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Sperber J, Owolo E, Zachem TJ, Bishop B, Johnson E, Lad EM, Goodwin CR. Perioperative Blindness in Spine Surgery: A Scoping Literature Review. J Clin Med 2024; 13:1051. [PMID: 38398364 PMCID: PMC10889585 DOI: 10.3390/jcm13041051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/22/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Perioperative vision loss (POVL) is a devastating surgical complication that impacts both the recovery from surgery and quality of life, most commonly occurring after spine surgery. With rates of spine surgery dramatically increasing, the prevalence of POVL will increase proportionately. This scoping review aims to aggregate the literature pertinent to POVL in spine surgery and consolidate recommendations and preventative measures to reduce the risk of POVL. There are several causes of POVL, and the main contribution following spine surgery is ischemic optic neuropathy (ION). Vision loss often manifests immediately following surgery and is irreversible and severe. Diffusion weighted imaging has recently surfaced as a diagnostic tool to identify ION. There are no effective treatments; therefore, risk stratification for counseling and prevention are vital. Patients undergoing prone surgery of long duration and/or with significant expected blood loss are at greatest risk. Future research is necessary to develop effective treatments.
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Affiliation(s)
- Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
| | - Tanner J. Zachem
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC 27710, USA
| | - Brandon Bishop
- College of Medicine, Kansas City University; Kansas City, MO 64106, USA
| | - Eli Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
| | - Eleonora M. Lad
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC 27710, USA
| | - C. Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA (E.J.)
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
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Jayaram RH, Joo PY, Gouzoulis MJ, Ratnasamy PP, Caruana DL, Grauer JN. Single-level Anterior Cervical Discectomy and Fusion Results in Lower Five-year Revisions than Posterior Cervical Foraminotomy in a Large National Cohort. Spine (Phila Pa 1976) 2023; 48:1266-1271. [PMID: 37339256 DOI: 10.1097/brs.0000000000004754] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
STUDY DESIGN A retrospective cohort study using the 2010-2020 MSpine PearlDiver administrative data set. OBJECTIVE To compare perioperative adverse events and five-year revisions for single-level anterior cervical discectomy and fusion (ACDF) versus posterior cervical foraminotomy (PCF). SUMMARY OF BACKGROUND DATA Cervical disk disease can often be treated surgically using single-level ACDF or PCF. Prior studies have suggested that posterior approaches provide similar short-term outcomes as ACDF; however, posterior procedures may have an increased risk of revision surgery. MATERIALS AND METHODS The database was queried for patients undergoing elective single-level ACDF or PCF (excluding cases performed for myelopathy, trauma, neoplasm, and/or infection). Outcomes, including specific complications, readmission, and reoperations, were assessed. Multivariable logistic regression was used to ascertain odds ratios (OR) of 90-day adverse events controlling for age, sex, and comorbidities. Kaplan-Meier survival analysis was performed to determine five-year rates of cervical reoperation in the ACDF and PCF cohorts. RESULTS A total of 31,953 patients treated by ACDF (29,958, 93.76%) or PCF (1995, 6.24%) were identified. Multivariable analysis, controlling for age, sex, and comorbidities, demonstrated that PCF was associated with significantly greater odds of aggregated serious adverse events (OR 2.17, P <0.001), wound dehiscence (OR 5.89, P <0.001), surgical site infection (OR 3.66, P <0.001), and pulmonary embolism (OR 1.72, P =0.04). However, PCF was associated with significantly lower odds of readmission (OR 0.32, P <0.001), dysphagia (OR 0.44, P <0.001), and pneumonia (OR 0.50, P =0.004). At five years, PCF cases had a significantly higher cumulative revision rate compared with ACDF cases (19.0% vs. 14.8%, P <0.001). CONCLUSIONS The current study is the largest to date to compare short-term adverse events and five-year revision rates between single-level ACDF and PCF for nonmyelopathy elective cases. Perioperative adverse events differed by procedure, and it was notable that the incidence of cumulative revisions was higher for PCF. These findings can be used in decision-making when there is clinical equipoise between ACDF and PCF.
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Affiliation(s)
- Rahul H Jayaram
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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Deng R, Huang X, Xiao Y, Meng L, Wang J. A Percutaneous Nephrolithotripsy Performed in the Oblique Supine Lithotomy Position: A Better Choice. Surg Innov 2021; 29:360-366. [PMID: 34696633 DOI: 10.1177/15533506211041895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate the efficacy and safety of the oblique supine lithotomy during percutaneous nephrolithotomy (PCNL) to treat upper urinary calculi. Methods. Clinical data were retrospectively analyzed for 371 patients with upper urinary calculi who underwent PCNL at The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2017 to October 2020. Based on different positions, patients were divided into the observation group (oblique supine lithotomy position, 155 cases, Group 1) or control group (prone position, 216 cases, Group 2). Groups were compared for effectiveness, complications, bleeding, surgical time, clinical indicators, and hospitalization time. Results. There were no significant differences in the clinical baseline data between the two groups (p > .05). However, the stone-free rate for patients was significantly higher in the observation than in the control group (p < .05). Both operation time and hospital stay time were significantly lower in the observation versus the control groups (p < .05). No significant differences were observed for complications or amount of blood loss (p > .05). Conclusion. In patients with upper urinary calculi, percutaneous nephrolithotomy in the oblique supine lithotomy position has a higher stone-free rate than the prone position. This approach can shorten the operation and provide better comfort and quicker recovery to the patients. A further advantage is that there is no difference in safety and blood loss between the prone position and the oblique lithotomy position.
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Affiliation(s)
- Runpei Deng
- 47879The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xueyang Huang
- 47879Baiyun Hospital, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yonglin Xiao
- 47879Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Meng
- Department of Urology, 47879The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun Wang
- Department of Urology, 47879The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Choi MA, Kim MS, Kim C. Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room. J Tissue Viability 2021; 30:331-338. [PMID: 34154878 DOI: 10.1016/j.jtv.2021.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
AIM We aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery. MATERIALS AND METHODS This was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ2 -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%. RESULTS The mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37-340.26), 3.96 (95% CI: 1.13-13.86), and 5.60 times (95% CI: 1.62-19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35-38.00) and 7.93 times (95% CI: 1.45-43.27) for<3 and ≥3 h' duration, respectively. CONCLUSION The difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.
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Affiliation(s)
- Mi Ae Choi
- Master, Unit Manager, Operating Room, Department of Nursing, Busan Korea Hospital, Busan, South Korea
| | - Myoung Soo Kim
- Professor, Department of Nursing, Pukyong National University, Busan, South Korea.
| | - Cheol Kim
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Spine Center, Busan Korea Hospital, Busan, South Korea
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Neal-Smith G, Kim DS, Wood A. A Review of Orthopaedic Surgical Set-Up and Introduction of the TULIPS Mnemonic - Six Simple Steps for Optimising Set-Up in Orthopaedic Surgery. Cureus 2020; 12:e9806. [PMID: 32953318 PMCID: PMC7494417 DOI: 10.7759/cureus.9806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/16/2020] [Indexed: 11/27/2022] Open
Abstract
Conducting a thorough check to ensure that all equipment and personnel are positioned correctly at the start of any operation is essential for both the safety of the surgical team and the patient outcome. Orthopaedic surgery in particular carries a high risk of occupational injury and this group could benefit greatly from ergonomic improvements. This review highlights multiple factors that can influence safety of surgeons, surgical efficiency and patient outcomes. "TULIPS" is a mnemonic that lists six key steps in optimising the surgical procedure through effective positioning of equipment and personnel pre-operatively. This was trialled by distribution amongst orthopaedic registrars regionally and it received excellent feedback, with the majority changing their current practice. Here we report that using this simple and memorable checklist can assist orthopaedic surgeons in setting up the operating theatre, facilitating ergonomic improvements that can reduce the risk of musculoskeletal injury and radiation exposure.
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Affiliation(s)
- Gregory Neal-Smith
- Trauma and Orthopaedics, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - David S Kim
- Trauma and Orthopaedics, Oxford University Medical School, Oxford, GBR
| | - Alexander Wood
- Trauma, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
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Badhiwala JH, Ellenbogen Y, Khan O, Nouri A, Jiang F, Wilson JR, Jaja B, Witiw CD, Nassiri F, Fehlings MG, Wilson JR. Comparison of the Inpatient Complications and Health Care Costs of Anterior versus Posterior Cervical Decompression and Fusion in Patients with Multilevel Degenerative Cervical Myelopathy: A Retrospective Propensity Score–Matched Analysis. World Neurosurg 2020; 134:e112-e119. [DOI: 10.1016/j.wneu.2019.09.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Park JH, Kwon JY, Lee SE, Kim YH, Kim SH. Sudden hemodynamic collapse after prone positioning on a Jackson spinal table for spinal surgery. Korean J Anesthesiol 2018; 73:71-74. [PMID: 30590915 PMCID: PMC7000273 DOI: 10.4097/kja.d.18.00339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background The prone position is used for a variety of procedures and surgeries, and hypotension is a commonly encountered complication. Case A 75-year-old obese woman with lumbar spinal stenosis underwent posterior lumbar spinal fusion and posterolateral interbody fusion under general anesthesia. Before the surgery, when she was positioned on a Jackson spinal table in the prone position, sudden severe hypotension and hemodynamic collapse developed. The circulatory collapse was refractory to intravascular volume expansion and administration of inotropes and vasopressors. However, the application of external abdominal support immediately restored hemodynamic stability. The patient successfully underwent the surgery using an external abdominal support, and no post-operative complication was noted, including abdominal compartment syndrome. Conclusions The Jackson spinal table allowed the abdomen to hang freely, providing abdominal decompression while resulting in a severely sagged abdomen. We suspected that the sagging abdomen had pulled the abdominal contents downwards, kinking the inferior vena cava or causing a venous pool in the abdomen, resulting in the obstruction of venous return to the heart.
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Affiliation(s)
- Jae Hong Park
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Yeon Kwon
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Eun Lee
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Han Kim
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Se Hun Kim
- Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg 2016; 100:292-303. [PMID: 25692433 DOI: 10.9738/intsurg-d-13-00256.1] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.
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Complications in spinal deformity surgery: issues unrelated directly to intraoperative technical skills. Spine (Phila Pa 1976) 2010; 35:2215-23. [PMID: 21102296 DOI: 10.1097/brs.0b013e3181fd591f] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature review of complications unrelated directly to surgical skills involved in spinal deformity surgery. OBJECTIVE Highlight complications associated with perioperative issues. SUMMARY OF BACKGROUND DATA Complications can arise from mundane events that arise during the operative experience, but are not directly related to surgical skills. METHODS Literature reviews that touches on the more common potential complication events that do not involve direct surgical expertise. RESULTS The topics of positioning, nutrition, blood loss, comorbidities, OR time, and pulmonary and GI concerns are discussed as basics that could derail a surgical outcome even with an otherwise uneventful surgical technique. The need for vigilance is stressed and the nuances of understanding these are discussed. CONCLUSION Mundane events can derail a perfectly executed surgical undertaking. Attention to detail, team work, close monitoring, and checklist type focus will help to improve, focus, and avoid these preventable complications that have nothing to do with direct surgical skills.
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2008; 16:394-7. [PMID: 18626261 DOI: 10.1097/moo.0b013e32830c1edc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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