The Successful Evolution of Endoscopic Spine Surgery: Coincidence or Human Spirit?

Spine Surgery Assisted by Augmented Reality: Where Have We Been?

This present systematic review examines spine surgery literature supporting augmented reality (AR) technology and summarizes its current status in spinal surgery technology. Database search strategies were retrieved from PubMed, Web of Science, Cochrane Library, Embase, from the earliest records to April 1, 2021. Our review briefly examines the history of AR, and enumerates different device application workflows in a variety of spinal surgeries. We also sort out the pros and cons of current mainstream AR devices and the latest updates. A total of 45 articles are included in our review. The most prevalent surgical applications included are the augmented reality surgical navigation system and head-mounted display. The most popular application of AR is pedicle screw instrumentation in spine surgery, and the primary responsible surgical levels are thoracic and lumbar. AR guidance systems show high potential value in practical clinical applications for the spine. The overall number of cases in AR-related studies is still rare compared to traditional surgical-assisted techniques. These lack long-term clinical efficacy and robust surgical-related statistical data. Changing healthcare laws as well as the increasing prevalence of spinal surgery are generating critical data that determines the value of AR technology.

The risk factors associated with delirium after lumbar spine surgery in elderly patients

Background

To prospectively explore the incidence and risk factors for postoperative delirium in elderly patients following lumbar spine surgery.

Methods

This prospective study enrolled 148 consecutive patients over the age of 65 who were scheduled to undergo spine surgery. Patients were screened for delirium using the short Confusion Assessment Method (CAM) postoperatively. Patient demographics and relevant medical information were collected. Logistic regression analysis was used to identify the risk factors associated with postoperative delirium.

Results

Eighty-three patients (56.1%) who underwent lumbar spine surgery (not coexisting with cervical or thoracic spine surgery) were enrolled in our study. Post-operative delirium was noted in 14.5% of patients over 65 years old. The presence of preoperative Parkinsonism was significantly higher in the delirium group (41.7% vs. 8.5%, P=0.002), as was a higher preoperative C-reactive protein (CRP) (7.0±15.2 vs. 1.3±2.3 mg/L, P=0.017) when compared with the non-delirium group. Of the risk factors, male sex [odds ratio (OR) =0.10, 95% confidence interval (CI): 0.01-0.66, P=0.017], Parkinsonism (OR =5.83, 95% CI: 1.03-32.89, P=0.046), and lower baseline MMSE score (OR =0.71, 95% CI: 0.52-0.97, P=0.032) were independently associated with postoperative delirium in elderly patients undergoing lumbar spine surgery.

Conclusions

Post-operative delirium occurred in 14.5% of elderly patients who underwent lumbar spine surgery. Male sex, Parkinsonism, and lower baseline MMSE score were identified as independent risk factors for postoperative delirium in elderly patients following lumbar surgery.