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Complex Spine Surgery in the Setting of Alpha-Gal Syndrome
Bayan W Razzaq1, Justin N Passman1, Stefano DiMaria2
1Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
World Neurosurgery
|November 8, 2025
Summary
Alpha-gal syndrome (AGS) poses significant risks in spine surgery due to common use of mammalian products in surgical agents. Identifying safe alternatives and implementing a structured perioperative pathway are crucial for preventing anaphylaxis in AGS patients.
Area of Science:
- Allergy and Immunology
- Neurosurgery
- Anesthesiology
Background:
- Alpha-gal syndrome (AGS) is an IgE-mediated allergy to the mammalian oligosaccharide galactose-α-1,3-galactose (α-gal).
- AGS can cause delayed anaphylaxis following exposure to nonprimate mammal products.
- Perioperative guidance for AGS patients undergoing spine surgery is limited, despite its known impact in cardiac surgery.
Purpose of the Study:
- To investigate the safety of common hemostatic agents, dural substitutes, and grafts used in spine surgery for patients with Alpha-gal syndrome.
- To classify surgical agents as safe or unsafe based on the presence of mammalian products.
- To discuss anesthetic considerations, patient workup, and pretreatment strategies for AGS patients in the context of spine surgery.
Main Methods:
- Review of 25 commonly used agents in spine surgery at an institution in Suffolk County, NY, an area with high AGS prevalence.
- Classification of agents based on the presence or absence of mammalian-derived products.
- Discussion of anesthetic management, preoperative workup, and pretreatment protocols for AGS patients.
Main Results:
- 64% of commonly used spine surgery agents were identified as potentially unsafe for AGS patients.
- Plant-based polysaccharide powders, oxidized cellulose, human recombinant thrombin, and synthetic dural sealants were identified as safe alternatives.
- A case of intraoperative anaphylaxis in an AGS patient during deformity correction surgery was presented.
Conclusions:
- AGS presents unique challenges in spine surgery due to the frequent use of mammalian-derived hemostatic, graft, and dural-repair agents.
- A structured perioperative pathway involving allergy consultation, α-gal IgE testing, premedication, and clear communication is essential for preventing anaphylaxis.
- Spine surgeons must recognize high-risk patients, utilize safe biomaterial alternatives, and coordinate care to mitigate the risks associated with AGS.
