV was a better choice for patients undergoing lumbar spine fusion surgery. Chinese Clinical Trial Registry ChiCTR-TRC-14005086.