New Cervical Spine Surgery Protocol May Reduce Delirium

Early movement and reduced methylprednisolone can decrease postoperative delirium risk in elderly
By Jane Parry
HealthDay Reporter

FRIDAY, Dec. 4 (HealthDay News) -- A modified perioperative protocol for elderly patients undergoing cervical spine surgery that involves early commencement of mobilization, resumption of normal circadian rhythm, and reduction or avoidance of methylprednisolone may reduce postoperative delirium risk, according to a Japanese study published in the Nov. 1 issue of Spine.

Takahiro Ushida, M.D., of Kochi Medical School in Japan, and colleagues conducted a study of 122 cervical myelopathy patients, of whom 81 underwent cervical spine surgery under regular therapeutic protocols, while 41 were treated under a modified protocol that encouraged free movement with neck immobilization and reduced the dosage of methylprednisolone.

The researchers found that patients who received a methylprednisolone dosage over 1,000 mg were more likely to experience postoperative delirium, as were those aged over 70 years and with hearing impairment. When the investigators reduced the methylprednisolone dosage and encouraged free movement immediately after surgery, they found that the incidence of postoperative delirium decreased significantly.

"Since a state of delirium can possibly bring about unexpected traumatic conditions to the spine and spinal cord, preventing such a state is important for postoperative management of cervical spine surgery," the authors write. "Judging from our results, early postoperative free movement by wearing of cervical orthosis and reduced usage of methylprednisolone could be effective in preventing postoperative delirium."

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