Optimization of Surgical Care and Anesthesia in the Treatment of Multilevel Degenerative Diseases of the Lumbar Spine in Patients with Overweight and Obesity

Cover Page


Cite item

Full Text

Abstract

Background: The provision of surgical care in the treatment of degenerative diseases of the lumbar spine in patients with obesity and obesity is associated with significant risks of anesthesia and the development of perioperative complications. Aims: to analyze the results of the introduction of a combination of surgical procedures and anesthesia in the treatment of multilevel degenerative diseases of the lumbar spine in patients with excessive body weight and obesity.

Materials and methods: The results of surgical treatment of 86 patients were studied, 2 groups were identified. In the study group (SG, n=37), minimally invasive surgical techniques and original surgical approach, paravertebral musculature infiltration with bupivacaine with epinephrine, and multimodal anesthesia with dexmedetomidine were used. The comparison group (CG, n=49) consisted of patients who used the technique of traditional open transpedicular fixation in combination with the posterior interbody fusion without the above combination of surgical procedures and anesthesia. Observation and clinical evaluation was performed in the early (during hospitalization) and in the distant (on average 36 months) postoperative periods.

Results: In SG there were no changes in hemodynamics and better results were obtained on the speed of recovery of psychomotor functions. The use of local anesthetics significantly reduced the local pain syndrome (p<0.05) and the need for analgesics (p=0.002). Comparative analysis in the main group revealed significantly better results in indices of the duration of the operation [SG 145 (105; 155) min, CG 185 (100; 205) min; p=0.02], the volume of blood loss [SG 110 (90; 140) ml, CG 510 (390; 640) ml; p<0.001], the activation time [SG 1 (1; 2) days, CG 3 (3; 4) days; p=0.01], the length of hospitalization [SG 10 (9; 11) days, CG 13 (12; 15) days; p=0,03], remote clinical parameters of the pain syndrome level from the visual analogue scale in the lower extremities [SG 3 (1; 4) mm, CG 9 (6; 14) mm; p=0.006] and the lumbar spine [SG 6 (4; 9) mm, CG 16 (11; 21) mm; p=0.001], functional state according to ODI [SG 8 (6; 10) points, CG 16 (12; 24) points; p=0.008], subjective satisfaction with the operation performed on the Macnab scale (p=0.01). The number of postoperative complications in SG was 8%, in CG ― 18% (p=0.006).

Conclusions: Analysis of the results of the introduction of a combination of surgical and anesthetic support methods in the treatment of multilevel degenerative diseases of the lumbar spine in patients with overweight and obesity, including minimally invasive surgical techniques, infiltration of paravertebral muscles with bupivacaine and epinephrine, multimodal anesthesia with dexmedetomidine showed its high perioperative safety, low number of complications, as well as better and clinical outcomes in the early and late postoperative periods.

About the authors

Vadim A. Byvaltsev

Irkutsk State Medical University; Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.; Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk State Academy of Postgraduate Education

Author for correspondence.
Email: byval75vadim@yandex.ru
ORCID iD: 0000-0003-4349-7101

Doctor of Medical Sciences, Chief Neurosurgeon of the Department of Health of JSCo «Russian Railways», Head of the Center for Neurosurgery of the RCHat St. Irkutsk-Passenger OJSC Russian Railways, Head of the course of neurosurgery of the ISMU, Head of the SClDN of the ISCST, Professor of the Department of Traumatology, Orthopedics and Neurosurgery of the ISMA PE.

10, Botkina street, 664082 Irkutsk

SPIN-code: 5996-6477

Россия

Andrey A. Kalinin

Irkutsk State Medical University; Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.

Email: andrei_doc_v@mail.ru
ORCID iD: 0000-0001-9039-9147

Candidate of Medical Sciences, Associate Professor of Neurosurgery at the ISMU, neurosurgeon of the Center for Neurosurgery of the Road CHat St. Irkutsk-Passenger JSC RR

SPIN-code: 9707-8291

Россия

Victoria Yu. Goloborodko

Irkutsk State Medical University; Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd.

Email: gra4ova.viky@gmail.com
ORCID iD: 0000-0002-9420-368X

Head of the department of anesthesiology and resuscitation No. 1 of the RCHat st. Irkutsk-Passenger OJSC Russian Railways

SPIN-code: 7534-8961

Россия

References

  1. Головин К.Ю., Аганесов А.Г., Хейло А.Л., Гурова О.Ю. Хирургическое лечение дегенеративно-дистрофических заболеваний поясничного отдела позвоночника у лиц с избыточной массой тела и ожирением // Хирургия позвоночника. — 2013. — №3 — С. 53–61.
  2. who.int [Internet]. Global Health Observatory (GHO) data. Overweight and obesity [cited 2018 Mar 5]. Available at: http://www.who.int/gho/ncd/risk_factors/overweight_text/en//index.html.
  3. Elgafy H, O’Brien P, Blessinger B, Hassan A. Challenges of spine surgery in obese patients. Am J Orthop (Belle Mead NJ). 2012;41:E46−E50.
  4. Yadla S, Malone J, Campbell PG, et al. Obesity and spine surgery: reassessment based on a prospective evaluationof perioperative complications in elective degenerative thoracolumbar procedures. Spine J. 2010;10(7):581–587. doi: 10.1016/j.spinee.2010.03.001.
  5. Guh DP, Zhang W, Bansback N, et al. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. 2009;9:88. doi: 10.1186/1471-2458-9-88.
  6. Shiri R, Karppinen J, Leino-Arjas P, et al. The association between obesity and low back pain: a metaanalysis. Am J Epidemiol. 2010;171(2):135–154. doi: 10.1093/aje/kwp356.
  7. DeMaria EJ, Carmody BJ. Perioperative management of special populations: obesity. Surg Clin North Am. 2005;85(6):1283–1289. doi: 10.1016/j.suc.2005.09.002.
  8. Seicean A, Alan N, Seicean S, et al. Impact of increased body mass index on outcomes of elective spinal surgery. Spine (Phila Pa 1976). 2014;39(18):1520–1530. doi: 10.1097/BRS.0000000000000435.
  9. Casati A, Putzu M. Anesthesia in the obese patient: pharmacokinetic considerations. J Clin Anesth. 2005;17:134–145. doi: 10.1016/j.jclinane.2004.01.009.
  10. Vaidya R, Carp J, Bartol S, et al. Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976). 2009;34(5):495–500. doi: 10.1097/BRS.0b013e318198c5f2.
  11. Patel N, Bagan B, Vadera S, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007;6(4):291–297. doi: 10.3171/spi.2007.6.4.1.
  12. Senker W, Meznik C, Avian A, Berghold A. Perioperative morbidity and complications in minimal access surgery techniques in obese patients with degenerative lumbar disease. Eur Spine J. 2011;20(7):1182–1187. doi: 10.1007/s00586-011-1689-6.
  13. Gu G, Zhang H, He S, et al. The effect of body mass index on the outcome of minimally invasive surgery for lumbar spinal stenosis complicated with lumbar instability. Chin J Spine Spinal Cord. 2012;(4):313–317.
  14. Rihn JA, Kurd M, Hilibrand AS, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013;95(1):1–8. doi: 10.2106/JBJS.K.01558.
  15. Бывальцев В.А., Калинин А.А., Оконешникова А.К., и др. Фасеточная фиксация в комбинации с межтеловым спондилодезом: сравнительный анализ и клинический опыт нового способа хирургического лечения пациентов с дегенеративными заболеваниями поясничного отдела позвоночника // Вестник Российской академии медицинских наук. — 2016. — Т.71. — №5 — С. 375–383. doi: 10.15690/vramn738.
  16. Adogwa O, Carr K, Thompson P, et al. A prospective, multi-institutional comparative effectiveness study of lumbar spine surgery in morbidly obese patients: does minimally invasive transforaminal lumbar interbody fusion result in superior outcomes? World Neurosurg. 2015;83(5):860–866. doi: 10.1016/j.wneu.2014.12.034.
  17. Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech. 2005;18 Suppl:S1–S6. doi: 10.1097/01.bsd.0000132291.50455.d0.
  18. Wang J, Zhou Y, Zhang ZF, et al. Comparison of clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion. J Spinal Disord Tech. 2014;27(4):202–206. doi: 10.1097/BSD.0b013e31825d68ac.
  19. Патент РФ на изобретение №2508909/ 10.03.14. Бюл. №7. Калинин А.А., Бывальцев В.А., Сороковиков В.А., Белых Е.Г. Способ доступа к позвоночному каналу при стенозирующем поражении пояснично-крестцового отдела позвоночника. Доступно по: http://www.freepatent.ru/patents/2508909. Ссылка активна на 12.12.2018.
  20. Бывальцев В.А., Калинин А.А., Белых Е.Г., и др. Оптимизация результатов лечения пациентов с сегментарной нестабильностью поясничного отдела позвоночника при использовании малоинвазивной методики спондилодеза // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2015. — T.79. — №3 — С. 45–54. doi: 10.17116/neiro201579345-54.
  21. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–1344. doi: 10.1164/rccm.2107138.
  22. Olson D, Lynn M, Thoyre SM, Graffagnino C. The limited reliability of the Ramsay scale. Neurocrit Care. 2007;7(3):227–231. doi: 10.1007/s12028-007-0069-x.
  23. Rouben D, Casnellie M, Ferguson M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. J Spinal Disord Tech. 2011;24(5):288–296. doi: 10.1097/BSD.0b013e3181f9a60a.
  24. Terman SW, Yee TJ, Lau D, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients. J Neurosurg Spine. 2014;20(6):644–652. doi: 10.3171/2014.2.SPINE13794.
  25. Knutsson B, Michaelsson K, Sanden B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine (Phila Pa 1976). 2013;38(5):435–441. doi: 10.1097/BRS.0b013e318270b243.
  26. Бывальцев В.А., Калинин А.А. Возможности применения минимально инвазивных дорсальных декомпрессивно-стабилизирующих вмешательств у пациентов с избыточной массой тела и ожирением // Вопросы нейрохирургии им. Н.Н. Бурденко. — 2018. — T.82. — №5 — С. 69–80. doi: 10.17116/neiro20188205169.
  27. Park Y, Ha JW, Lee YT, Sung NY. Percutaneous placement of pedicle screws in overweight and obese patients. Spine J. 2011;11(10):919−924. doi: 10.1016/j.spinee.2011.07.029.
  28. Tian NF, Wu YS, Zhang XL, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J. 2013;22(8):1741−1749. doi: 10.1007/s00586-013-2747-z.
  29. Schizas C, Tzinieris N, Tsiridis E, Kosmopoulos V. Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience. Int Orthop. 2009;33(6):1683−1688. doi: 10.1007/s00264-008-0687-8.
  30. Бабаев М.А., Зюлева Т.П., Бугаенко Д.В., и др. Факторы риска и предикторы легочной дисфункции у хирургических пациентов // Анестезиология и реаниматология. — 2015. — Т.60. — №4S — С. 14–15.
  31. Полупан А.А., Бирг Т.М., Ошоров А.В., Савин И.А. Коррекция артериальной гипертензии в послеоперационном периоде у нейрохирургических пациентов // Анестезиология и реаниматология. — 2017. — Т.62. — №3 — С. 190–194.
  32. Bianconi M, Ferraro L, Ricci R, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion Surgery. Anesth Analg. 2004;98(1):166–172.
  33. Xu B, Ren L, Tu W, et al. Continuous wound infusion of ropivacaine for the control of pain after thoracolumbar spinal surgery: a randomized clinical trial. Eur Spine J. 2017;26(3):825–831. doi: 10.1007/s00586-015-3979-x.
  34. Greze J, Vighetti A, Incagnoli P, et al. Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study. Eur Spine J. 2017;26(3):832–839. doi: 10.1007/s00586-016-4428-1.
  35. Eren G, Cukurova Z, Demir G, et al. Comparison of dexmedetomidine and three different doses of midazolam in preoperative sedation. J Anaesthesiol Clin Pharmacol. 2011;27(3):367–372. doi: 10.4103/0970-9185.83684.
  36. Urban MK, Wukovits B, Flynn E. Dexmedetomidine versus propofol for the sedation of ventilated spinal patients. Anesthesiology. 2004;101:A158.
  37. Арефьев А.М., Куликов А.С., Лубнин А.Ю. Дексмедетомидин в нейроанестезиологии // Анестезиология и реаниматология. — 2017. — Т.62. — №3 — С. 213–219.
  38. Gupta P, Joshi S, Jethava D, Kumar A. Dexmedetomidine ameliorates monitored anaesthesia care. Indian J Anaesth. 2014;58(2):154–159. doi: 10.4103/0019-5049.130816.
  39. Bekker A, Haile M, Kline R, et al. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after major spinal surgery. J Neurosurg Anesthesiol. 2013;25(1):16–24. doi: 10.1097/ANA.0b013e31826318af.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2018 "Paediatrician" Publishers LLC



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies