Application of novel knotless barbed sutures in open posterior cervical spine surgery: A prospective cohort study

Open posterior cervical spine surgery is associated with higher rates of postoperative wound complications compared to anterior approaches. This study aimed to compare the incidence of complications and cost-effectiveness between barbed and traditional sutures in open posterior cervical spine surgery.

A retrospective analysis of prospectively collected data (2022-2024) was performed on 270 adult patients undergoing elective posterior cervical surgery. Of these, 138 (51%) received traditional sutures and 132 (49%) received barbed sutures. The primary outcome was the incidence of wound-related complications, specifically surgical site infection, dehiscence, and hematoma; secondary outcomes encompassed patient-reported metrics (NRS and NDI), wound closure efficiency, and perioperative costs.

The barbed suture group showed significantly shorter operative time (P < 0.001), wound closure time (P < 0.001), and drain removal time (P = 0.013), along with lower rates of wound dehiscence and hematoma (P = 0.049 and P = 0.038, respectively). No significant differences were noted in infection rates, incision length, hospital stay, 90-day readmission, or total hospitalization expenses. Barbed sutures were associated with higher rates of MCID achievement at 3 months in NRS-neck pain (P = 0.016) and NDI (P = 0.046). BMI, diabetes, and suture type were independent predictors of complications.

Barbed sutures improve surgical efficiency, reduce mechanical wound complications, and enhance neck pain-related outcomes in posterior cervical spine surgery. Their potential benefit for arm pain requires further investigation.