Perioperative Care of the Complex Spine and Scoliosis Surgery Patient

  • Darren R. LeblEmail author
  • Michael K. Urban


Modern spinal surgery can range from relatively simple ambulatory micro-discectomy to complex front and back approaches to deformity correction and spine fusion. Patients are best served using a multidisciplinary team including surgeons, perioperative medical specialists, ENT surgeons, subspecialty-trained anesthesiologists, nurses, and physical therapists. Complications are an intrinsic reality of complex modern spinal surgery. Complications are observed more commonly as the complexity of the surgery is increased as well as in patients with preoperative medical comorbidities. The cardiopulmonary complications are the most common necessitating careful preoperative evaluation and optimization. Intraoperative neurologic monitoring has become the standard of care and has benefitted from recent technological advances such as the ability to monitor motor evoked potentials. Specialized anesthetic approaches including total intravenous anesthesia may improve the accuracy and effectiveness of the monitoring. Postoperative vision loss occurs infrequently following complex and prolonged spinal procedures. The most common cause is ischemic optic neuropathy. The etiology of postoperative ION at present is unknown and unpredictable. However, several possible pathogenic factors have been suggested including duration in the prone position, blood loss, anemia, hypotension, abnormal optic nerve blood supply, low cup-to-disc ratio, use of vasopressors, excessive crystalloid infusion, and patient comorbidities, particularly smoking, diabetes, and vascular disease. The ASA practice advisory on POVL recommends the use of both colloids and crystalloids to maintain intravascular volume in spinal surgery patients who have substantial blood loss. Since ION occurs in the absence of vascular injury to other critical organs and in cases where neither hypotension or anemia are reported, optic nerve blood supply may be uniquely vulnerable to hemodynamic perturbances in the prone position. Blood management may include preoperative autologous donation. Antifibrinolytic agents have been demonstrated to be a useful adjunct in reducing perioperative blood loss. Pain management can be a challenging problem for the complex spine patient. Patient-controlled intravenous analgesia is associated with higher patient satisfaction. Specialized pain management teams will often provide for better resource and pain management utilization.


Scoliosis Spinal fusion Complications and perioperative care 


  1. 1.
    Machado GC, Ferreira S, Harris A, Pinheiro MB, Koes BW, van Tulder M, et al. Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One. 2015;10(3):e0122800.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wainwright TW, Immins T, Middleton RG. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best Pract Res Clin Anaesthesiol. 2016;30:91–102.CrossRefGoogle Scholar
  3. 3.
    Cloyd JM, Acosta FL Jr, Cloyd C, Ames CP. Effects of age on perioperative complications of extensive multilevel thoracolumbar spinal fusion surgery. J Neurosurg Spine. 2010;12(4):402–8.CrossRefGoogle Scholar
  4. 4.
    Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine (Phila Pa 1976). 1995;20(14):1592–9.CrossRefGoogle Scholar
  5. 5.
    Fujita T, Kostuik JP, Huckell CB, Sieber AN. Complications of spinal fusion in adult patients more than 60 years of age. Orthop Clin North Am. 1998;29(4):669–78.CrossRefGoogle Scholar
  6. 6.
    Smith JS, Klinebery E, Lafage V, Shaffrey CI, Schwab F, Lafage R, et al. Prospective multi-center assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine. 2016;25(1):1–14.CrossRefGoogle Scholar
  7. 7.
    Fu KM, Smith JS, Polly DW Jr, Ames CP, Berven SH, Perra JH, et al. Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery. J Neurosurg Spine. 2011;14(4):470–4.CrossRefGoogle Scholar
  8. 8.
    Hamilton DK, Smith JS, Sansur CA, Glassman SD, Ames CP, Berven SH, et al. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine (Phila Pa 1976). 2011;36(15):1218–28.CrossRefGoogle Scholar
  9. 9.
    Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW Jr, et al. Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine (Phila Pa 1976). 2011;36(9):E593–7.CrossRefGoogle Scholar
  10. 10.
    Schoenfeld AJ, Ochoa LM, Bader JO, Belmont PJ Jr. Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am. 2011;93(17):1577–82.CrossRefGoogle Scholar
  11. 11.
    Buchlak OD, Yanamadala V, Levesque JC, Sethi R. Complication avoidance with preoperative screening insights form the Seattle spine team. Curr Rev Musculoskelet Med. 2016;9:316–26.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lamperti M, Tulegdzic B, Avitsian R. Management of complex spine surgery. Anesthesiology. 2017;30:551–6.Google Scholar
  13. 13.
    Salerno SM, Carlson DW, Soh EK, Lettieri CJ. Impact of perioperative cardiac assessment guidelines on management of orthopedic surgery patients. Am J Med. 2007;120(2):185.e1–6.CrossRefGoogle Scholar
  14. 14.
    Urban M, Jules-Elysee K, Loughlin C. The one-year incidence of postoperative myocardial infarction in an orthopedic population. HSS J. 2009;5:27–30.CrossRefGoogle Scholar
  15. 15.
    Sinatra RS, Torres J, Bustos AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg. 2002;10(2):117–29.CrossRefGoogle Scholar
  16. 16.
    Poldermans D, Bax JJ, Schouten O, Neskovic AN, Paelinck B, Rocci G, et al. Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control? J Am Coll Cardiol. 2006;48(5):964–9.CrossRefGoogle Scholar
  17. 17.
    Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S, et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery. Can J Cardiol. 2017;33(1):17–342.CrossRefGoogle Scholar
  18. 18.
    Eagle KA, Rihal CS, Mickel MC, Holmes DR, Foster ED, Gersh BJ. Cardiac risk of noncardiac surgery: influence of coronary disease and type of surgery in 3368 operations. CASS Investigators and University of Michigan Heart Care Program. Coronary Artery Surgery Study. Circulation. 1997;96(6):1882–7.CrossRefGoogle Scholar
  19. 19.
    McFalls EO, Ward HB, Moritz TE, Goldman S, Krupski WC, Littooy F, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351(27):2795–804.CrossRefGoogle Scholar
  20. 20.
    Vicenzi MN, Meislitzer T, Heitzinger B, Halaj M, Fleisher LA, Metzler H. Coronary artery stenting and non-cardiac surgery—a prospective outcome study. Br J Anaesth. 2006;96(6):686–93.CrossRefGoogle Scholar
  21. 21.
    Brilakis ES, Banerjee S, Berger PB. Perioperative management of patients with coronary stents. J Am Coll Cardiol. 2007;49(22):2145–50.CrossRefGoogle Scholar
  22. 22.
    Saia F. Surgery after drug-eluting stent implantation: it’s not all doom and gloom. J Thorac Dis. 2017;9(4):E373–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Raby KE, Brull SJ, Timimi F, Akhtar S, Rosenbaum S, Naimi C, et al. The effect of heart rate control on myocardial ischemia among high-risk patients after vascular surgery. Anesth Analg. 1999;88(3):477–82.CrossRefGoogle Scholar
  24. 24.
    Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P. Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg. 2000;90(6):1257–61.CrossRefGoogle Scholar
  25. 25.
    Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173(6):627–34.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Wiesbauer F, Schlager O, Domanovits H, Wildner B, Maurer G, Muellner M, et al. Perioperative beta-blockers for preventing surgery-related mortality and morbidity: a systematic review and meta-analysis. Anesth Analg. 2007;104(1):27–41.CrossRefGoogle Scholar
  27. 27.
    Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. ACC/AHA 2006 guideline update on perioperative cardiovascular evaluation for noncardiac surgery: focused update on perioperative beta-blocker therapy—a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2007;104(1):15–26.CrossRefGoogle Scholar
  28. 28.
    Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest. 1993;104(5):1445–51.CrossRefGoogle Scholar
  29. 29.
    Culver BH. Preoperative assessment of the thoracic surgery patient: pulmonary function testing. Semin Thorac Cardiovasc Surg. 2001;13(2):92–104.CrossRefGoogle Scholar
  30. 30.
    Glassman SD, Anagnost SC, Parker A, Burke D, Johnson JR, Dimar JR. The effect of cigarette smoking and smoking cessation on spinal fusion. Spine (Phila Pa 1976). 2000;25(20):2608–15.CrossRefGoogle Scholar
  31. 31.
    Nakagawa M, Tanaka H, Tsukuma H, Kishi Y. Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest. 2001;120(3):705–10.CrossRefGoogle Scholar
  32. 32.
    Truntzer J, Vopat B, Feldstein M, Mattayahu A. Smoking cessation and bone healing: optimal cessation timing. Eur J Orthop Surg Traumatol. 2015;25(2):211–5.CrossRefGoogle Scholar
  33. 33.
    Rizzi PE, Winter RB, Lonstein JE, Denis F, Perra JH. Adult spinal deformity and respiratory failure. Surgical results in 35 patients. Spine (Phila Pa 1976). 1997;22(21):2517–30.CrossRefGoogle Scholar
  34. 34.
    Ramakrishna G, Sprung J, Ravi BS, Chandrasekaran K, McGoon MD. Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol. 2005;45(10):1691–9.CrossRefGoogle Scholar
  35. 35.
    Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90(1):62–9.CrossRefGoogle Scholar
  36. 36.
    van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67.CrossRefGoogle Scholar
  37. 37.
    Kao LS, Meeks D, Moyer VA, Lally KP. Peri-operative glycaemic control regimens for preventing surgical site infections in adults. Cochrane Database Syst Rev 2009;(3):CD006806.Google Scholar
  38. 38.
    Wiener RS, Wiener DC, Larson RJ. Benefits and risks of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2008;300(8):933–44.CrossRefGoogle Scholar
  39. 39.
    Stryker LS, Abdel MP, Morrey ME, Morrow MM, Kor DJ, Morrey BF. Elevated postoperative blood glucose and preoperative hemoglobin A1C are associated with increased wound complications following total joint arthroplasty. J Bone Joint Surg Am. 2013;95(9):808–14. S1–2.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434–41.CrossRefGoogle Scholar
  41. 41.
    Lindsay R, Nieves J, Formica C, Henneman E, Woelfert L, Shen V, et al. Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet. 1997;350(9077):550–5.CrossRefGoogle Scholar
  42. 42.
    Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, et al. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int. 2005;16(5):510–6.CrossRefGoogle Scholar
  43. 43.
    Karikari IO, Nimjee SM, Hardin CA, Hughes BD, Hodges TR, Mehta AI, et al. Extreme lateral interbody fusion approach for isolated thoracic and thoracolumbar spine diseases: initial clinical experience and early outcomes. J Spinal Disord Tech. 2011;24(6):368–75.CrossRefGoogle Scholar
  44. 44.
    Campos JH. An update on bronchial blockers during lung separation techniques in adults. Anesth Analg. 2003;97(5):1266–74.CrossRefGoogle Scholar
  45. 45.
    Brier-Jones JE, Palmer DK, Inceoglu S, Cheng WK. Vertebral body fractures after transpsoas interbody fusion procedures. Spine J. 2011;11(11):1068–72.CrossRefGoogle Scholar
  46. 46.
    Moller DJ, Slimack NP, Acosta FL Jr, Koski TR, Fessler RG, Liu JC. Minimally invasive lateral lumbar interbody fusion and transpsoas approach-related morbidity. Neurosurg Focus. 2011;31(4):E4.CrossRefGoogle Scholar
  47. 47.
    Papanastassiou ID, Eleraky M, Vrionis FD. Contralateral femoral nerve compression: an unrecognized complication after extreme lateral interbody fusion (XLIF). J Clin Neurosci. 2011;18(1):149–51.CrossRefGoogle Scholar
  48. 48.
    Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res. 1973;93:173–8.CrossRefGoogle Scholar
  49. 49.
    Eggspuehler A, Sutter MA, Grob D, Jeszenszky D, Dvorak J. Multimodal intraoperative monitoring during surgery of spinal deformities in 217 patients. Eur Spine J. 2007;16(Suppl 2):S188–96.CrossRefGoogle Scholar
  50. 50.
    Raynor BL, Bright JD, Lenke LG, Rahman RK, Bridwell KH, Riew KD, et al. Significant change or loss of intraoperative monitoring data: a 25 year experience in 12,375 spinal surgeries. Spine. 2013;38(2):101–8.CrossRefGoogle Scholar
  51. 51.
    Rabai F, Sessions R, Seubert CN. Neuromonitoring and spinal cord integrity. Best Pract Res Clin Anaesthesiol. 2016;30:53–68.CrossRefGoogle Scholar
  52. 52.
    Bekker A, Haile M, Kline R, Didehvar S, Babu R, Martiniuk F, et al. The effect of intraoperative infusion of dexmedetomidine on the quality of recovery after spinal surgery. J Neurosurg Anesthesiol. 2013;25(1):16–24.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Kumar A, Bhattacharya A, Makhija N. Evoked potential monitoring in anaesthesia and analgesia. Anaesthesia. 2000;55(3):225–41.CrossRefGoogle Scholar
  54. 54.
    Sihle-Wissel M, Scholz M, Cunitz G. Transcranial magnetic-evoked potentials under total intravenous anaesthesia and nitrous oxide. Br J Anaesth. 2000;85(3):465–7.CrossRefGoogle Scholar
  55. 55.
    Farag E, Ghobrial M, Sessler DI, Dalton JE, Liu J, Lee JH, et al. Effect of perioperative lidocaine administration on pain, opioid consumption and quality of life after complex spine surgery. Anesthesiology. 2013;119:933–40.CrossRefGoogle Scholar
  56. 56.
    Gottschalk A, Durieux ME, Nemergut EC. Intraoperative methadone improves postoperative pain control in patients undergoing complex spine surgery. Anesth Analg. 2011;112:218–23.CrossRefGoogle Scholar
  57. 57.
    Nuttall GA, Horlocker TT, Santrach PJ, Oliver WC Jr, Dekutoski MB, Bryant S. Predictors of blood transfusions in spinal instrumentation and fusion surgery. Spine (Phila Pa 1976). 2000;25(5):596–601.CrossRefGoogle Scholar
  58. 58.
    Goodnough LT, Rudnick S, Price TH, Ballas SK, Collins ML, Crowley JP, et al. Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy. N Engl J Med. 1989;321(17):1163–8.CrossRefGoogle Scholar
  59. 59.
    Murray D. Acute normovolemic hemodilution. Eur Spine J. 2004;13(Suppl 1):S72–5.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Urban MK, Beckman J, Gordon M, Urquhart B, Boachie-Adjei O. The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine (Phila Pa 1976). 2001;26(10):1152–6.CrossRefGoogle Scholar
  61. 61.
    Soroceanu A, Oren JH, Smith JS, Hostin R, Shaffrey CI, Mundis GM, et al. Effect of antifibrinolytic therapy on complications, thromboembolic events, blood product utilization, and fusion in adult spinal deformity surgery. Spine (Phila Pa 1976). 2016;41:E879–86.CrossRefGoogle Scholar
  62. 62.
    Verma K, Errico T, Diefenbach C, Hoelscher C, Peters A, Dryer J, et al. The relative efficacy of antifibrinolytics in adolescent idiopathic scoliosis: a prospective randomized trial. J Bone Joint Surg Am. 2014;96:e80.CrossRefGoogle Scholar
  63. 63.
    Winter SF, Santaguida C, Wong J, Fehlings MG. Systemic and topical use of tranexamic acid in spinal surgery; a systematic review. Global Spine J. 2016;6(3):284–95.CrossRefGoogle Scholar
  64. 64.
    Solomon DH, O’Driscoll K, Sosne G, Weinstein IB, Cayre YE. 1 alpha,25-dihydroxyvitamin D3-induced regulation of protein kinase C gene expression during HL-60 cell differentiation. Cell Growth Differ. 1991;2(4):187–94.PubMedGoogle Scholar
  65. 65.
    Zausig YA, Weigand MA, Graf BM. Perioperative fluid management: an analysis of the present situation. Anaesthesist. 2006;55(4):371–90.CrossRefGoogle Scholar
  66. 66.
    Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–8.CrossRefGoogle Scholar
  67. 67.
    Urban MK, Urquhart B, Boachie-Adjei O. Evidence of lung injury during reconstructive surgery for adult spinal deformities with pulmonary artery pressure monitoring. Spine (Phila Pa 1976). 2001;26(4):387–90.CrossRefGoogle Scholar
  68. 68.
    Tuman KJ, Roizen MF. Outcome assessment and pulmonary artery catheterization: why does the debate continue? Anesth Analg. 1997;84(1):1–4.CrossRefGoogle Scholar
  69. 69.
    Cregg N, Mannion D, Casey W. Oliguria during corrective spinal surgery for idiopathic scoliosis: the role of antidiuretic hormone. Paediatr Anaesth. 1999;9(6):505–14.CrossRefGoogle Scholar
  70. 70.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345(19):1368–77.CrossRefGoogle Scholar
  71. 71.
    Funk DJ, Moretti EW, Gan TJ. Minimally invasive cardiac output monitoring in the perioperative setting. Anesth Analg. 2009;108(3):887–97.CrossRefGoogle Scholar
  72. 72.
    Michard F, Lopes MR, Auler JO Jr. Pulse pressure variation: beyond the fluid management of patients with shock. Crit Care. 2007;11(3):131.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Benes J, Mariateresa G, Nicola B, Michard F. The effects of goal directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care. 2014;18:584–94.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Chang SH, Miller NR. The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital Experience. Spine (Phila Pa 1976). 2005;30(11):1299–302.CrossRefGoogle Scholar
  75. 75.
    Patil CG, Lad EM, Lad SP, Ho C, Boakye M. Visual loss after spine surgery: a population-based study. Spine (Phila Pa 1976). 2008;33(13):1491–6.CrossRefGoogle Scholar
  76. 76.
    Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009;109(5):1534–45.CrossRefGoogle Scholar
  77. 77.
    Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105(4):652–9. Quiz 867–8.CrossRefGoogle Scholar
  78. 78.
    Roth S. Perioperative visual loss: what do we know, what can we do? Br J Anaesth. 2009;103(Suppl 1):i31–40.CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Cheng MA, Todorov A, Tempelhoff R, McHugh T, Crowder CM, Lauryssen C. The effect of prone positioning on intraocular pressure in anesthetized patients. Anesthesiology. 2001;95(6):1351–5.CrossRefGoogle Scholar
  80. 80.
    Holy SE, Tsai JH, McAllister RK, Smith KH. Perioperative ischemic optic neuropathy: a case control analysis of 126,666 surgical procedures at a single institution. Anesthesiology. 2009;110(2):246–53.PubMedGoogle Scholar
  81. 81.
    Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA. Visual loss as a complication of spine surgery. A review of 37 cases. Spine (Phila Pa 1976). 1997;22(12):1325–9.CrossRefGoogle Scholar
  82. 82.
    Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116:15–24.Google Scholar
  83. 83.
    Rubin DS, Parakati I, Lee LA, Moss HE, Joslin CE, Roth S. Perioperative vision loss in spine fusion surgery; ischemic optic neuropathy in the United States from 1998 to 2012 in the nationwide inpatient sample. Anesthesiology. 2016;125:457–64.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Jacob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, et al. Dexmedetomidine vs midazolam vs propofol for sedation during prolonged mechanical ventilation: two randomized control trials. JAMA. 2012;307(11):1151–60.CrossRefGoogle Scholar
  85. 85.
    Bible JE, Biswas D, Whang PG, Simpson AK, Rechtine GR, Grauer JN. Postoperative bracing after spine surgery for degenerative conditions: a questionnaire study. Spine J. 2009;9(4):309–16.CrossRefGoogle Scholar
  86. 86.
    Horodyski M, DiPaola CP, Conrad BP, Rechtine GR 2nd. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41(5):513–9.CrossRefGoogle Scholar
  87. 87.
    Naylor JR, Mulley GP. Surgical collars: a survey of their prescription and use. Br J Rheumatol. 1991;30(4):282–4.CrossRefGoogle Scholar
  88. 88.
    Abbott A, Halvorsen M, Dedering A. Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial. Physiother Theory Pract. 2013;29(4):290–300.CrossRefGoogle Scholar
  89. 89.
    Miller RA, Hardcastle P, Renwick SE. Lower spinal mobility and external immobilization in the normal and pathologic condition. Orthop Rev. 1992;21(6):753–7.PubMedGoogle Scholar
  90. 90.
    Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci. 2015;22(6):930–8.CrossRefGoogle Scholar
  91. 91.
    Urban MK, Jules-Elysee K, Urquhart B, Cammisa FP, Boachie-Adjei O. Reduction in postoperative pain after spinal fusion with instrumentation using intrathecal morphine. Spine (Phila Pa 1976). 2002;27(5):535–7.CrossRefGoogle Scholar
  92. 92.
    Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J. 2008;4(1):62–5.CrossRefGoogle Scholar
  93. 93.
    Kim JC, Choi YS, Kim KN, Shim JK, Lee JY, Kwak YL. Effective dose of oral pregabalin as an adjunct to multimodal analgesic regimen in lumbar spinal fusion surgery. Spine. 2011;36:428–33.CrossRefGoogle Scholar
  94. 94.
    Urban MK, Labib KM, Reid SC, Goon AK, Rotundo V, Cammisa FP Jr, et al. Pregabalin did not improve pain management after spinal fusions. HSS J. 2018;14(1):41–6.CrossRefGoogle Scholar
  95. 95.
    Sivaganessan A, Chotai S, White-Dzuro G, McGirt MJ, Devin CJ. The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal and human studies. Eur Spine J. 2017;26(11):2719–28.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Hospital for Special SurgeryCornell UniversityNew YorkUSA
  2. 2.Department of Anesthesiology, Critical Care, and Pain ManagementHospital for Special Surgery, Weill Cornell MedicineNew YorkUSA

Personalised recommendations