Macías IJA, Lima PG, Terreros SO, Tamayo GCD, Gervacio GHC, Pavón FJ, Jiménez FA, Marroquín HO

Language: English
References: 13
Page: 283-293
PDF size: 1541.64 Kb.

ABSTRACT

Introduction: during spinal surgical procedures, proper prone positioning is essential to reduce intraabdominal pressure and prevent hemodynamic and ventilatory physiological alterations. Material and methods: a randomized observational comparative case-control study was conducted at a national tertiary referral center for spine surgery. Forty-three patients who underwent posterior thoracic and lumbosacral spine surgery over a one-year period were evaluated. Patients were classified according to the spinal segment involved, type of instrumentation, and intraoperative positioning using surgical bolsters. Statistical validity and correlations were assessed using Spearman’s Rho. Results: the study population consisted of 36 male and seven female patients, with a mean age of 39.1 ± 21.1 years. The sensitivity phase was based on the evaluation performed by five fellowship-trained spine orthopedic surgeons at this institution. Hemodynamic and ventilatory changes were assessed in the preoperative, intraoperative, and postoperative periods in patients undergoing posterior thoracolumbar instrumentation, using bolster configuration (longitudinal vs transverse) as the primary variable. 18 patients were positioned using longitudinal bolsters and 25 using transverse bolsters. Significant hemodynamic differences were identified between bolster configurations, with greater intraoperative blood loss observed in patients positioned with transverse bolsters compared with longitudinal bolsters (Spearman’s Rho, p = 0.025). Additionally, a strong positive correlation was observed between tranexamic acid administration and reduced intraoperative blood loss, with a 99% confidence level (Spearman’s Rho, p < 0.01). Ventilatory changes were also identified, with higher intraoperative FiO2 requirements in patients positioned with transverse bolsters compared with longitudinal bolsters (p = 0.030). Discussion: based on the available literature, there are no comparable studies directly evaluating these variables, limiting positive or negative comparisons. Therefore, this study establishes a clinically relevant precedent for future research. Conclusion: longitudinal bolster positioning is associated with reduced intraoperative blood loss and lower oxygen requirements. Tranexamic acid administration decreases intraoperative bleeding in both groups, with a greater hemodynamic benefit observed when combined with longitudinal bolster positioning.

REFERENCES

1. Schonauer C, Bocchetti A, Barbagallo G, Albanese V,Moraci A. Positioning on surgical table. Eur Spine J. 2004; 13: S50-55. doi: 10.1007/s00586-004-0728-y.

2. Yadav M, Reddy EP, Sharma A, Kulkarni DK, GopinathR. The Effect of position on PaCO2 and PETCO2 inpatients undergoing cervical spine surgery in supineand prone position. J Neurosurg Anesthesiol. 2017; 29:298-303. doi: 10.1097/ANA.0000000000000322.

3. Jain M, Lal J, Aggrawal D, Sharma J, Singh AK, BansalT. A Study to evaluate changes in modified mallampaticlass in patients undergoing spine surgery in proneposition. Cureus. 2022; 14: e25767. doi: 10.7759/cureus.25767.

4. Plataniotis N, Evangelopoulos DS, Katzouraki G,Pneumaticos S. The effect of patient positioning on therelative position of the aorta to the thoracic spine. EurSpine J. 2019; 28: 477-483. doi: 10.1007/s00586-018-5812-9.

5. Lin S, Hey HWD, Lau ETC, Tan KA, Thambiah JS,Lau LL, et al. Prevalence and predictors of pressure injuries from spine surgery in the prone position: dobody morphological changes during deformity correctionincrease the risks? Spine (Phila Pa 1976). 2017; 42:1730-1736.

6. Shriver MF, Zeer V, Alentado VJ, Mroz TE, BenzelEC, Steinmetz MP. Lumbar spine surgery positioningcomplications: a systematic review. Neurosurg Focus.2015; 39: E16. doi: 10.3171/2015.7.FOCUS15268.

7. Kim JH, Kim S, Yu T, Yang WS, Hong SW. Suddenarrhythmia in the prone position during spinal surgery:a case report. Medicine (Baltimore). 2022; 101: e30137.doi: 10.1097/MD.0000000000030137.

8. Jin SJ, Park YS, Kim SH, Kim D, Shim WH, JangDM, et al. Effect of prone positional apparatus on theoccurrence of acute kidney injury after spine surgery.World Neurosurg. 2019; 128: e597-e602. doi: 10.1016/j.wneu.2019.04.216.

9. Yoon HK, Lee HC, Chung J, Park HP. Predictivefactors for hypotension associated with supine-topronepositional change in patients undergoing spinesurgery. J Neurosurg Anesthesiol. 2020; 32: 140-146.doi: 10.1097/ANA.0000000000000565.

10. Poon KS, Wu KC, Chen CC, Fung ST, Lau AW, HuangCC, et al. Hemodynamic changes during spinal surgeryin the prone position. Acta Anaesthesiol Taiwan. 2008;46: 57-60. doi: 10.1016/S1875-4597(08)60026-0.

11. Mahajan S, Swami AC, Kumar A. Cardiovascularchanges and lumbar spine surgery: a neglected entity.Asian J Neurosurg. 2019; 14: 1253-1255. doi: 10.4103/ajns.AJNS_224_19.

12. Yang SY, Shim JK, Song Y, Seo SJ, Kwak YL. Validationof pulse pressure variation and corrected flow time aspredictors of fluid responsiveness in patients in theprone position. Br J Anaesth. 2013; 110: 713-720. doi:10.1093/bja/aes475.

13. Bible JE, Mirza M, Knaub MA. Blood-loss managementin spine surgery. J Am Acad of Orthop Surg. 2018; 26:35-44. doi: 10.5435/jaaos-d-16-00184.