Comparative efficacy of ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in instrumented lumbar spinal surgeries.

OBJECTIVE: This study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation. METHODS: In this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated. RESULTS: Both ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect. CONCLUSION: While both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered.

Factors associated with rod fracture following surgery for adult spinal deformity: a single-center retrospective study.

PURPOSE: Adult spinal deformity (ASD) has a significant impact on trunk balance and quality of life in the elderly. Postoperative rod fractures pose significant challenges, but the mechanisms of their occurrence are underexplored compared to other complications such as proximal junctional kyphosis. This study investigated factors associated with rod fracture in patients with ASD. METHODS: A retrospective single-center study analyzed 110 adult patients who underwent spinal deformity correction between 2012 and 2020. Comparative analysis and univariate and multivariate Cox regression analyses were employed to identify factors associated with rod fracture. RESULTS: In this study, rod fracture occurred in 14.5% of patients. The rod fracture group exhibited a larger change in lumbar lordosis (LL), a higher proportion of patients with pre-operatively existing (pre-existing) vertebral fractures, and a greater percentage of patients with a rod diameter of 6 mm or less compared to the non-rod fracture group. Univariate Cox regression analysis revealed that rod fracture was associated with pre-existing vertebral fracture, LL change, preoperative sagittal vertical axis, and preoperative pelvic tilt. Multivariate Cox regression analysis identified pre-existing vertebral fractures and the amount of LL change as independent factors associated with rod fractures. CONCLUSION: Pre-existing vertebral fractures and the magnitude of lumbar lordosis correction are independent risk factors for rod fracture following ASD surgery. Surgeons should consider these factors during preoperative planning to reduce the risk of postoperative rod fracture. LEVEL OF EVIDENCE: IV.

Neuro Navigation Versus Conventional Spinal Techniques in Analyzing Nerve Injury and Anatomical Accuracy: A Systematic Review.

Neuronavigation, a computer-assisted surgical technique, enhances the accuracy of spinal surgery by using medical imaging to guide the surgeon's instruments. This method mitigates the serious complications of screw misplacement, such as dural tears, nerve damage, vascular injuries, and internal organ damage, by integrating pre-operative imaging data with real-time intraoperative sensor readings. Because of this integration, it is possible to visualize the spine in three dimensions, guaranteeing accurate instrument placement and greatly lowering the risk of complications. Despite its growing popularity, the benefits of neuronavigation in spinal instrumentation are debated. While some studies report improved accuracy in pedicle screw placement, others find no significant difference compared to conventional freehand techniques. Further research is required to determine the long-term benefits of neuronavigation, including its impact on patient outcomes, like reduced pain and improved function. This systematic review will evaluate the evidence on the risks and benefits of neuronavigation in spinal instrumentation surgery, compared to conventional techniques.

Consensus statement by the Belgian Society of Neurosurgery and literature review on the diagnosis and management of postoperative spinal epidural hematoma.

Introduction: Postoperative spinal epidural hematoma (SEH) is a potentially devastating complication for patients and caregivers, and a leading cause for litigation in spine surgery. This article provides a literature review and the consensus statement of the Belgian Society of Neurosurgery (BSN) on the management of postoperative SEH. Research question: Can we implement current evidence to establish a framework on the management of postoperative SEH? Material and methods: Based on a Pubmed search, abstracts were screened for topics covering incidence, pathophysiology, risk factors, surveillance, diagnosis, treatment, and outcome. Relevant topics are presented in a narrative review format, followed by a consensus statement of the BSN with emphasis on rapid diagnosis and treatment. Results: Symptomatic SEH is rare (0.3-1%) and can have an insidious onset with rapid progression to neurological deficits. Recurring risk factors are coagulation deficiencies and multilevel surgery. The protective effect of a postoperative drainage system is uncertain, and early thrombo-embolic prophylaxis does not increase the risk of SEH. Prognosis is dependent on residual neurological function and critically, on the time to reintervention. There is a need for structured neurological observation formats after spine surgery. Discussion and conclusion: Symptomatic SEH after surgery is an unpredictable and severe complication requiring rapid action to maximize outcomes. The BSN proposes three nuclear terms central to SEH management, converging on a triple 'S': 1) high level of suspicion 2) speed of diagnosis and 3) immediate surgery. All spine centers can benefit from an institutional protocol in which SEH should be treated as an emergency.

Relationship of the Iliac Crest Height with Subsidence After Oblique Lateral Interbody Fusion at L4-5: A Quantitative and Categorical Analysis.

Background: This study aimed to evaluate the impact of iliac crest height on clinical and radiological outcomes following oblique lateral interbody fusion (OLIF) at the L4-5 level. Methods: Data of patients who underwent single-level OLIF at the L4-5 level for degenerative spinal stenosis were retrospectively analyzed. The patients were categorized into three groups based on their iliac crest height measured relative to the L4 and L5 pedicles. Categorical and quantitative analyses, including univariate and multivariate logistic regressions, were performed to identify subsidence predictors. Clinical outcomes, including visual analog scale scores for back and leg pain, were assessed over a minimum 2-year follow-up. Results: No significant differences in cage obliquity were observed across the iliac crest height groups (axial angles, p = 0.39; coronal angles, p = 0.79). However, subsidence was significantly more common in patients with higher iliac crest heights, particularly at crest level III, where the subsidence rate reached 43% (p = 0.01). Subsidence was predominantly associated with damage to the L5 endplate, which occurred in 83% of subsidence cases at crest level III. A cutoff value of 12 mm for iliac crest height, above which the risk of subsidence significantly increased, was identified (AUC = 0.688, p = 0.042). Conclusions: Iliac crest height is a critical factor for predicting subsidence following OLIF at the L4-5 level. Surgeons should consider alternative strategies and meticulous preoperative planning in patients with an iliac crest height ≥ 12 mm to reduce the risk of adverse outcomes. Further studies are needed to validate these findings and to explore their long-term implications.

Investigating Optic Nerve Sheath Diameter in Prone Position Spinal Surgery Patients: A Pilot Study.

Purpose: This study aimed to evaluate the effect of intraoperative positioning and ocular immobility on the amount of cerebrospinal fluid around the optic nerve in patients undergoing prone spinal surgery by measuring the optic nerve sheath diameter (ONSD) using ultrasound. Methods: Consecutive participants (n = 15 patients, 30 eyes) were scanned preoperatively, intraoperatively approximately 20 minutes before the end of the surgery, and postoperatively in the post-anesthesia care unit at least 10 min after the completion of the surgery at one academic hospital. Results: On average, patients who underwent prone spinal surgery had a 21% increase in ONSD intraoperatively, with a positive time-dependent relationship with the overall length of surgery (P < 0.001). ONSDs postoperatively returned to baseline and were not significantly different from preoperative measurements. Conclusion: Our findings suggest pooling and inadequate clearance of perioptic cerebrospinal fluid during prone spinal surgery that improves following termination of the procedure and return of the patient to an upright position.

Role of Spinal Surgery Drainage Techniques in Postoperative Outcomes: Insights From a Comprehensive Literature Review.

Postoperative management often demands the introduction of several strategies in an attempt to minimize complication rates. One of the routine strategies includes the use of spinal drains, which have been questioned for their efficacy in improving postoperative outcomes. However, its role in postoperative outcomes is still debated. In general, this elucidation of an extensive literature review supports the synthesis of current evidence regarding the role of spinal drains in infection rates, hematoma formation, and overall patient recovery. A comprehensive search of PubMed from 2000 to 2024 was performed, focusing on studies investigating the use of spinal drains in spinal surgeries and their associated postoperative outcomes. It followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The inclusion criteria were studies related to spinal surgeries, excluding case reports, reviews, and editorials, and limited to articles published in English. Quality assessment was performed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A total of 19 studies were included, with different designs and varied sample sizes. The sample size was from 25 to 2,446 patients. Findings on infection rates were mixed; while one group of studies showed no significant differences in patients with and without drains, another group showed a reduced rate of reoperation for surgical site infections in patients with drains. In general, hematoma formation rates were reported to be the same across groups, while a few studies indicated that drains were more effective in managing wound exudates compared to no drains. Recovery outcomes indicated that patients who had a wound drain were more likely to stay in the hospital longer, although an improvement was noticed with time-driven wound drain removal, which resulted in shorter hospital stays and earlier ambulation. The use of spinal drains in postoperative spinal surgery presents both benefits and drawbacks. Spinal drains can assist in the management of wound exudates, and earlier detection of infection complications increases hospital stays and complications. Indeed, whether to use spinal drains or not should be an individual decision, weighing the potential benefits and risks. Future studies need to be done in order to establish clear guidelines for the use of drainage systems in various spinal surgical cases.

Surgical Specialty Outcome Differences for Major Spinal Procedures in Low-Acuity Patients.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: There is an ongoing debate as to the influence of specialty training on spine surgery. Alomari et al. indicated the influence of specialty on ACDF procedures. However, deeper analysis into other spine procedures and lower-acuity procedures has yet to occur. In this study, we aim to determine if the outcomes of the low American Society of Anesthesiologists (ASA) classification (ASA 1&2) patients undergoing spine surgery vary based on whether the operating surgeon was an orthopedic surgeon or a neurosurgeon. METHODS: The NSQIP databases from 2015 to 2021 were queried based on the CPT code for nine common spine procedures. Indicators of surgical course and successful outcomes were documented and compared between specialties. RESULTS: Neurosurgeons had minimally shorter operative times in the ASA 1&2 combined classification (ASA-C) group for cervical, lumbar, and combined spinal procedural groups. Neurosurgeons had a slightly lower percentage of perioperative transfusions in select ASA-C classes. Orthopedic surgeons had shorter lengths of stay for the cervical groups in ASA-C and ASA-1 classes (ASA-1). However, many specialty differences found in spine patients become less pronounced when considering only ASA-1 patients. Finally, postoperative complication outcomes and re-admission were similar between orthopedic and neurological surgeons in all cases. CONCLUSIONS: These results, while statistically significant, are very likely clinically insignificant. They demonstrate that both orthopedic surgeons and neurosurgeons perform spinal surgery exceedingly safely with similarly low complication rates. This lays the groundwork for future exploration and benchmarking of performance in spine surgeries across neurosurgery and orthopedics.

Traumatic and Non-traumatic Radiculomedullary Compressions: A Comparative Analysis.

Background Radiculomedullary lesions represent a significant public health issue, with their epidemiological, clinical, and therapeutic characteristics varying depending on whether they are of traumatic or non-traumatic origin. The aim of this study was to compare clinical, therapeutic, and postoperative aspects between traumatic radiculomedullary lesions (TRML) and non-traumatic radiculomedullary lesions (NTRML). Methods This was a prospective cohort study conducted from 2020 to 2023 involving patients suffering from radiculomedullary lesions operated at the Department of Neurosurgery, University Teaching Hospital of Kinshasa. In addition to socio-demographic characteristics, the two patient groups - traumatic and non-traumatic - were compared based on clinical, therapeutic, and postoperative aspects using the American Spinal Injury Association (ASIA) and Spinal Cord Independence Measures (SCIM III) scores.  Results We included 153 patients, with 73 traumatic cases (47.7%) and 80 non-traumatic cases (52.3%). TRMLs were predominantly caused by road traffic accidents (34%) and falls (11%), while NTRMLs were mainly due to disc herniations (22.2%) and tuberculosis (13.7%). The mean age for TRMLs was 35.4 ±12.8 years with a sex ratio of 3.5, compared to 50.7±15.9 years and a sex ratio of 1.1 for NTRMLs. TRMLs were more frequently located in the cervical region (32.8%) and the thoracolumbar junction (40%), whereas NTRMLs predominantly affected the thoracic (22.5%) and lumbar (63.7%) regions. Patients with NTRMLs had more incomplete lesions (98.7%) and better SCIM III scores at admission compared to TRMLs (p ˂ 0.001). TRMLs had more complete deficits 42 (57.3%) vs 1 (1.3%). Both groups significantly improved their ASIA and SCIM III scores postoperatively (p ˂ 0.001) but in a similar manner (Diff-in-diff: ASIA, p=0.955; SCIM, p=0.967). TRMLs developed more complications than NTRMLs (p˂0,001). Only five patients (11.6%) with ASIA A progressed to higher grades, and all remained dependent (SCIM III score ˂50). The average hospital stay was 89.2 ±74.2 days for TRMLs and 57.5±52.9 days for NTRMLs (p˂0.001). Conclusion This study revealed that TRMLs frequently affect young male individuals and are often located in the cervical region and thoracolumbar junction. In contrast, NTRMLs affect older individuals without gender preference and are usually found in the thoracic and lumbar regions. TRMLs often lead to complete deficits, pressure sores, urinary infections, and longer hospital stays compared to NTRMLs. Both patient groups showed significant postoperative improvement with no significant difference between them. However, patients with complete deficits showed less improvement in both groups.

Preoperative frailty tendency predicts delirium occurrence in older people undergoing spinal surgery.

BACKGROUND: This prospective cohort study focused on the predictive value of frailty or pre-frailty assessed by Edmonton Frailty Scale (EFS) for postoperative delirium in spinal surgery patients. METHODS: The primary outcome measurement was postoperative delirium (POD) evaluated by Confusion Assessment Method at day 1, day 2, and day 3 after the surgery. Secondary outcomes included severity and duration of POD, severe postoperative pain measured by Faces Pain Scale-Revised. Patients scheduled for elective spinal surgery were enrolled and assessed for frailty by EFS before surgery. Demographic data, preoperative, intraoperative, and postoperative information were collected. RESULTS: 231 out of 325 patients were enrolled and analyzed in this study at last. The cohort with 36.8% being frail and 28.5% being vulnerable. Postoperative delirium was detected in 41 in 231 patients. Multivariate logistic regression analysis revealed that vulnerable to frailty (OR = 4.681, 95% CI: 1.199 to 18.271, P = 0.026), after adjusted duration of surgery more than 3 h, using flumazenil at the end of surgery, using butorphanol only in postoperative patient-controlled intravenous analgesia, moderate-to-severe pain at day 1 and 2, is a strong predictor of postoperative delirium. Frailty was associated with longer duration (frailty vs. fit, P = 0.364) and stronger severity of postoperative delirium in the first two days (P < 0.001). High EFS score was independent risk factor of severe postoperative pain (Frailty vs. Fit: OR = 5.007, 95% CI: 1.903 to 13.174, P = 0.001; Vulnerable vs. Fit: OR = 2.525, 95% CI: 1.008 to 6.329, P = 0.048). In stratified tests, Sufentanil regimen in intravenous PCA significantly increase the proportion of POD in vulnerable group (P = 0.030), instead of frailty group (P = 0.872) or fit group (P = 0.928). CONCLUSIONS: Frailty can increase the risk, severity, duration of delirium and severe postoperative pain in the first 3 days after surgery of patients. TRIAL REGISTRATION: The protocol of this study has been approved by the Ethic Committee of Shanghai Changzheng Hospital (Approval file number: 2022SL044) and informed consent was obtained from all the patients. The trial was retrospectively registered at chictr.org.cn (ChiCTR2300073306) on 6th July 2023.

Barbed sutures versus conventional sutures for wound closure in spine surgeries: a systematic review and meta-analysis.

Suturing techniques for wound closure in spine surgeries play a critical role in patient outcomes, including wound healing, reintervention, and risk of complications. Barbed sutures, characterized by their self-anchoring properties, have emerged as a potential alternative to conventional sutures in various surgical disciplines. While previous studies have underscored their efficacy and safety in spine surgeries, no meta-analysis has been conducted. Therefore, we are undertaking this study. Following the PRISMA guidelines, we conducted a literature search on electronic databases to obtain the relevant studies until May 5, 2024. Our primary outcomes were operative time, wound closure time, and postoperative wound complications like seroma or hematoma formation and wound infection. The secondary outcomes were the length of hospital stay, reintervention rates, and costs. Data was pooled using a random effects model. We included seven eligible studies with a total of 8645 patients. Our meta-analysis showed that barbed sutures had shorter operative time and wound closure time compared to conventional sutures (MD -20.13 min, 95% CI [-28.47, -11.78], P < 0.001) and (MD -16.36 min, 95% CI [-20.9, -11.82], P < 0.001), respectively. Both suturing techniques showed comparable results in terms of overall postoperative wound complications (RR 0.83, 95% CI [0.60, 1.14], P = 0.25), postoperative infections (RR 0.59, 95% CI [0.33, 1.06], P = 0.08), length of hospital stay (MD -0.26 day, 95% CI [-0.75, 0.22], P = 0.28), rates of reintervention between the two groups (RR 0.99, 95% CI [0.48, 2.05], P = 0.98). Barbed sutures in spine surgeries are associated with significantly shortened wound closure and operative times. However, high-quality RCT's with long-term follow-up and cost-effectiveness assessment are required to support the evidence.

The hidden risk: Intracranial hemorrhage following durotomies in spine surgery.

Objective: Intracranial hemorrhage (ICH) after durotomy in elective spine surgery, though rare, can pose a significant risk to patient outcomes. Spine surgeries bear a risk of dural tears (DT) with potential of postoperative cerebrospinal fluid leakage (PCSFL). Excessive PCSFL can precipitate a decrease in intracranial pressure, potentially leading to ICH. Literature on ICH as a postoperative complication is scarce. The aim was to assess the incidence and risk factors of ICH in patients undergoing elective spine surgery. Methods: Utilizing the 2020 National Impatient Sample (NIS) adults (>18 years) were selected by primary procedure category codes for spine fusion, discectomy, spinal cord decompression and cervicothoracic/lumbosacral nerve decompression. Exclusion criteria were trauma and malignancy. The primary outcome was occurrence of ICH. Comparative analysis and a multivariable logistic regression were used to identify independent risk. Results: In total, 40,990 patients met our criteria with an incidence of ICH at 0.08%. The ICH-group showed an increased length of stay and higher mortality compared to the control group. Spinal cord decompression, DT and PCSFL were significantly more frequent in patients with ICH. Alcohol, drug abuse and hypertension were significantly more prevalent in patients with ICH. DT, alcohol abuse and hypertension were independent risk factors for ICH. Conclusions: This study underscores the rarity and severity of ICHs following elective spine surgery, emphasizing awareness and looking for possible preventive measures. Our finding suggests that DT, as a complication of surgical techniques, as well as alcohol abuse and hypertension are significant predictors of ICH.

Acute postoperative complications after spine deformity correction in patients with Down syndrome.

Introduction: Down syndrome, or trisomy 21, is the most diagnosed chromosomal abnormality and is associated with multiple orthopedic concerns, including scoliosis. We sought to examine the surgical treatment of scoliosis associated with Down syndrome with an emphasis on specific complications in this population. Methods: A retrospective review of 13 patients with Down syndrome who underwent surgical intervention for spinal deformity between 2000 and 2018 were identified. Postoperative complications were classified using the modified Clavien-Dindo-Sink system. Perioperative and final follow-up radiographic data were analyzed. Results: The mean age at surgery was 14.2 years (11-19) with a mean follow-up of 3.6 years (0.4-6.2) at the time of data collection. Seven (54%) patients had postoperative complications, all related to wound healing. Three patients (23%) had major complications (Clavien-Dindo-Sink grade ≥3). These included one deep surgical site infection, one hematoma, and one seroma, all requiring surgical drainage. Four additional patients (31%) had minor complications (Clavien-Dindo-Sink grade ≤2). Discussion: Surgical intervention for scoliosis in patients with Down syndrome is associated with high complication rates despite the use of more modern surgical techniques and implant types. Complications in this cohort primarily involved wound healing, whereas previous studies described high rates of postoperative implant failure, pseudoarthrosis, and significant curve progression, which were not experienced by the patients in this study. Although the etiology of wound-related complications is unknown, awareness of this risk may help surgeons optimize surgical technique, postoperative monitoring, and preoperative counseling of families. Level of Evidence: IV-single-institution retrospective case series.

PICO™ (Closed-Incision Negative-Pressure Wound Therapy) Dressing Use as Postoperative Prophylaxis for Preventing Surgical Site Infections in Spinal Surgery: A Retrospective Single-Centre Study.

Introduction Surgical site infections (SSIs) are one of the dreaded complications of spinal surgery. These typically develop within the first 30 days following surgery. The overall pooled incidence of SSIs is reported at 3.1%. Negative pressure wound therapy (NPWT) has been employed for the management of open wounds and soft tissue injury. There has been a recent trend towards the use of closed incision NPWT (ciNPT), such as PICO. There are only a few studies evaluating the prophylactic use of ciNPT in spinal surgery. The aim of this study was to evaluate whether prophylactic use of PICO dressings can reduce SSI incidence and complications in spinal surgery. Methods Data were collected retrospectively for patients undergoing spinal surgery, with a PICO dressing used for closed surgical incisions, from February 2021 to October 2022. Each patient was followed up for 30 days. The results were compared with local hospital infection control statistics for previous years. Results A total of 50 patients underwent spinal surgery and had PICO dressings post-operatively. None of the patients developed a seroma. Two out of 50 (4.0%) patients developed wound dehiscence and then subsequent SSI (1 superficial, 1 deep). These were managed conservatively with the use of antibiotics and prolonged ciNPT. None of these patients returned to the theatre. The average SSI incidence from previous years was 9.27 ± 4.14 per annum (1.15%), but with an average of 77.3% of these requiring a return to theatres. Conclusion Our study reflects that there is no difference in the incidence rates for SSIs for patients who have PICO dressings versus those having standard occlusive dressings as post-operative closed surgical incision site wound closure following spinal surgery. For those who do develop SSIs, there was no difference in the rates of return to theatres among the two patient populations.

Conotoxins: emerging analgesics for neck and spinal surgery pain management.

Conotoxins, peptides derived from the venom of marine cone snails, have emerged as promising analgesics for managing pain associated with neck and spinal surgery. These toxins target specific neurotransmitter receptors and ion channels in the nervous system, offering an alternative to traditional opioids with potentially fewer side effects. By interacting with receptors such as nicotinic acetylcholine and voltage-gated sodium and calcium channels, conotoxins disrupt pain signal transmission and induce muscle relaxation, providing effective pain relief. Research into conotoxins is ongoing, with the goal of developing novel, safer analgesics that mitigate the risks of opioid addiction. This exploration not only holds promise for surgical pain management but also advances our understanding of venom pharmacology and its therapeutic applications.

Clinical presentation, magnetic resonance imaging findings, and outcome of 80 Dachshunds with cervical intervertebral disc extrusion.

Introduction: Large clinical studies regarding cervical intervertebral disc extrusion (IVDE) in Dachshunds are lacking. This retrospective multicentric study therefore aims to describe the clinical features, magnetic resonance imaging (MRI) findings and outcomes of Dachshunds diagnosed with cervical IVDE. Methods: Medical records of Dachshunds with cervical IVDE were reviewed for signalment, onset of clinical signs, neurological examination, MRI features, treatment and outcome. Results: Eighty Dachshunds were included in the study, mostly ambulatory (55% grade 1 and 33% grade 2) and without nerve root signature (85% of cases) on presentation. Information on coat type was available for 56% of dogs; specifically, 41% were smooth-haired, 9% were long-haired and 6% were wire-haired Dachshunds. There were 29 (36%) neutered female, 27 (34%) male entire, 15 (19%) male neutered and 9 (11%) entire female dogs. The onset of clinical signs was most often >48 h (84%). The most common intervertebral disc space affected was C2-C3 (38%) and foraminal IVDEs were reported in 14% of dogs. A foraminal IVDE was diagnosed in only 25% of dogs presented with nerve root signatures. Most dogs (77.5%) were treated surgically. In this group, a higher body condition score on presentation and a higher mean spinal cord compression ratio calculated on MRI were directly and moderately associated with a longer hospitalization time (r = 0.490 p = 0.005 and r = 0.310 p = 0.012, respectively). The recovery time was longer in dogs with an onset of clinical signs <24 h or 24-48 h compared to those with an onset of clinical signs >48 h (3.1 ± 6.5 days versus 1.6 ± 6.2, p < 0.001) in both medically and surgically treated groups. Data about the outcome was available for 83% of dogs. Eighty percent of the entire population of dogs was considered to have completely returned to normal. There was no association between the therapeutic choice (surgical versus medical management) and the outcome of the dogs included in this study.

The effect of forced-air warming blanket position during spinal surgery on patients' intra-operative body temperature.

BACKGROUND: The use of body-warming systems is recommended by international anaesthesia societies for patients undergoing surgery. Limited research is however available on the influence of positioning of forced-air warming blankets for patients undergoing spinal surgery. This study aimed to investigate how patients' intra-operative body temperature was affected by the position of forced-air warming blankets while undergoing spinal surgery on a spinal table. DESIGN: A randomized comparative experimental study was conducted with 60 adult patients undergoing posterior spinal surgery. METHODS: Patients were randomized into full underbody (n = 30) or surgical access (n = 30) forced-air warming blanket groups. Intra-operative body temperature was recorded at regular time intervals. The student's T-test, Chi-square, and MANOVA tests were performed to determine the differences between the two groups. RESULTS: Intraoperative hypothermia was significantly lower in the full underbody group than in the surgical access group (p = 0.020). The change in body temperature differed significantly between the two groups from 15 min until 240 min, with a mean difference of 0.5 °C. CONCLUSION: The full underbody position of the forced-air warming blanket was effective for maintaining normal range core body temperature. The use of full underbody forced-air warming blanket for spinal surgery when patients are positioned on a spinal table in a prone position is recommended.