Attention to key preoperative factors can reduce cervical spine surgery complication risk
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Cervical spine surgery results may be improved by addressing patients’ nutritional status, bone mineral density, frailty, mental health and other factors preoperatively, a presenter said at the North American Spine Society Annual Meeting.
“For all patients, we need a preoperative evaluation,” Teresa Bas, MD, PhD, of Valencia, Spain, said.
“Beside the normal checkup for health, lungs, metabolic disease, we must work up all the aspects in order to avoid post-surgery complications,” she said, noting the ageing population being treated for spinal deformity needs extra consideration for conditions like diabetes and metabolic syndrome.
“Be aware of the degenerative cascade,” Bas said.
The nutritional status of patients undergoing adult spinal deformity surgery must be checked, she said, noting research shows malnutrition is present in up to 70% of patients at the time of surgery and 20% of patients at the time of hospital discharge.
Bas and her colleagues use albumin and pre-albumin levels to screen patients for nutrition status.
“Any patient being considered for surgery or has low level of albumin is either referred to the nutritional unit or to the internist to work up the etiology of these low levels,” she said.
Checks of bone mineral density and frailty are equally important, according to Bas.
“Any patient with a T-score of less than –1.5 is started on teriparatide 20 µg subcutaneous daily for 3 months prior to surgery and 3 months after surgery,” she said.
Patients with a vitamin D deficit are referred to the hospital’s bone health clinic at least 4 weeks preoperatively, Bas said.
It is also important to assess the mental health of patients scheduled to undergo spine fusion surgery, she said. However, despite impaired mental health having long been known to be associated with spinal complaints, there is not yet widespread agreement about the best ways to evaluate the mental health of patients scheduled for spine surgery and to treat the condition, according to Bas.
“SF-22 is enough to check the mental health of these patients,” she said.
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Bas T. Pre-operative optimization for adult spinal deformity surgery. Presented during NASS international symposium: Adult spinal deformity at: North American Spine Society Annual Meeting; Oct. 6-9, 2020 (virtual meeting).
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