postoperative changes after spinal fusion

Lee CH, Chung CK, Kim CH, Kwon JW. The surgery is done to help stabilize your spine, reduce pain, or address spine issues, such as scoliosis. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schnemann HJ GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Eur Spine J. Intra- and postoperative very low dose intravenous ketamine infusion does not increase, [65]. It is necessary to compare current images with previous studies to identify any subtle changes and disease progression. We used open questions to prevent false confirmation of suggested measures in the answers. Spinal Instrumentation Thoracolumbar Instrumentation (4) Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. We calculated RR for dichotomous data in the presence of interventions of 3 or more trials, with a 95% CI. When comparing the preoperative and 1-year-postoperative images, multifidus muscle (MF) reduction was consistently observed in the MRI and CT groups, right and left (p=0.003, p<0.001, p=0.005 and p<0.001, respectively). The epidural and ketamine groups achieved MCID. Orthostatic hypotension following posterior spinal fusion surgeries for In comparison of the MRI and CT group, both groups showed similar measurements before surgery (Table 1). Heterogeneity was moderate I2 = 65% (Appendix 4, available at https://links.lww.com/PR9/A157). may email you for journal alerts and information, but is committed The heterogeneity was moderate, I2 = 79% (Fig. [67]. Perera AP, Chari A, Kostusiak M, Khan AA, Luoma AM, Casey ATH. Postoperative ION is a devastating complication that can occur after a variety of surgical procedures, most often following cardiothoracic surgery, instrumented spinal fusion[16,17], and head and neck surgery. Post-med: 200 g i.v. Search for Similar Articles In patients with lumbar spinal stenosis who require spinal instrumentation owing to distinct dynamic components or overt instability, utilizing the anterior approach can reduce MF injury. We managed and compared risk of bias using Covidence (Covidence systematic review software; Veritas Health Innovation, Melbourne, Australia). 2015;9:25. However, it mirrors the pragmatism in the clinical field. [12]. [49]. [37]. pointed out that the cause of postoperative atrophy was iatrogenic denervation of the paraspinal muscles during lumbar surgery [20]. Introduction Pain management after spine surgery represents a unique challenge. Google Scholar. However, Wilcoxon signed ranks test was used for the right psoas muscle because it did not follow a normal distribution. Spine. Your privacy choices/Manage cookies we use in the preference centre. There are many reports of postoperative paraspinal muscle atrophy associated with posterior lumbar surgery. your express consent. Spine J 2020. Spine. Effective dose of peri-operative oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar, [40]. Laigaard J, Pedersen C, Thea N, Mathiesen O, Peder A. [14]. It was not possible to perform TSA if the accrued information size was <5% or the data were insufficient. INTRODUCTION. Br J Anaesth 2013;111:6305. We illustrate the imaging features of common postoperative complications associated with various surgical and instrumentation techniques. 2). Ann Surg 2008;248:18998. Pain at the bone graft site. after skin incision; postop: paracetamol 1 g i.v. Raja SDC, Shetty AP, Subramanian B, Kanna RM, Rajasekaran S. A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery. The lumbar multifidus muscle five years after surgery for a lumbar intervertebral disc herniation. Health care burden of spinal diseases in the Republic of Korea: analysis of a nationwide database from 2012 through 2016. Spine (Phila Pa 1976) 2017;42:108895. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. 3). Hyun JK, Lee JY, Lee SJ, Jeon JY. Brown L, Weir T, Shasti M, Yousaf O, Yousaf I, Tannous O, Koh E, Banagan K, Gelb D, Ludwig S. The Efficacy of liposomal bupivacaine in lumbar spine surgery. Mengiardi B, Schmid MR, Boos N, Pfirrmann CW, Brunner F, Elfering A, et al. Spine. Avoid strenuous activities of any kind (golfing, tennis, home improvement tasks, etc.). 9 Radiographically, osseous fusion is defined by the development of bridging trabecular bone. Three trials reported on ketamine and postoperative pain at mobilization 6 2 hours.44,59,73 The meta-analysis showed no significant difference in mean VAS 4 mm (95% CI: 412), heterogeneity I2 = 0% (Appendix 8, available at https://links.lww.com/PR9/A157). PCA on demand in PACU, after induction + postoperatively, 1: (n = 15) ketamine bolus 0.15 mg/kg at induction and continued on 2 mg/kg/min infusion intraoperatively and postoperatively for 24 hours, Perop: spinal morphine before wound closure postop: PCA hydromorphone ketamine if NRS = 10, 1: (n = 43) pregabalin 150 mg po, 1hour prior to surgery. Because the MF is an important stabilizer of the lumbar spine, MF atrophy is considered to be related to LBP [19]. Statistical calculations were performed using SPSS software, version 20.0 (IBM Corp., Armonk, NY, USA). Postoperative Spinal CT: What the Radiologist Needs to Know intravenous; PCA, patient-controlled analgesia; NRS, numerical rating scale; VAS, visual analog scale. 2). Trends in lumbar, [59]. However, there are only limited data identifying the rate of instrumentation changes on radiographs after complex spine surgery involving 5-level fusions.METHODSThe medical records of 136 adult ( 18 years old) patients with spine deformity undergoing elective, primary complex spinal fusion ( 5 levels) for deformity correction at a . Brill S, Ginosar Y, Davidson EM. Postoperative Pain Management after Spinal Fusion Surgery: An Analysis Anaesthesia and positioning The reported incidence of postoperative respiratory compromise varies from 0%-14% [ 1, 2, 3, 4 ]. J Orthop Surg Res 2018;13:1518. *Corresponding author. For an accurate postoperative assessment of spinal instrumentation and of any complications, it is important that radiologists be familiar with the normal imaging appearances of the lumbar spine after stabilization, fusion, and disk replacement with various techniques and devices. [74]. Ghabach MMB, Mhanna NE, Abou Al Ezz MR, Mezher GN, Chammas MJ, Ghabach MMB. Six authors extracted the data, assessed the full texts independently, and compared their findings afterward. The volume of the ES muscles, which are located relatively laterally, also tended to decrease at 1year after surgery. Furthermore, it was impossible because of sparse data to report a reduced LOS regarding any analgesic treatment. Both groups achieved the MCID of 10 mm. [35]. [46]. Kehlet H, Dahl JB. Remifentanil used as adjuvant in general anesthesia for, [73]. 2011;24(7):4514. Minimally invasive spinal surgery for adult spinal deformity. We searched published systematic reviews and articles by hand for eligible trials and screened The PROSPECT Database8 and reference lists from relevant reviews. [23]. 2018;15(1):66. Loading dose + i.v. Four studies reported on i.t. There has been a substantial increase in the number of patients undergoing spinal fusion surgery. 4). Although larger studies are required to validate these results, we should consider the effects of motion reduction after fusion and 6weeks of immobilization with bracing, and not just direct injury or denervation, as causes of muscle atrophy. Greze J, Vighetti A, Incagnoli P, Quesada JL, Albaladejo P, Palombi O, Tonetti J, Bosson JL, Payen JF. All authors read and approved the final manuscript. If a preoperative MRI was performed at baseline then an MRI was used in the follow up. Kim SI, Ha KY, Oh IS. None of the studies reported SAE. [57]. Assessing the extent of fusion, or lack thereof, is a common imaging indication in the late postoperative period. Radiographic demonstration of paraspinal muscle wasting in patients with chronic low back pain. suggested that ipsilateral MF changes were significantly higher than contralateral in the quantitative study of multifidus muscle changes after minimally invasive (MIS) lumbar discectomy [8]. However, in South Korea, the cost of an MRI is 34 times that of a CT; therefore, there is a cost disadvantage for monitoring the muscle status with MRI, and the instrumentation may interfere with accurate muscle demarcation due to metallic artifacts. 1: (n = 23) morphine 0.4 mg before wound closure i.t. To control for random errors, we performed TSA for the primary and secondary outcomes dealing with pain intensity, and we calculated and visualized the diversity-adjusted required information size (DARIS) and the cumulative Z-curve. All patients received the same postoperative treatment, with ambulation starting on the second postoperative day, application of a brace for 6weeks, and no special rehabilitation exercises. Unfortunately, they do not investigate opioid consumption. Therefore, we chose random-effects models to accommodate that. 1996;5(3):1937. No trials reported on pain after 6 hours during rest or mobilization, and no studies were detected dealing with pain during mobilization after 24 hours. [34]. Anesthesiology 2020, 132:9921002. 10 minutes before skin closure, 1: (n = 32) ketamine i.v. Sihvonen T, Herno A, Paljarvi L, Airaksinen O, Partanen J, Tapaninaho A. Therefore, a mean difference was set to 10 mg morphine i.v. Atrophy of sacrospinal muscle groups in patients with chronic, diffusely radiating lumbar back pain. Imaging Features of Postoperative Complications After Spinal - AJR The requirement for written informed consent was waived by the board. infusion of 1 g/kg/min after bolus 0.5 mg/kg, before skin incision + continued 48 hours postoperatively, 1: (n = 40) celecoxib 200 mg, pregabalin 75 mg, acetaminophen 500 mg, extended-release oxycodone 10 mg 1 hour preop + twice daily, 1: (n = 12) magnesium 50 mg/kg i.v. We performed funnel plots if 10 or more trials were included in the meta-analysis and assessed the presence of heterogeneity by using the magnitude by I2 and forest plots.27, To detect a minimal clinical relevant effect, we chose to detect even a small beneficial effect. At 1year after surgery, the volume of the MF muscle decreased by 41.6% ~49.6% in the MRI group, while the decrease was 19.3% ~23.0% in the CT group (Table 2). Patients diagnosed with degenerative lumbar spinal stenosis who underwent posterior lumbar interbody fusion (PLIF) surgery at the L4/5 level in the period from May 2010 to June 2017 were included in this study. Hartwig T, Streitparth F, Gross C, Muller M, Perka C, Putzier M, et al. Measurements of paraspinal muscles. Preemptive analgesia for postoperative, [3]. Improve postoperative sleep: what can we do?. Six trials reported on PONV.1,5,41,53,64,66 The meta-analysis found no significant difference between groups, RR 0.99 (95% CI: 0.761.28) with low heterogeneity I2 = 12% (Appendix 5, available at https://links.lww.com/PR9/A157). In 22 cases, patients had a patient-controlled analgesia device with hydromorphone, oxycodone, meperidine, piritramide, sufentanil, pirimidine, or fentanyl. When applying meta-analyses and TSA, in summary, we found a significant reduction in opioid consumption for NSAIDs and epidural, and both groups achieved the minimal clinical important difference (MCID) of 10 mg. For 6 hours of pain at rest, we found a significant reduction in VAS for NSAID and i.t. Comparison of effects of hemostatic gelatin sponge impregnated with ropivacaine versus normal saline applied on the transverse process of the operated vertebrae on postoperative, [19]. The quality of evidence (GRADE) was moderate (Table 2). Seven trials reported on ketamine as an intervention.1,5,24,41,53,64,66 The risk of bias for all trials was low in 2 trials, unclear in 2 trials, and high in 3 trials (Fig. Therefore, this systematic review aims to investigate whether the existing literature contains evidence concerning procedure-specific, medication-based interventions for 1- or 2-level spinal fusion surgery. Study design: Retrospective cohort study. J Clin Anesth 2016;31:14953. Spinal fusion surgery is a major procedure with a lengthy recovery time. or orally, 8 trials administrated different kinds of NSAIDs, 4 studies administrated pregabalin or gabapentin, 3 trials used other analgesics. Geisler, Anjaa,*; Zachodnik, Josephinea,b; Kppen, Kaspera; Chakari, Rehanc; Bech-Azeddine, Rachidd, aDepartment of Anesthesiology, Zealand University Hospital,Denmark, bInstitution of Health Sciences, Lund University, Lund, Sweden, cDepartment of Surgical Sciences, Plastic Surgery, Akademiska University Hospital Uppsala, Uppsala, Sweden, dCopenhagen Spine Research Unit (CSRU), Section of Spine Surgery, Centre for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark. Therefore, based on the current literature, it is not possible to identify any best-proven analgesic treatment for patients undergoing 1- or 2-level spinal fusion. The advantage of our study is that it can be easily applied at any time in clinical practice because we measured the muscle volume using MRI and CT scans, which are commonly used in practice, without the help of any special software or image processing device. The area of the upper surface of the truncated elliptic cone for muscle volume calculation was measured as the cross-sectional area on the axial MRI or CT image taken at the L3 lower endplate level (Fig. CT is beneficial in terms of the cost and time required for testing, however, it requires the patient to be exposed to radiation. 4). [50]. Four trials reported on PONV.7,21,32,60 The meta-analysis found no significant difference between groups, RR 0.70 (95% CI: 0.421.14), with moderate heterogeneity I2 = 60% (Appendix 5, available at https://links.lww.com/PR9/A157). Our systematic review is, in our knowledge, the first to investigate the procedure-specific pain treatment for 1- or 2-level spinal fusion, a frequently performed surgical procedure. suggested the possibility of denervation-related atrophy in lumbosacral radiculopathy [11]. morphine. Cite this article. Nielsen RV, Fomsgaard JS, Siegel H, Martusevicius R, Nikolajsen L, Dahl JB, Mathiesen O. Intraoperative ketamine reduces immediate postoperative opioid consumption after, [52]. suggested that when disc herniation compresses the spinal nerve, it also compresses the dorsal rami innervating the MF and ES, thereby causing muscle damage [16], and they asserted through the MF biopsy study that these muscle changes can be reversed by appropriate surgical treatment [16]. Patients undergoing complex spine surgery often present with pre-existing chronic pain and dependence on chronic opioid therapy. SKH: analysis and interpretation of data. Changes in Paraspinal Muscles and Facet Joints after - Hindawi Four trials reported on NSAIDs and postoperative pain at rest after 6 2 hours.3,59,62,71 The meta-analysis found a significant reduction of 12 mm in mean VAS score (95% CI: 617.5). Digital 3-dimensional analysis of the paravertebral lumbar muscles after circumferential single-level fusion. Conversely, regression analysis showed a negative correlation between MF muscle volume loss and age in the MRI group (right and left, p=0.002 and p=0.015, respectively), that is, the younger the age, the greater loss of muscle mass. UIV+2 and LIV+1 vBMD changes showed similar trends. The quality of evidence (GRADE) was very low (Table 2). The authors have no conflicts of interest to declare. For adverse events, it was only possible to perform meta-analysis on PONV because very few studies reported on other types of adverse events, and no trials reported SAEs. The results showed a significant reduction in opioid consumption for treatment with NSAID (P < 0.0008) and epidural (P < 0.0006) (predefined minimal clinical relevance of 10 mg). In one study, the patients had flurbiprofen at request. Perioperative management of chronic. Four trials reported on local infiltration/wound analgesia and 24-hour opioid consumption.6,22,44,61 The meta-analysis favored the control group and reported no significant reduction in opioid consumption 2 mg i.v. The quality of evidence (GRADE) was high (Table 2). Trial sequential analysis showed that the required information size was not reached, but the DARIS line was crossed (Appendix 4, available at https://links.lww.com/PR9/A157). https://doi.org/10.1186/s12891-020-3104-0, DOI: https://doi.org/10.1186/s12891-020-3104-0. We used sensitivity analyses to explore whether the choice of summary statistics and choices made through the review process, such as selection of event category, were critical for the conclusions of the meta-analysis. Most previous studies explored the effects of posterior lumbar fusion surgery on the paraspinal muscles by quantitative analysis of magnetic resonance imaging (MRI) or computed tomography (CT) images using specific software [4, 5, 9,10,11,12]. Patients undergoing spinal surgery are at high risk of acute and persistent postoperative pain. Intramuscular local anesthetic infiltration at closure for postoperative analgesia in lumbar spine surgery. Reuben SS, Buvanendran A, Kroin JS, Raghunathan K. The analgesic efficacy of celecoxib, pregabalin, and their combination for, [60]. 1 2 3 When the curvature exceeds a certain severity, spinal fusion surgery is indicated, with a goal of correcting the existing curve and preventing further progression while . B=maximum diameter perpendicular to A on the same slice (cm). Wen X, Huang Y, Chen Y, Fang S, Wu S. Clinical research on postoperative analgesia effect of using dezocine before suturing skin in patients with internal fixation of spine. The quality of evidence (GRADE) was moderate (Table 2). We performed a search in PubMed, Embase, and The Cochrane Library for randomized controlled trials. AJNR Am J Neuroradiol. Quality of evidence (GRADE) was moderate (Table 2). Rate of Instrumentation Changes on Postoperative and Follow-Up - PubMed Evidence-based surgical care and the evolution of fast-track surgery. Morphine consumption assessed with 024 hours postoperatively assessed with: mg, The mean morphine consumption assessed with 024 hours postoperatively was, Dizziness assessed with: number of events, MD 3.19 higher (24.37 lower30.75 higher), Wound infiltration compared with placebo for. 0.1 mg/kg during surgery, 1: (n = 12) flurbiprofen 1 mg/kg i.v. Lee JC, Cha JG, Kim Y, Kim YI, Shin BJ. Idiopathic scoliosis (IS) is the most common spinal deformity in children and adolescents, with the definitive surgical treatment being posterior spinal fusion (PSF). Urban MK, Labib KM, Reid SC, Goon AK, Rotundo V, Cammisa FP, Girardi FP. One trial reported on pruritus.68. The meta-analysis reported a significant reduction in opioid consumption of 35.7 mg i.v. However, the accuracy of the cross-section seems to be limited considering that the cross-section may not be uniform during MRI. Postoperative imaging plays an important role in the assessment of fusion and bone formation.
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