Trends in Spinal Deformity Surgery and Reducing Narcotic Consumption During Surgery

Article Published on June 3, 2019

Originally published in Becker's Spine Review

For over a decade, adult spinal deformity surgeons have relied on two main ways to prevent proximal junctional kyphosis—global alignment and proportion score and age-adjusted parameters
Stuart Hershman, MD, believes that reviewing past research in other fields of medicine and taking a multimodal approach are critical for reducing narcotic consumption after spinal surgery
This multimodal approach involves using medications pre- and postoperatively, local anesthetics, behavior modification techniques, educating patients and managing their expectations

Preventing proximal junctional kyphosis is an area of focus in spinal deformity surgery. Stuart Hershman, MD, orthopaedic spine surgeon in the Department of Orthopaedics at Massachusetts General Hospital, describes how for over a decade, orthopedic spine surgeons have relied on two main ways to prevent proximal junctional kyphosis, a complication following adult spinal deformity surgery. These two methods use spinopelvic parameters as a reference for presurgical planning.

The first is the global alignment and proportion score, which analyzes the sagittal plane to predict mechanical complications. The second method uses age-adjusted parameters, which lets surgeons know when they have been overcorrecting patients so that they can strive for less correction.

At the American Academy of Orthopaedic Surgeons 2019 Annual Meeting, experts discussed ways to reduce and prevent proximal junctional kyphosis. New research suggests focusing on how much lordosis should be restored to decrease the risk of proximal junctional kyphosis.

With regard to pain-management in adult spinal deformity surgery, Dr. Hershman believes that it is necessary to observe the research done in other areas of medicine.

Dr. Hershman highlights a study out of Arizona that uses a long-acting liposomal bupivacaine injection during wound closure, where the researchers found that using this type of local anesthetic was successful in reducing narcotic consumption during the acute perioperative period.

He also suggests taking a multimodal approach to reduce narcotic consumption after adult spinal deformity surgery by utilizing various medications given both pre- and postoperatively, local anesthetics, behavior modification techniques, and by educating patients and managing their expectations.