Abstract
The surgical incision closure technique is an important and indispensable part of spinal surgery. It greatly affects the postoperative prognosis of spinal disease, and for certain diseases, it can even become a critical factor determining the success or failure of the treatment. By taking cervical, thoracic, and lumbar posterior median surgical approaches as examples, this section will focus on the closure techniques of spinal incisions, operating skills, and precautions for the reconstruction and closure of the soft tissue of surgical incisions.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Albee FH. Transplantation of a portion of the tibia into the spine for Pott’s disease. JAMA. 1911;57:885.
Hibbs RH. An operation for progressive spinal deformities NY. J Med. 1911;93:1013.
Gililland JM, Anderson LA, Barney JK, Ross HL, Pelt CE, Peters C. Barbed versus standard sutures for closure in Total knee arthroplasty: a multicenter prospective randomized trial. J Arthroplast. 2014;29(Suppl. 2):135–8.
Borzio RW, Piveci R, Kapadian BH, Jauregui JJ, Maheshwari AV. Barbed sutures in total hip and knee arthroplasty: what is the evidence? A meta-analysis. Int Orthopaedics (SICOT). 2016;40:225–31.
Ting NT, Moric MM, Della Valle CJ, Levine BR. Use of knot-less suture for closure of Total hip and knee arthroplasties a prospective, randomized clinical trial. J Arthoplasty. 2012;27(10):1783–8.
Smith EL, DiSegna ST, Shukla PY, Matzkin EG. Barbed versus traditional sutures: closure time, cost, and wound related outcome in Total joint arthroplasty. J Arthroplast. 2014;29:283–7.
Gililland JM, Anderson LA, Sun G, Ericksoo JA, Peters CL. Perioperative closure-related complication rates and cost analysis of barbed suture for closure in TKA. Clin Orthop Relat Res. 2012;470:125–9.
Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013 May 1;95(9):775–82.
Fowler JR, Perkins TA, Buttaro BA, Truant AL. Bacteria adhere less to barbed monofilament than braided sutures in a contaminated wound model. Clin Orthop Relat Res. 2013;471:665–71.
Mansour A, Ballard R, Garg S, Baulesh D, Erickson M. The use of barbed sutures during scoliosis fusion wound closure: a quality improvement analysis. J Pediatr Orthop. 2013;33:786–90. PMID: 24213622
Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg. 2009;124:1551–8.
Wu YJ, et al. Repositioning suture of the erector spinae muscle for lumbar spine surgery via the posterior approach: a prospective randomized study. Cell Biochem Biophys. 2014;69(1):75–80.
Shani A, Poliansky V, et al. Nylon skin sutures carry a lower risk of post-operative infection than metal Staples in open posterior spine surgery: a retrospective case-control study of 270 patients. Surgical infections. Published online December 31, 2019.
Shakil H, Iqbal ZA, Al-Ghadir AH. Scoliosis: review of types of curves, etiological theories and conservative treatment. J Back Musculoskelet Rehabil. 2014;27(2):111–5.
McLeod L, Flynn J, Erickson M, Miller N, Keren R, Dormans J. Variation in 60-day readmission for surgical-site infections (SSIs) and reoperation following spinal fusion operations for neuromuscular scoliosis. J Pediatr Orthop. 2016;36(6):634–9.
Mackenzie WG, Matsumoto H, Williams BA, et al. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am. 2013;95(9):800–S2.
Subramanyam R, Schaffzin J, Cudilo EM, Rao MB, Varughese AM. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. Spine J. 2015;15(6):1422–31.
Sullivan BT, Abousamra O, Puvanesarajah V, et al. Deep infections after pediatric spinal arthrodesis: differences exist with idiopathic, neuromuscular, or genetic and syndromic cause of deformity. J Bone Joint Surg Am. 2019;101(24):2219–25.
Yagi M, Hosogane N, Watanabe K, Asazuma T, Matsumoto M. Keio spine research group. The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis. Spine J. 2016;16(4):451–8.
Akhaddar A, Alaoui M, Turgut M, Hall W. Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review [published online ahead of print, 2020 May 12]. Neurosurg Rev. 2020; https://doi.org/10.1007/s10143-020-01311-5.
Mange TR, Sucato DJ, Poppino KF, Jo CH, Ramo BR. The incidence and risk factors for perioperative allogeneic blood transfusion in primary idiopathic scoliosis surgery [published online ahead of print, 2020 Mar 9]. Spine Deform. 2020; https://doi.org/10.1007/s43390-020-00093-6.
Subramanyam R, Schaffzin J, Cudilo EM, Rao MB, Varughese AM. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. Spine J. 2015;15(6):1422–31.
Vitale MG, Riedel MD, Glotzbecker MP, et al. Building consensus: development of a best practice guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop. 2013;33(5):471–8.
Kalevski SK, Peev NA, Haritonov DG. Incidental Dural tears in lumbar decompressive surgery: incidence, causes, treatment, results. Asian J Neurosurg. 2010;5(1):54–9.
AH S, G C, D S, et al. Predictive factors for dural tear and cerebrospinal fluid leakage in patients undergoing lumbar. Surgery. 2006;5(3):224–7.
Shengsheng C, Minjie R, Yuhong Q, et al. Clinical efficacy of medical glue combined with gelatin sponge in preventing cerebrospinal fluid leakage after spinal dural suture. J Chin Medical Guide. 2015;13(21):4–6.
Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg American. 1981;63(7):1132–6.
Papavero L, Engler N, Kothe R. Incidental durotomy in spine surgery: first aid in ten steps. Eur Spine J: official publication of the European Spine Society tESDS. 2015;24(9):2077–84.
Strömqvist F, Jönsson B, Strömqvist B, et al. Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome. Eur Spine J. 2010;19(3):439–42.
Fang Z, Tian R, Jia Y-T, et al. Treatment of cerebrospinal fluid leak after spine surgery. Chin J traumatol = Zhonghua chuang shang za zhi. 2017;20(2):81–3.
Qi S. A randomized controlled study of suturing deep fascia during lumbar posterior short-segment decompression and fusion with barb-free sutures. Chin Tissue Eng Res. 2020;24(10):1585–90.
Zixiang W. Guidelines for evidence-based clinical diagnosis and treatment of orthopedics of the orthopedics branch of the Chinese medical doctor association: evidence-based clinical diagnosis and treatment guidelines for spinal dural tear and postoperative cerebrospinal fluid leakage. J Chin J Surgery. 2017;55(02):86–9.
Hida K, Yano S, Iwasaki Y. Considerations in the treatment of cervical ossification of the posterior longitudinal ligament. Chin Neurosurg. 2008;55:126–32.
Bosacco SJ, Gardner MJ, Guille JT, et al. Evaluation and treatment of dural tears in lumbar spine surgery: a review. Clin Orthop Relat Res. 2001;389:238–47.
Black P. Cerebrospinal fluid leaks following spinal surgery: use of fat grafts for prevention and repair. Technical note. J Neurosurg. 2002;96:250–2.
Narotam PK, Jose S, Nathoo N, et al. Collagen matrix (DuraGen) in dural repair: analysis of a new modified technique. Spine. 2004;29(24):2861–7.
Matsuoka T, Yamaura I, Kurosa Y, et al. Long-term results of the anterior floating method for cervical myelopathy caused by ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976). 2001;26(3):241–8.
Hu P, Yu M, Liu X, et al. Cerebrospinal fluid leakage after surgeries on the thoracic spine: a review of 362 cases. Asian Spine J. 2016;10(3):472–9.
Khan MH, Rihn J, Steele G, et al. Postoperative management protocol for incidental dural tears during degenerative lumbar spine surgery: a review of 3,183 consecutive degenerative lumbar cases. Spine (Phila Pa 1976). 2006;31(22):2609–13.
Gandhi J, DiMatteo A, Joshi G, et al. Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management. Int J Neurosci. 2020;13:1–13.
Vaccaro AR. What is new in the diagnosis and prevention of spine surgical site infections. Spine J. 2015;15(2):336–47.
Ma L. Treatment of early infection after posterior spinal internal fixation with closed lavage and drainage. Sichuan Med. 2015;4
Samuel AM. CORR insights®: incidence of surgical site infection after spine surgery: what is the impact of the definition of infection. Clin Orthop Related Res. 2015;473(5):1620–1.
Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. Spine J Official J North American Spine Soc. 2013;13(9):1017–29.
Deyu C. Risk factors of incision infection after spinal surgery. Chin J Spine Spinal Cord. 3:77–80.
Bradford DS. Risk factors for infection after spinal surgery. Spine (Phila Pa 1976). 2005;30(12):1460–5.
Fangcai L. Clinical features and treatment of early deep infection after spinal internal fixation. Zhejiang J Traumatic Surg. 024(004): 739–741.
Hu SS. Clinical outcome of deep wound infection after instrumented posterior spinal fusion. Spine (Phila Pa 1976). 2009;34(6):578–83.
Patel R. A biofilm approach to detect bacteria on removed spinal implants. Spine (Phila Pa 1976). 2010;35(12):1218–24.
Kaye KS. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(S2):S66–88.
Gluch H. Management of postoperative wound infection in posterior spinal fusion with instrumentation. J Spinal Disord. 1996;9(6):505–8.
Shugang L. Treatment of infection after posterior scoliosis orthopedic fusion. Chinese Journal of Orthopaedics. 21(8): 453–456.
Zhongjun L. Treatment of deep wound infection after spinal surgery. Chin J Surg. 043(4): 229–231.
Jing L. Treatment of deep infection after thoracolumbar posterior internal fixation. Chin J Surg. 2005;43(20):1325–7.
Wang Y. Delayed infection after spinal internal fixation. Chin J Orthop. (08):88–89.
Giacomini S. Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. Eur Spine J. 2011;20(1 Supplement):121–7.
Qiu G. Abnormalities associated with congenital scoliosis a retrospective study of 226 chinese surgical cases. Spine (Phila Pa 1976). 2012;38(10):814–8.
Sheng L. Treatment strategy for early incision deep infection after spinal internal fixation. J Clin Orthop. (5):50–53+59.
Haoning Z. Treatment of infection after spinal internal fixation. Chin J Orthop. (015): 1357–1362.
Cohen DB. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery. Spine (Phila Pa 1976). 2010;35(13):1323–8.
Guo X. Debridement with preserving internals combined with vacuum negative pressure sealing drainage to treat early postoperative spinal infection. Chin J Spine and Spinal Cord. 2015;25(12):1123–5.
Lee JS. Implant removal for the management of infection after instrumented spinal fusion. J Spinal Disord Tech. 2010;23(4):258–65.
Wang X. Treatment of delayed infection after internal fixation of the spine pedicle screw system. Chin J Orthop. 190(20): 1577–1578.
Vaccaro A. Is surgical case order associated with increased infection rate after spine surgery. Spine (Phila Pa 1976). 2012;37(13):1170–4.
van Middendorp JJ. A methodological systematic review on surgical site infections following spinal surgery: part 1 risk factors. Spine (Phila Pa 1976). 2012;37(24):2034–45.
Sosna A. Antibiotic treatment for prevention of infectious complications in joint replacement. Acta Chir Orthop Traumatol Cech. 2006;73(2):108–14.
Oliveri G. Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone–iodine and hydrogen peroxide. Arch Orthop Trauma Surg. 2011;131(9):1203–6.
Zhikui L. Analysis of related factors of incisional infection after single-opening of the posterior cervical spine. Chin J Clin Res. v.31(5): 67–70.
Zhisheng L, Feipeng G, Gang C, et al. The causes and treatment of postoperative infection after superior cervical spine surgery. Pract Clin Med, 2013, 014(009): 71–72, 87, cover 3.
Dong Y, Zheng X, Honglin G, et al. Treatment of delayed deep infection after spinal internal fixation. Chin J Orthop. 2017;37(18):1150–5.
Guo L, Degang T, Wang J, et al. Observation on the therapeutic effects of early debridement and closed negative pressure drainage in the treatment of incisional infection after cervical posterior approach. Zhejiang J Traumatic Surg. 2014;000(004):528–529,530.
Nan Z, Faming T, Zihong L, et al. Analysis of effects of wound hedging and drainage for incision infection after cervical posterior approach single-opening surgery. Chin J Medical Guide. 2017;16(4):367–9.
Kuibo Z, Tao C, Guo Y, et al. Analysis of risk factors for early surgical site infection after thoracolumbar posterior internal fixation. J Sun Yat-sen Univ. 2013;34(6):986–90.
Kim JI, Suh KT, Kim SJ, et al. Implant removal for the man-agement of infection after instrumented spinal fusion. J Spi-nal Disord Tech. 2010;23(4):258–65.
Chen SH, Lee CH, Huang KC. et al.Postoperative wound infection after posterior spinal instrumentation: analysis of long-term treatment outcomes. Eur Spine J. 2015;24(3):561–70.
Fei C, Lu G, Yijun K, et al. Treatment of deep infection after thoracolumbar posterior internal fixation. Chin J Surg. 2005;43(20):1325–7.
Zheng Y, Yu B, Lu S, Xiaoqiang Z. Application of vacuum sealing drainage in the treatment of early wound deep infection after thoracolumbar posterior internal fixation. Orthop Biomech Mater Clin Study. 2013;10(1):35–6.
Nenggao F. Zhang Yingbo, Zhang Zhiming, Jiang Cheng, VSD combined with lavage and drainage in the treatment of thoracolumbar incision infection. J Pract Orthop. 2014;20(1):145–8.
Xu Y. Analysis of related factors of postoperative wound infection in patients with spinal surgery. Diet Sci 2018 (16).
Ke J. Analysis of therapeutic effects of erected “voilet braided sutures” on .postoperative fat liquefaction for obese patients. Chin J Misdiagnostics. 2011;19:4639.
Allegranzi B, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016 Dec;16(12):e288–303.
ACS and surgical infection society: surgical site infection guidelines, 2016 Update.
Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. Published online May 3, 2017.
Guidelines for the prevention of surgical site infections in China. Chin J Gastrointest Surg. 2019;22(4):301–14.
Ueno M, Saito W, et al. Triclosan-coated sutures reduce wound infections after spinal surgery: a retrospective, nonrandomized, clinical study. Spine J. 2015 May 1;15(5):933–8.
Shani A, Poliansky V, et al. Nylon skin sutures carry a lower risk of post-operative infection than metal staples in open posterior spine surgery: a retrospective case-control study of 270 patients. Srugical Infections. Published online December 31, 2019.
Yonggang T, Yi J, Lianping X, et al. Treatment strategies for postoperative spinal infection. Chin J Spine Spinal Cord. 2009;19(9):717–71.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Li, W. et al. (2021). Suture Techniques for Spinal Soft Tissue Reconstruction. In: Tang, P., Wu, K., Fu, Z., Chen, H., Zhang, Y. (eds) Tutorials in Suturing Techniques for Orthopedics. Springer, Singapore. https://doi.org/10.1007/978-981-33-6330-4_13
Download citation
DOI: https://doi.org/10.1007/978-981-33-6330-4_13
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-33-6329-8
Online ISBN: 978-981-33-6330-4
eBook Packages: MedicineMedicine (R0)