Updated imaging does not affect revision rates in adults undergoing spine surgery for lumbar degenerative disease

Preliminary Evaluation of Standing Full-Length Plain Radiographs Utility in an Adult Degenerative Spine Practice

INTRODUCTION

The role of weight-bearing full-length standing radiographs (FLSRs) of the spine in the preoperative workup of adult degenerative disease of the lumbar spine is a subject of increasing research. This investigation aims to determine whether FLSR influences preoperative planning decisions.

METHODS

In this prospective study, eight spine surgeons reviewed two 30-patient case series. The first set (set A) contained a patient history, physical examination data, and preoperative images. The second set (set B) contained all information in set A in addition to preoperative FLSR AP and lateral radiographs. Within 2 weeks of evaluating set A, reviewers assessed set B. Case sets were randomized. After reviewing each set, reviewers gave surgical plans and whether they believed an FLSR was important in planning. Decisions were evaluated by subspecialty, years of practice, and postfellowship years. A McNemar test assessed differences between set viewings. A chi-square test assessed differences of preoperative decision changes between different specialties and levels of experience. A Poisson regression assessed characteristics associated with changing preoperative plans. We analyzed patients by the number of unique reviewer procedures, surgical levels, and associated pathology.

RESULTS

After viewing an FLSR, 44.7% of reviewers changed procedure. Reviewer opinion of FLSR importance differed between sets (27.1% versus 35.7%, P = 0.047). Among all reviewers, FLSR presentation was associated with aligning the number of proposed procedures in 15 patients. Scoliosis and sacral dysplasia were associated with negative deltas. FLSR viewing reduced the span of operational levels considered. Along the most divided patients, those with a high magnitude (≥6 choices) of initial procedures had more negative deltas than did those with a high number (≥5 choices) of surgical level choices.

CONCLUSION

FLSR remains a critical aspect of presurgical planning. Even when reviewers initially believed patients would not benefit from FLSR, we observed changes in preoperative planning after FLSR viewing.

Bacteria in Surgical Smoke: A Self-controlled Laboratory Study Using Porcine Spinal Tissues

STUDY DESIGN

A laboratory study performed in a self-controlled fashion.

OBJECTIVE

The aim of this study was to examine whether "surgical smoke" generated by using the electrocautery on porcine spinal tissues could contain viable bacteria.

SUMMARY OF BACKGROUND DATA

The year 2020 has seen a surge in legislation regarding surgical smoke evacuation in the operating room across the United States. Surgical smoke contains numerous toxic and carcinogenic substances, which spine surgeons and operating room staff are regularly exposed to. Although the smoke's chemical toxicity has been extensively studied, little is known about its biohazard level.

METHODS

The electrocautery was used to "operate on" 20 segments of porcine spinal tissues on a clean bench. In each operation, the generated smoke was captured with a swab, which was positioned above the surgical site and within the smoke, to obtain bacteria cultures. Two other swabs-a tissue swab (swabbing the porcine tissue itself) and a blank swab (swabbing an empty sterile bowl)-were collected as controls. The culture results were compared among the three groups. An additional experiment was conducted to see whether using a mask can reduce the "infection rate" of the swab.

RESULTS

Although all blank swabs tested negative, 95% (19/20) of the smoke swabs tested positive, with a total of nine bacteria species identified. The most prevalent species observed in the smoke swabs included Serratia liquefaciens, Lactococcus garvieae, and Hafnia alvei, and so on. Among the positive smoke swabs, 84% (16/19) had one or more bacteria species that were consistent with the cultures of their corresponding tissue swabs. Using a surgical or N95 mask reduced the "infection rate" of the swab.

CONCLUSION

"Surgical smoke" generated by electrocauterization of porcine spinal tissues contains viable bacteria. Further research in actual spine surgery is needed next.Level of Evidence: N/A.