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KMID : 0388720230300030109
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Journal of Korean Society of Spine Surgery
2023 Volume.30 No. 3 p.109 ~ p.118
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Perioperative Considerations in Lumbar Fusion Surgery
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Park Sang-Min
Suh Seung-Pyo
Baik Jong-Min
Kwon Ki-Youn
Jang Hae-Dong
Lim Soo-Taek
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Abstract
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Study Design: Review article.
Objectives: The purpose of this study was to review the perioperative considerations for lumbar fusion surgery.
Summary of Literature Review: With an aging population, degenerative lumbar spine diseases are on the rise. The number of patients who have comorbidities and undergo complex lumbar spine surgery is also increasing. There are many points to consider before and after lumbar fusion surgery.
Materials and Methods: Review of the relevant articles.
Results: In spine surgery, conservative treatment is often considered before surgical treatment because symptoms often improve with conservative treatment. If conservative treatment fails, surgical treatment is then considered. Once the decision to operate has been made, the patient's past medical history is taken, and medical conditions are assessed before surgery. The severity of osteoporosis is also assessed to determine the surgical approach. If severe osteoporosis is present, osteoporosis treatment may be considered first, and if it is very severe, various pedicle screw fixation techniques should be considered. Finally, a multidisciplinary approach to surgery is necessary to ensure rapid recovery. Enhanced recovery after surgery (ERAS) protocols have recently been applied to lumbar fusion surgery.
Conclusions: Adequate and appropriate conservative treatment should be implemented before spine surgery. Medical risk factors (diabetes, smoking, osteoporosis, kidney disease, medications, etc.) should be identified and corrected preoperatively. In addition, early patient recovery with perioperative ERAS should be considered, as ERAS protocols may have a positive effect in older patients with a higher frequency of postoperative complications.
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KEYWORD
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Conservative treatment, Osteoporosis, Perioperative evaluation, Enhanced recovery after surgery
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