Perioperative management and best practices

Appropriate patient selection, perioperative diagnostic workup, and adherence to perioperative guidelines are not only crucial to improving patient response to percutaneous fusion procedures but also, more importantly, to reducing the risk for morbidity, mortality, and other complications related to the procedure. In the preoperative setting, the clinician should evaluate the patient for an appropriate clinical indication that would benefit from a percutaneous fusion procedure, perform psychiatric assessment, obtain pertinent advanced imaging of the anatomical area of interest, hold anticoagulation per standard guidelines, optimize glucose control, recommend tobacco cessation, and provide antibiotic prophylaxis if necessary. In the intraoperative setting, antibiotic administration for prophylaxis against surgical infection is warranted. In the postoperative period, the clinician should prescribe appropriate antibiotic therapy for an adequate duration, determine when it is safe to resume anticoagulation therapy, prescribe a multimodal analgesia regimen for postoperative incisional pain control, recommend adherence to activity restrictions, and monitor patients at interval routine follow-up visits.