scholarly journals Prophylactic Norepinephrine Infusion Reduces Postoperative Complications and Hospitalization Time in Elderly Patients Undergoing Posterior Lumbar Spinal Fusion

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Tao Liang ◽  
Jianshe Yu ◽  
Libiao Li ◽  
Yaying Xie ◽  
Fan Wu
Keyword(s):  
Hyaluronic Acid ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Spinal Fusion ◽  
Serum Levels ◽  
Control Group ◽  
Lumbar Spinal Fusion ◽  
Hospitalization Time ◽  
Norepinephrine Infusion ◽  
Lumbar Spinal

This single-center prospective randomized controlled trial explores the effect of prophylactic norepinephrine infusion on the incidence of complications and hospitalization time in elderly patients (60-85 years old) undergoing posterior lumbar spinal fusion. In total, 129 elderly patients were randomized into two groups: a group that received norepinephrine during general anesthesia and a control group not receiving norepinephrine. The primary outcomes were in-hospital complications and 90-day postoperative complications and hospitalization time. The results show that in-hospital complications occurred in 24 of 60 patients (40%) in the control group versus 11 of 60 patients (18.3%) in the norepinephrine group (RR, 2.182; 95% CI, 1.177–4.045; P = 0.015 ). Cardiac events occurred significantly more frequently in the control than in the norepinephrine group. Total number of patients experiencing complications within 90 days postoperatively was lower in the norepinephrine (11 of 60; 18.3%) than in the control group (26 of 60; 43.3%; RR, 2.364; 95% CI, 1.288–4.339; P = 0.005 ). The median length of hospital stay was 17 days (11–27) in the control group and 15 days (10– 23) in the norepinephrine group ( P = 0.01 ). The secondary outcomes were serum levels of syndecan-1, hyaluronic acid, heparan sulfate, and brain natriuretic peptide. Logistic regression analysis is used to describe the relationship between selected independent variables and in-hospital complications. Intraoperative total fluid, crystalloid, and colloid volumes were significantly higher in the control than in the norepinephrine group. The patients in the norepinephrine group had a higher MAP but a lower heart rate than those in the control group after the induction of anesthesia and intraoperatively. Syndecan-1, hyaluronic acid, and heparan sulfate serum levels showed a different course in the two groups. In conclusion, prophylactic norepinephrine infusion during posterior lumbar spinal fusion is preferable for elderly patients undergoing lumbar spinal fusion under general anesthesia. It can reduce postoperative complications and hospitalization time by reducing the injury to the vascular endothelium. This trial is registered with Clinical Trial Registration http://www.chictr.org.cn/showproj.aspx?proj=33660, identifier ChiCTR-1900021309.

Risk of Postoperative Complications and Revision Surgery Following Robot-assisted Posterior Lumbar Spinal Fusion

Spine ◽  
2020 ◽  
Vol 45 (24) ◽  
pp. E1692-E1698
Author(s):  
Daniel S. Yang ◽  
Neill Y. Li ◽  
Dominic T. Kleinhenz ◽  
Shyam Patel ◽  
Alan H. Daniels
Keyword(s):  
Postoperative Complications ◽  
Spinal Fusion ◽  
Revision Surgery ◽  
Lumbar Spinal Fusion ◽  
Robot Assisted ◽  
Lumbar Spinal

scholarly journals Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion

2021 ◽  
Author(s):  
Pascal R. Furrer ◽  
Sebastiano Caprara ◽  
Florian Wanivenhaus ◽  
Marco D. Burkhard ◽  
Marco Senteler ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Sagittal Alignment ◽  
Shape Modeling ◽  
Patient Specific ◽  
Control Group ◽  
Lumbar Spinal Fusion ◽  
Spinal Sagittal Alignment ◽  
Statistical Shape ◽  
Lumbar Spinal ◽  
Asymptomatic Control

Abstract Purpose The present study compared patients developing ASD after L4/5 spinal fusion with a control group using a patient-specific statistical shape model (SSM) to find alignment-differences between the groups. Methods This study included patients who had undergone spinal fusion at L4/5 and either remained asymptomatic (control group; n = 25, follow-up of > 4 years) or required revision surgery for epifusional ASD (n = 22). Landmarks on preoperative and postoperative lateral radiographs were annotated, and the optimal spinal sagittal alignment was calculated for each patient. The two-dimensional distance from the SSM-calculated optimum to the actual positions before and after fusion surgery was compared. Results Postoperatively, the additive mean distance from the SSM-calculated optimum was 86.8 mm in the ASD group and 67.7 mm in the control group (p = 0.119). Greater differences were observed between the groups with a larger distance to the ideal in patients with ASD at more cranial levels. Significant difference between the groups was seen postoperatively in the vertical distance of the operated segment L4. The patients with ASD (5.69 ± 3.0 mm) had a significant greater distance from the SSM as the control group (3.58 ± 3.5 mm, p = 0.034). Conclusion Patients with ASD requiring revision after lumbar spinal fusion have greater differences from the optimal spinal sagittal alignment as an asymptomatic control group calculated by patient-specific statistical shape modeling. Further research might help to understand the value of SSM, in conjunction with already established indexes, for preoperative planning with the aim of reducing the risk of ASD. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding

scholarly journals Do Clinical Outcomes and Sagittal Parameters Differ Between Diabetics and Nondiabetics for Degenerative Spondylolisthesis Undergoing Lumbar Fusion?

2019 ◽  
Vol 10 (3) ◽  
pp. 286-293
Author(s):  
Jannat M. Khan ◽  
Joseph Michalski ◽  
Bryce A. Basques ◽  
Philip K. Louie ◽  
Oscar Chen ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Spinal Fusion ◽  
Clinical Outcomes ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Diabetic Patients ◽  
Lumbar Spinal Fusion ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Lumbar Spinal

Study Design: Retrospective cohort study. Objective: To assess the effect of diabetes mellitus (DM) on clinical and radiographic outcomes in patient with degenerative spondylolisthesis undergoing posterior lumbar spinal fusion. Methods: Analysis of patients who underwent open posterior lumbar spinal fusion from 2011 to 2018. Patients being medically treated for DM were identified and separated from nondiabetic patients. Visual analogue scale Back/Leg pain and Oswestry Disability Index (ODI) were collected, and achievement of minimal clinically important difference was evaluated. Lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), and PI-LL difference were measured on radiographs. Rates of postoperative complications were also collected. Results: A total of 850 patients were included; 78 (9.20%) diabetic patients and 772 (90.80%) nondiabetic patients. Final PI-LL difference was significantly larger ( P = .032) for patients with diabetes compared to no diabetes, but there were no other significant differences between radiographic measurements, operative time, or postoperative length of stay. There were no differences in clinical outcomes between the 2 groups. Diabetic patients were found to have a higher rate of discharge to a facility following surgery ( P = .018). No differences were observed in reoperation or postoperative complication. Conclusions: While diabetic patients had more associated comorbidities compared with nondiabetic patients, they had similar patient-reported and radiographic outcomes. Similarly, there are no differences in rates of reoperation or postoperative complications. This study indicates that diabetic patients who have undergone thorough preoperative screening of related comorbidities and appropriate selection should be considered for lumbar spinal fusion.

scholarly journals Adequate Dosage of Norepinephrine Infusion Combined with Goal-Directed Fluid Therapy During General Anesthesia May Improve Elderly Patients’ Postoperative Outcome Undergoing Lumbar Spinal Fusion

2020 ◽  
Author(s):  
Fan Wu ◽  
Tao Liang ◽  
Jie Wu ◽  
Wei Xiao ◽  
Long Fan ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Elderly Patients ◽  
Fluid Therapy ◽  
Postoperative Outcome ◽  
Postoperative Hospital Stay ◽  
Lumbar Spinal Fusion ◽  
Norepinephrine Infusion ◽  
Goal Directed Fluid Therapy ◽  
Group 3 ◽  
Lumbar Spinal

Abstract Background: Norepinephrine is used to prevent anesthesia-related disorders in elderly patients. However, optimal dosage that improve the postoperative outcome undergone lumbar spinal fusion is unknown.Methods: A total of 108 elderly patients were randomized into three groups of norepinephrine infusion as 0.030 µg.kg− 1.min− 1, 0.060 µg.kg− 1.min− 1 and 0.090 µg.kg− 1.min− 1. The hemodynamics and related parameters were monitored at the entrance to the operation room (T0), 15 min following anesthesia induction (T1), 60 min after surgical incision (T2), and immediately after surgery (T3), respectively. The primary outcome was set as the incidence of postoperative complications and wound infections. The secondary outcomes were recorded by the incidence of nausea and vomiting, the time of first flatus, first ambulation, first intake and postoperative hospital stay.Results: Finally, 90 patients were recruited into the clinical trial, with 30 in each group. The incidence of delayed wound healing and infection were increase with the dose of 0.030 µg.kg− 1.min− 1 compared to others (0.030 µg.kg− 1.min− 1 vs. 0.060 µg.kg− 1.min− 1 vs. 0.090 µg.kg− 1.min− 1: 33.3% vs. 10% vs. 10%, P = 0.024; 26.7% vs. 6.7% vs. 6.7%, P = 0.031). Intraoperative total fluid volume and crystalloids, colloids volume in 0.030 µg.kg− 1.min− 1 group were significantly higher than 0.060 and 0.090µg·kg− 1·min− 1. The incidence of intraoperative hypotension effectively decreased in 0.060µg·kg− 1·min− 1 and 0.090µg·kg− 1·min− 1 compared to 0.030µg·kg− 1·min− 1(6.7%vs33.3%, P = 0.01, 3.3% vs. 33.3%, P = 0.003).The frequency of bradycardia in 0.090 µg.kg− 1.min− 1 group’s patients was significantly higher than that in the dosage 0.030 µg.kg− 1.min− 1 group (3%vs26%, P = 0.026) and 0.060 µg.kg− 1.min− 1 group (3% vs. 6.7%, P = 0.038). Patients with 0.060 µg.kg− 1.min− 1 had earlier first intaking by 1.4 hours and first flatus by 1.1 hours. Overall, Postoperative hospital stay was reduced by around 1 day in the 0.060 µg.kg− 1.min− 1 and 0.090 µg.kg− 1.min− 1 group among three groups (6.0 vs. 6.2 vs. 7.1days, P = 0.066).Conclusion: The 0.060 µg·kg− 1·min− 1 dosage of norepinephrine infusion combined with goal-directed fluid therapy can improve the elderly patients’ postoperative outcome and accelerate their rehabilitation process.Clinical Trial Registration: Identifier ChiCTR-1900021309, Registration date: September 19, 2018; www.chictr.org.cn.

scholarly journals Evaluation of ultrasound-guided lateral thoracolumbar interfascial plane block for postoperative analgesia in lumbar spine fusion surgery: a prospective, randomized, and controlled clinical trial

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7967 ◽  
Author(s):  
Ke Chen ◽  
Lizhen Wang ◽  
Meng Ning ◽  
Lianjie Dou ◽  
Wei Li ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Fusion ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Single Shot ◽  
Lumbar Spinal Fusion ◽  
Ultrasound Guided ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

Objective Ultrasound-guided lateral thoracolumbar interfascial plane block (US-TLIP block) is a novel regional technique for anesthesia or analgesia. However, there has been no prospective, randomized and controlled clinical trial investigating the perioperative analgesic effect of US-TLIP block on lumbar spinal fusion surgery. The aim of this study was to investigate the analgesic effect of bilateral single-shot US-TLIP in patients undergoing lumbar spinal fusion surgery. Methods A prospective and randomized comparative clinical study was conducted. A total of 60 patients (ASA classes: I–II), aged 21–74 years who were scheduled for lumbar spinal fusion surgery were randomized and divided into the TLIP group (Group T, n = 30) and control group (Group C, n = 30). The patients in Group T received preoperative bilateral single-shot US-TLIP with 30 ml of 0.375% ropivacaine at the third lumbar spine (L3) vertebral level, and the patients in Group C received an injection of 30 ml 0.9% saline through same technique. All patients received patient-controlled analgesia (PCA) after their operation. The frequency of PCA compressions and rescue analgesic administrations were recorded. Opioids (sufentanil and remifentanil), anesthetic consumption, the number of postoperative days spent in a hospital bed, overall hospital stay time and postoperative complications were recorded. The Visual Analogue Scale (VAS) and Bruggemann Comfort Scale (BCS) scores for pain and comfort assessment were recorded at 1, 12, 24, 36, and 48 hours postoperatively. Results Opioids and anesthetic consumption in the perioperative period decreased significantly in the TLIP group compared to the control group (P < 0.05). The VAS and BCS scores in the TLIP group were lower at 12, 24, and 36 hours postoperatively (P < 0.05). US-TLIP block has been shown to shorten postoperative hospital stays (P < 0.05). There was no significant difference in postoperative complications between the two groups. Conclusion Our study findings show that bilateral US-TLIP block exhibits significant analgesia and safety in patients undergoing lumbar spinal fusion surgery.

Complications and Mortality After Lumbar Spinal Fusion in Elderly Patients With Late Stage Renal Disease

Spine ◽  
2016 ◽  
Vol 41 (21) ◽  
pp. E1298-E1302 ◽  
Author(s):  
Varun Puvanesarajah ◽  
Amit Jain ◽  
Daniel E. Hess ◽  
Adam L. Shimer ◽  
Francis H. Shen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Renal Disease ◽  
Spinal Fusion ◽  
Late Stage ◽  
Lumbar Spinal Fusion ◽  
Stage Renal Disease ◽  
Lumbar Spinal ◽  
Complications And Mortality
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