201. Intraoperative placement of analgesic calcium sulfate beads improves functional outcomes in thoracolumbar spine surgery

• Published in: The spine journal 2022-09, Vol.22 (9), p.S106-S107
• Main Authors: Kumar, Vignessh, Burks, Stephen S., Wang, Michael Y.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2022.06.221

Synthetic calcium sulfate beads serve as a carrier for delayed release of medication in a surgical wound. Bead size is customizable to effect duration, typically lasting 18-24 days. While use has been published in surgical literature, use of beads in spine surgery is relatively new. Beads have been used to fill dead space in orthopedic surgery. Incorporating antibiotics into beads decreases rate of surgical site infection. Lidocaine and bupivacaine beads have been tested for analgesic effects in orthopedic surgery without significant results. This study is the first to demonstrate the effect of analgesic beads on improvement in functional outcomes after spine surgery. Case-matched cohort study design. All patients undergoing open thoracolumbar spine surgery from January 2020 were considered for inclusion in this study. Only patients undergoing open surgery were considered for enrollment. Only patients undergoing open surgery were considered for enrollment, as opposed to patients undergoing surgery through minimally invasive or endoscopic approaches. There was no restriction on number of levels required for enrollment in this surgery. All patients had a posterior approach for surgery, in some patients this was supplemented by an anterior or lateral approach. Patients undergoing revision surgeries were not excluded from this study. Patients were randomized in their assignment to the calcium sulfate group and control group. Pain scores, pain medication usage, ambulation data and disposition as recorded postoperatively. Beads were composed by mixing 12 mg of morphine sulfate and vancomycin powder into a calcium sulfate base. Beads were prepared immediately prior to placement. Beads were placed within posterior spine incisions in the space of the paraspinal musculature deep to the fascia. Twenty patients were included in each the calcium sulfate group and control group. There was no significant difference in demographics, preoperative functional status, number of levels performed, percentage of surgeries comprising revisions, percent of posterior-only versus multi-approach surgeries or percent of surgeries using an interbody. Patients in the calcium sulfate group had a one-day shorter length-of-stay (4.25) compared to the control group (5.60), p=.012. A greater percentage of patients were discharged home in the calcium sulfate group (65.0%) compared to the control group (35.0%), p=.018. Patients in the calcium sulfate group reported better pain control througho