Spinal fusion is an aerosol generating procedure.

Area of Science:

• Neurosurgery
• Surgical Safety
• Infectious Disease Transmission

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission can occur via aerosols during medical procedures.
• Spinal fusion involves steps that may aerosolize blood, but the associated risk to surgeons is not well-quantified.
• Infectious coronavirus aerosols are typically in the 0.5-8.0 μm size range.

Purpose of the Study:

• To quantify aerosol generation during spinal fusion surgeries.
• To identify specific surgical steps associated with increased aerosol particle counts.
• To assess the risk of infectious aerosol exposure for surgeons during spinal fusion.

Main Methods:

• A handheld optical particle sizer (OPS) was used to measure airborne particle counts during five posterior spinal instrumentation and fusion surgeries.
• Particle counts were analyzed in three size groups: 0.3-0.5 μm/m³, 1.0-5.0 μm/m³, and 10.0 μm/m³.
• Hierarchical logistic regression modeled the odds of a spike (defined as >3 standard deviation increase from baseline) in particle counts based on the surgical step.

Main Results:

• Bovie electrocautery, high-speed pneumatic burring, and ultrasonic bone scalpel use were significantly associated with increased particle counts in the 0.3-0.5 μm/m³ and 1.0-5.0 μm/m³ ranges.
• Bovie and burring showed the highest odds of particle count spikes across multiple size ranges.
• Pedicle drilling was not associated with increased particle counts in any measured size range.

Conclusions:

• Several surgical steps during spinal fusion, including electrocautery, burring, and bone scalpel use, increase airborne particle counts within the aerosol size range.
• These findings suggest a potential inhalation hazard for surgeons, similar to electrocautery smoke.
• Further research is needed to confirm if these aerosolized particles can contain infectious viruses.