Table-mounted retractors can improve operative efficiency without leading to inferior outcomes

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With proper application, the use of a table-mounted retractor can help improve operative efficiency without leading to inferior outcomes in patients undergoing anterior cervical spine surgeries (ACSS). This was the main finding of a recent study, presented at the Global Spine Congress annual meeting (3–6 November 2021, Paris, France), by Athan Zavras (Rush University Medical Centre, Chicago, USA).

The study found no significant difference in rates and severity of dysphagia or patient reported outcomes for neck or arm pain between those who underwent ACSS with either self-retaining or table-mounted retractors. Furthermore, operative time was significantly shortened with the use of a table-mounted retractor arm.

The researchers retrospectively evaluated all patients who underwent ACSS with a single surgeon between 2014 and 2020. Patients with a minimum follow-up of six-months were stratified into two cohorts depending on the type of retractor used.

Patients in the first group underwent ACSS with self-retaining retraction, whereas a table-mounted retractor arm was used for the second group. Patient outcomes were quantified via retrospective collection of patient-reported outcome (PROs) and the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires, including the SWAL-QOL survey for dysphagia, Neck Disability Index (NDI), Visual Analog Scale (VAS) Arm, VAS Neck, Short Form 12-Item Health Survey (SF12), and Veteran’s Rand 12-Item Health Survey (VR12).

A total of 74 (31 female, 43 male) and 114 (55 female, 59 male) patients receiving either table-mounted, or self-retaining retraction were assessed with mean follow-up of 7.897 ± 7.01 and 10.46 ± 8.91 months (p=0.074), respectively. Table-mounted retraction patients were significantly younger with a mean age of 62.78 ± 10.3 compared to 58.05 ± 13.1 years in the self-retaining cohort (p=0.025).

There were no observed differences in postoperative dysphagia according to the SWAL-QOL assessment tool (table-mounted: 83.00 ± 19.0, self-retaining: 81.70 ± 21.0, p=0.819). There were also no differences noted between groups in postoperative PRO or PROMIS surveys. There were no differences in mean time of retraction per operated level (p=0.243) or intraoperative blood loss (p=0.985).

However, mean operative time was significantly shorter with table-mounted retraction compared to self-retaining retraction (table-mounted: 116.6 ± 44.82 minutes, self-retaining: 129.1 ± 49.38 minutes, p=0.015).


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