Application of novel knotless barbed sutures in open posterior cervical spine surgery: A prospective cohort study

BACKGROUND: Open posterior cervical spine surgery is associated with higher rates of postoperative wound complications compared to anterior approaches. This study aimed to compare the incidence of complications and cost-effectiveness between barbed and traditional sutures in open posterior cervical spine surgery. METHODS: A retrospective analysis of prospectively collected data (2022-2024) was performed on 270 adult patients undergoing elective posterior cervical surgery. Of these, 138 (51%) received traditional sutures and 132 (49%) received barbed sutures. The primary outcome was the incidence of wound-related complications, specifically surgical site infection, dehiscence, and hematoma; secondary outcomes encompassed patient-reported metrics (NRS and NDI), wound closure efficiency, and perioperative costs. RESULTS: The barbed suture group showed significantly shorter operative time (P < 0.001), wound closure time (P < 0.001), and drain removal time (P = 0.013), along with lower rates of wound dehiscence and hematoma (P = 0.049 and P = 0.038, respectively). No significant differences were noted in infection rates, incision length, hospital stay, 90-day readmission, or total hospitalization expenses. Barbed sutures were associated with higher rates of MCID achievement at 3 months in NRS-neck pain (P = 0.016) and NDI (P = 0.046). BMI, diabetes, and suture type were independent predictors of complications. CONCLUSION: Barbed sutures improve surgical efficiency, reduce mechanical wound complications, and enhance neck pain-related outcomes in posterior cervical spine surgery. Their potential benefit for arm pain requires further investigation.