Spine surgery continues to evolve and innovate as demonstrated by new literature in our top spine journals. The spine community tried tackling some very large clinical problems common to surgeons taking care of complex spine pathology. We will go through a brief review of some interesting articles that we hope will help clinicians taking care of patients.
Preventing Post Operative Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
A large group of spine surgeons and medical attendings have provided guidance on how best to handle post-operative deep venous thromboembolism (DVT)/pulmonary embolus (PE) prophylaxis after spine surgery(1). By using a Delphi method of consensus development the authors gave specific recommendations on 27 topics related to preventing DVT/PE prophylaxis. Eighteen institutions were involved with clinicians that had decades of surgical/medical experience. From my perspective as a surgeon, I was happy to find that I agreed with many of their findings. This included stopping anti-coagulation (AC) at least 2 days prior to surgery. Concise tables were also provided regarding when to start AC after surgery. For those at highest risk of DVT/PE it was recommended to start DVT ppx after 2 days. They even were able to provide a table for scoring patients on risk. This article is a tremendous accomplishment to provide clear guidelines in a situation where the literature is all over the place.
Novel Technique for Pedicle Screw Revision
Screw cutout during revision spine surgery is a disaster for patients. It can make an already difficult day in the OR nearly impossible. Shen et al. offered a solution for surgeons in this dire clinical situation(2). The authors performed a biomechanical study of pediculoplasty. This technique allows for impaction grafting when dealing with a lumbar pedicle with no bone for screw purchase. Surprising to me, they found that cement augmentation had a better biomechanical result. As someone who has seen complications with cement augmentation, I found this article very helpful in providing another bail out option during surgery when trying to place a pedicle screw during revision surgery.
Surgical Site Infections
A sobering article was provided by Grauer et al. regarding how we deal with spine surgical site infections(3). The authors reviewed over 11 thousand cases at a single institution over 8 years. They found 76 surgical site infections (SSIs). Those with bacteremia were found to have 38.3 times greater odds of failed attempt at one-stage I&D. Given the ever increasing rates of spine surgeries, this article provides support to surgeons who may want to do a “second look” procedure to ensure complete treatment of a SSI. This was an extremely informative read and I encourage clinicians to look over their findings.
I hope this brief synopsis stimulates discussion among you and your peers. Looking forward to keeping this conversation going with more articles to come on innovations in spine care. Month to month, great literature is out there and we will try to highlight articles of interest.
References
1. Zuckerman SL, Berven S, Streiff MB, Kerolus M, Buchanan IA, Ha A, et al. Management of Anticoagulation/Antiplatelet Medication and Venous Thromboembolism Prophylaxis in Elective Spine Surgery: Concise Clinical Recommendations Based on a Modified Delphi Process. 2023;48(5):301-9.
2. Shen FH, Hayward GM, Harris JA, Gonzalez J, Thai E, Raso J, et al. Impaction grafting of lumbar pedicle defects: a biomechanical study of a novel technique for pedicle screw revision %J Journal of Neurosurgery: Spine. 2023;38(3):313-8.
3. Dhodapkar MM, Galivanche AR, Halperin SJ, Elaydi A, Rubio DR, Grauer JN. Postoperative spine surgical site infections: high rate of failure of one-stage irrigation and debridement. The spine journal : official journal of the North American Spine Society. 2023;23(4):484-91.
