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Introduction: More spinal surgeries are being performed in patients taking low-dose aspirin for primary and secondary prevention of cardiovascular and cerebrovascular ischemic disease. However, there are no recommended guidelines for perioperative aspirin use in patients undergoing spinal surgery. This study evaluated the perioperative effect of continued low-dose aspirin on cervical laminoplasty. Methods: This was a single-institute retrospective study of patients who underwent laminoplasty at the C2/3 to C7/T1 levels for cervical compression lesions. The comparison of 73 patients who continued to take aspirin at 100 mg/day during the perioperative period and 322 patients who took no antiplatelet or anticoagulant drugs examined their patient characteristics, perioperative parameters, and perioperative complications. Results: A significantly higher proportion of patients with aspirin were men, and the mean age was significantly higher in patients with than without aspirin (P=0.011 and P<0.001, respectively). The preoperative hemoglobin level was significantly lower in patients with than without aspirin (P=0.033). The number of disk decompression levels, surgical time, intraoperative blood loss, and postoperative drainage volume were not significantly different between patients with and without aspirin. Reoperation for epidural hematoma formation was also not significantly different between patients with and without aspirin. Perioperative blood transfusions were performed in 1 of 73 patients with aspirin and 0 of 322 patients without aspirin, with no significant difference (P=0.185). No cardiovascular or cerebrovascular ischemic events occurred in either group. Conclusions: Continuing low-dose aspirin therapy during a perioperative period for cervical laminoplasty did not increase perioperative bleeding or the risk of bleeding-related complications. Therefore, continuing low-dose aspirin may be acceptable for patients undergoing cervical laminoplasty to prevent increased risk of cardiovascular and cerebrovascular accidents due to aspirin withdrawal.
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STUDY DESIGN: Single-center retrospective study. PURPOSE: This study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS). OVERVIEW OF LITERATURE: Intraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness. METHODS: This study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF). RESULTS: No significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group (210.1 mL; range, 50-367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260-760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180-890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145-637 mL) than in the PS-PLIF (639.6 mL; range, 285-1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270-950 mL; p=0.005) groups. CONCLUSIONS: Based on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.
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STUDY DESIGN: This was a single-institute retrospective study. OBJECTIVE: To evaluate postoperative complications in dialysis-dependent patients undergoing elective cervical and lumbar decompression surgery. SUMMARY OF BACKGROUND DATA: Spinal surgery in dialysis-dependent patients is very challenging due to the high risk of serious postoperative complications and mortality associated with their fragile general condition. However, the outcome of decompression surgery alone has not been evaluated in such patients. METHODS: An electronic medical record review showed that 338 and 615 patients had undergone cervical and lumbar spine posterior decompression, respectively. Among them, 48 and 42, respectively were dialysis-dependent patients. Postoperative complications were compared between dialysis-dependent and non-dialysis-dependent patients. RESULTS: Among patients who underwent cervical decompression, the rate of perioperative blood transfusion in dialysis-dependent patients (14.6%) was significantly higher than that in non-dialysis-dependent patients (0.7%). No severe complications or mortality occurred in association with cervical decompression. The incidence of postoperative complications in dialysis-dependent patients (6.3%) was not significantly different from that in non-dialysis-dependent patients (4.1%). Among patients who underwent lumbar decompression, the rate of perioperative transfusion in dialysis-dependent patients (11.9%) was also significantly higher than that in non-dialysis-dependent patients (0.7%). With respect to severe complications among patients who underwent lumbar decompression, cerebral hemorrhage occurred in one dialysis-dependent patient, and no mortality occurred. The incidence of postoperative complications in dialysis-dependent patients (9.2%) was not significantly different from that in non-dialysis-dependent patients (6.8%). CONCLUSION: Among patients who underwent posterior decompression alone for cervical or lumbar lesions, the rate of perioperative blood transfusion was significantly higher in dialysis-dependent than in non-dialysis-dependent patients. However, the postoperative rates of severe complications and mortality were not significantly different between the two groups. Therefore, decompression surgery alone is considered a rational surgical method with less invasiveness for dialysis-dependent patients with a fragile general condition. LEVEL OF EVIDENCE: 3.
