Study: Simple movements may improve the outcome of spinal fusion

A new approach that could revolutionize spinal fusion eliminates the need to “turn over” the patient from the back or side to the stomach during surgery. Switch researchers say the results will improve dramatically.

A new technique (called single-position lumbar surgery (SPLS)) allows the surgeon to complete the entire spinal fusion while the patient is lying down. The researchers examined 244 patients with an average age of 61 years who received this procedure between 2012 and 2019.

Spinal fusion is used to treat spinal conditions associated with degeneration or deformity, such as spinal canal stenosis, scoliosis, and spondylolisthesis.

The results were positive at many levels, researchers say. Compared to 153 patients who underwent standard surgery, SPLS patients lost less blood during surgery and had a lower risk of postoperative bowel obstruction, the researchers reported. Total surgery time has been reduced by two-thirds and postoperative hospital stays have been cut in half.

“Spinal fusion is a treatment option for severe cases of age-related changes in the spine,” said Dr. Kimberly Ashaeri, author of neurosurgery at NYU Langone Health in New York City. “The goal is to improve spinal alignment and relieve pressure on the nerves from the disc and other substances.”

According to her, in this surgery, “a screw connected by a rod is placed on the bone of the spine to hold the bone in place. Often, in addition to the rod and screw, the surgeon removes the disc. It needs to be replaced. With spacers. ”Langone alone performs about 2,000 spinal fusions a year.

Traditionally, surgery is done in two parts, Ashayeri said. When the surgeon places the spacer, the patient lies on his back or sideways. The patient is then turned over into the stomach to place the rods and screws.

However, she said the flip method is longer than SPLS and involves more anesthesia, more blood loss, and an increased risk of postoperative ileus.

SPLS “allows surgeons to work on both parts of the procedure at the same time,” Ashayeri said.

This reduces surgery time from about 5 hours to about 90 minutes, reduces anesthesia, blood loss, and possibly postoperative pain, and reduces the need for narcotic analgesics. She said the fusion rate was also high.

The findings suggest that SPLS is safe, effective, and beneficial to the right patients, but longer-term follow-up is needed before declaring new standard treatments, Ashayeri said. Stated.

In that regard, two experts who were not involved in the study responded cautiously to the findings.

“I think more work will be needed before SPLS can be considered a new standard of care,” said Dr. Andrew Schoenfeld, an associate professor of orthopedics at Harvard Medical School in Boston.

Schoenfeld said not all hospitals across the country are in a position to adopt this approach as much as Langone, a major medical center with “a large number of spine surgeons who have experience in implementing this technique.” It was. He said that these surgeries have a learning curve and it is important that the operating room has experienced surgeons, radiologists, nurses and support staff.

“In other inexperienced clinical environments, results can vary significantly,” Schoenfeld said.

In addition, not all spinal fusion patients require or are suitable for this approach, said Dr. Daniel Park, an orthopedic spine surgeon at William Beaumont Hospital in Royal Oak, Michigan. ..

Some people say that minimally invasive spinal fusion and conventional surgery work just as well, he said.

“The minimally invasive fusion that takes place when a person is lying down is probably as successful as this method,” Park said. And the SPLS approach is probably not suitable for some patients.

“This is not the new standard treatment,” he said. Instead, this study shows that the SPLS approach is safe and viable, adding an additional “option to the surgeon’s toolbag.”

Survey results published online this month Spine journal.

For more information

Find out more about spinal fusion at the Mayo Clinic.

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Study: Simple movements may improve the outcome of spinal fusion

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