Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2023; 14(5): 340-347
Published online May 18, 2023. doi: 10.5312/wjo.v14.i5.340
Spinal fusion is an aerosol generating procedure
Joanna Lind Langner, Nicole Segovia Pham, Ann Richey, Yousi Oquendo, Shayna Mehta, John Schoeneman Vorhies
Joanna Lind Langner, Nicole Segovia Pham, Ann Richey, Shayna Mehta, John Schoeneman Vorhies, Pediatric Orthopaedic Surgery, Stanford University, Palo Alto, CA 94304, United States
Yousi Oquendo, Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: All authors contributed to the study conception and design; Langner JL, Pham NS, Richey A, Oquendo Y, Mehta S, and Vorhies JS performed material preparation, data collection, and analysis; the first draft of the manuscript was mainly written by Langner JL and Vorhies JS and all authors assisted on previous versions of the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: Approval was granted an institutional review board statement waiver by the Ethics Committee of Stanford University (No. 58206).
Informed consent statement: The informed consent was waived from the patients.
Conflict-of-interest statement: Dr. John Vorhies receives grant funding from the Scoliosis Research Society (SRS), Pediatric Orthopaedic Surgery of North America (POSNA), and Stanford University. Dr. John Vorhies is a consultant for Ortho Pediatrics and Nview Medical, and a committee member of the SRS Research Grant Committee and POSNA’s Industry Relations Committee and Research Committee, and a former member of the POSNA Evidence-Based Practice committee. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this manuscript. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Data sharing statement: No additional data is available for sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Schoeneman Vorhies, MD, Assistant Professor, Pediatric Orthopaedic Surgery, Stanford University, 453 Quarry Road, 3rd Floor, MC 5658, Palo Alto, CA 94304, United States. john.vorhies@stanford.edu
Received: January 23, 2023
Peer-review started: January 23, 2023
First decision: January 31, 2023
Revised: February 14, 2023
Accepted: March 27, 2023
Article in press: March 27, 2023
Published online: May 18, 2023
Abstract
BACKGROUND

Transmission of severe acute respiratory syndrome coronavirus 2 can occur during aerosol generating procedures. Several steps in spinal fusion may aerosolize blood but little data exists to quantify the risk this may confer upon surgeons. Aerosolized particles containing infectious coronavirus are typically 0.5-8.0 μm.

AIM

To measure the generation of aerosols during spinal fusion using a handheld optical particle sizer (OPS).

METHODS

We quantified airborne particle counts during five posterior spinal instrumentation and fusions (9/22/2020-10/15/2020) using an OPS near the surgical field. Data were analyzed by 3 particle size groups: 0.3-0.5 μm/m3, 1.0-5.0 μm/m3, and 10.0 μm/m3. We used hierarchical logistic regression to model the odds of a spike in aerosolized particle counts based on the step in progress. A spike was defined as a > 3 standard deviation increase from average baseline levels.

RESULTS

Upon univariate analysis, bovie (P < 0.0001), high speed pneumatic burring (P = 0.009), and ultrasonic bone scalpel (P = 0.002) were associated with increased 0.3-0.5 μm/m3 particle counts relative to baseline. Bovie (P < 0.0001) and burring (P < 0.0001) were also associated with increased 1-5 μm/m3 and 10 μm/m3 particle counts. Pedicle drilling was not associated with increased particle counts in any of the size ranges measured. Our logistic regression model demonstrated that bovie (OR = 10.2, P < 0.001), burring (OR = 10.9, P < 0.001), and bone scalpel (OR = 5.9, P < 0.001) had higher odds of a spike in 0.3-0.5 μm/m3 particle counts. Bovie (OR = 2.6, P < 0.001), burring (OR = 5.8, P < 0.001), and bone scalpel (OR = 4.3, P = 0.005) had higher odds of a spike in 1-5 μm/m3 particle counts. Bovie (OR = 0.3, P < 0.001) and drilling (OR = 0.2, P = 0.011) had significantly lower odds of a spike in 10 μm/m3 particle counts relative to baseline.

CONCLUSION

Several steps in spinal fusion are associated with increased airborne particle counts in the aerosol size range. Further research is warranted to determine if such particles have the potential to contain infectious viruses. Previous research has shown that electrocautery smoke may be an inhalation hazard for surgeons but here we show that usage of the bone scalpel and high-speed burr also have the potential to aerosolize blood.

Keywords: Optical particle sizers, Aerosol, COVID-19, Orthopaedic procedures, Spinal fusion, SARS-CoV-2

Core Tip: In this study we use a handheld optical particle sizer to measure the generation of aerosols during surgical steps in spinal fusion because of the risk this may confer upon surgeons in regards to the airborne transmission of severe acute respiratory syndrome coronavirus 2. Several steps in spinal fusion, specifically the bone scalpel and high-speed burr, were found to be associated with increased airborne particle counts in the aerosol size range.