Perioperative Management for Complex Spine Fusion Surgery

T he number of complex spine surgeries performed world- wide on an annual basis continues to rise at a remarkable rate, with greater than 400,000 spinal fusions estimated to occur annually throughout the United States. 1 Some of the purported reasons for this trend include an aging population, with a concomitant higher preponderance of degenerative spinal conditions in the general population, and an increasing number of medically appropriate candidates for these interventions, due to improved overall medical therapies and perioperative optimization of comorbidities. Improvements in surgical technology, including minimally invasive techniques, and radiographic navigation tools have expanded the candidacy pool for complex multilevel spine fusion procedures even further. 2 Perhaps the most important reason for the rise in eligible patients, however, is the incorporation of proactive, patient-centered, and value-based perioperative protocols that are being increasingly implemented at many high-volume spine centers. These strategies have been adopted to optimize patient preparation and mitigate morbidity and mortality, thus creating "safer" spaces for complex surgical procedures in patients who would have previously been deemed medically inappropriate for surgery. 4]