Safety in Surgery
One of the most important topics in spine surgery this decade is safety. Surgical safety includes operation preparation, operation safety, and post-operation safety.
Use of Checklists
Checklists help ensure pre-, intra- and post-operative safety. The patients meet many health care providers and processes after hospital admission. Processes are executed through checklists by responsible medical personnel. If a step in the checklist is not completed, then the patient cannot proceed to the next step. The use of such checklists decreases potential errors almost by 100 percent. Please check whether the hospital or medical center where you plan to have surgery takes this type of safetyprecaution.
Use of Neuromonitorization
The most dramatic complication in scoliosis surgery is a spinal cord injury and paralysis. Neurological deficits can occur due to screw insertions or correction maneuvers. In the traditional approach, the patient is awaken and assessed after the correction is complete—called the ‘’wake up test’’. In this manner, if a deficit occurs, it’s difficult to determine its cause and, generally, is too late to correct it.
Nowadays, the use of allows for immediate recognition of stress in the spinal cord and injury type. Therefore, the stressful step can be reversed. Using intra-operative neuromonitorization therefore greatly decreases the incidence of spinal cord injuries.
Precautions for Blood Loss
Blood loss and transfusion are among the most important factors affecting the recovery rate and time of hospitalization post-scoliosis surgery. For safe surgery, blood loss should be reduced, and, thus, the need of blood transfusion should be decreased aswell.Patient positioning is a major factor leading toblood loss. To reduce the blood loss—and also assist in curvature correction and nerve damage prevention—Jackson tables were developed. Due to their transparent structure, the intraoperative X-rays are easier to take. Additionaly, special drug protocols are applied to the patients in order to decrease intraoperative blood loss and eliminate the need for blood transfusion.
Safety in Screw Placement
In surgical treatment of scoliosis, one of the widely used and standard implants are the pedicle screws. The replacement of the screws requires extreme experience, anatomical knowledge and orientation. Misplaced and/or loosened screws may prevent good correction, cause scoliosis to progress or create spinal cord injuries Placing screws to moderate curves in first-time operation patients are easier for the experienced surgeons; however, it can be difficult in severe curves and previously operated patients (the latter may increase screw misplacements). To increase pedicle screw placement safety in these surgeries, navigation devices and 3D mobile CT devices are used in the operating room for guidance.Navigation devices and robotic technologies do not replace experience, but increase safety in difficult cases. Always consider radiation exposure—unnecessary use of such devices should be avoided to reduce radiation exposure.
Safety in Radiographies
Progressive scoliotic curves need frequent follow-up with radiographs. Surgical preparations require additional X-rays. After the operation, the follow-up period is minimally two years. Recent scientific studies show that scoliosis patients have an increased risk of breast and endometrium cancer due to radiation exposure. Therefore, radiography safety has gained importance. A few years ago, biplaner slot scanner devices developed won the Nobel Physics Prize. The radiographs taken with these devices decrease the radiation exposure from 50 to 90 percent compared to the widely-used X-ray devices. Due to its high price, these EOS (şekil 8 EOS) devices are found in few scoliosis centers.
Scoliosis surgeries are commonly applied to children and adolescents. Recently, surgeries to address degenerative scoliosis are also increasing, generally applied for patients older than 50. When severe and/or progressive scoliosis is not surgically treated, it negatively affects quality of life but rarely has a life-shortening effect. Therefore, complications of surgery meant to preserve or increase the quality of life needs to be extremely low, if not null.
It is dramatic for a patient to loose his/her bowel and bladder control as well as mobility after the operation when performed for a non-life threatening condition. Before and after this treatment, radiographic controls are required. The probability of increased malignancy risk in long term follow-up further complicates the scoliosis treatment and follow-up period. Furthermore, since these surgeries are applied at school-age patients, they need to recover from them as fast as possible.
To conclude, the modern approach in scoliosis surgery is safety-first andfast and comfortable recovery.