Objective Spondylytic degeneration of the axial lumbar spine is a major cause of pain and disability. Recent advances in spinal surgical instrumentation, including percutaneous access and fusion techniques, have made possible the performance of instrumented fusion through small incisions. By blending strategies of interventional pain management, neuroradiology, and conventional spine surgery, it is now feasible to treat spinal axial pain using permanent fixation techniques and local anesthesia in the setting of a fluoroscopy suite using mild sedation and local anesthesia.
Methods The author presents a series of percutaneous thoracolumbar fusion procedures performed in a biplane neuroangiographic suite and without general anesthesia for the treatment of spondylytic pain. All procedures utilized pedicle screw fixation, harvesting of local bone autograft, and application of bone fusion material.
Results In this series of 13 patients, a statistically significant reduction of pain was seen at both the 2 week post-operative timepoint, as well as at the time of longest follow-up (mean 40 weeks). Specifically, axial spine pain as rated by the Visual Analog Scale was reduced from a preoperative mean level of 7.827 to a level of 4.000 at 2 weeks, and a level of 2.192 at longest follow-up. Five of the 13 patients were still taking narcotic medications for axial spine pain at the point of longest follow-up.
Discussion The advanced and rapid imaging capabilities afforded by a neuroangiographic biplane suite can be safely combined with percutaneous fusion techniques so as to allow for fusion therapies to be applied to patients where the avoidance of general anesthesia is desirable. Expanding instrumented fusion procedures into a non-traditional operating room setting requires sensitivity towards the inherent cultural differences between angiography suites and operating theaters in order to ensure sterility and best patient outcomes.
Disclosures B. Chopko: 2; C; Vertos Medical, Bacterin International.
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