Table 1.

Perioperative management of patients with polysegmental diseases of the lumbar spine

Criterion	ARP-guided dorsal decompression and stabilization	Traditional dorsal decompression and stabilization	Specialist in charge
Outpatient-ambulatory stage
Patient informed consent Discussion about the surgery and anesthesia, possible risks and complications; presentation of similar clinical examples and demonstration of video footage of relevant operations — to ensure the patient’s understanding and psychological readiness for the upcoming surgery	Outpatient	In the hospital	Neurosurgeon, anesthesiologist
Examination by an anesthesiologist Examination of the clinical and instrumental data needed to identify the patient’s potential to compensate for the comorbid conditions and the need for correction	Outpatient	In the hospital	Anesthesiologist
Quit smoking Ruling out the effect of nicotine on the rheological properties of blood and protecting against smoking-induced intoxication	Several weeks before surgery	No	Anesthesiologist, neurosurgeon
Hospitalization Preoperative stay in the hospital	On the day or the eve of the operation	3–5 days before surgery	Neurosurgeon
In-hospital stage (preoperative)
Food and fluid intake Discontinuation food and fluid intake to reduce the general stress of the patient’s body	Stop taking solid food 6 h before surgery, fluids — 2 h before surgery	Stop taking solid food 18 h before surgery, fluids — 10 h before surgery	Anesthesiologist
Premedication Reducing the drug burden on the patient and accelerating the rehabilitation process	Only in the presence of somatic disease	Midazolam, Promedol, Sibazon	Anesthesiologist
Prevention of infectious complications Use of antibacterial drugs	Antibiotic prophylaxis 2 h before the first incision	Antibiotic therapy	Anesthesiologist, neurosurgeon, clinical pharmacologist
Prevention of thromboembolic complications The use of compression hosiery. Ultrasound examination of lower limb veins before and the next day after surgery	Yes	Yes	Anesthesiologist, neurosurgeon, sonologist
In-hospital stage (intraoperative)
Anesthetic management: multimodal analgesia using non-steroidal anti-inflammatory drugs prior to skin incision and before suturing — to reduce the need for analgesics; using dexmedetomidine to help control the depth of anesthesia, the restoration of consciousness, prevention of cognitive dysfunctions, and reduction of analgesics dosing; use of sugammadex for fast and effective reversal of the neuromuscular block upon patient extubation in the operating room	Yes	No (only traditional anesthesia with arduan, propofol, and fentanyl)	Anesthesiologist
Surgical technique: the use of minimally invasive surgical technologies (operating microscope, tubular retractor systems, transcutaneous surgical techniques, specialized micro-instruments, low-traumatic stabilizing systems) — to reduce iatrogenic damage to paravertebral tissues; infiltration of local anesthetics around the surgical wound before suturing to reduce the need for analgesics	Yes	No (open interventions with the median access)	Neurosurgeon
In-hospital stage (postoperative)
Use of drains Prevention of infections and pain in the area of surgery	No drain or its early removal (on day 1)	Mandatory drain for 2–3 days	Neurosurgeon
Use of a urinary catheter Enabling early activation, reducing patient discomfort	Removing the urinary catheter in the operating room	After transferring to the post-surgery ward	Anesthesiologist
Postoperative pain relief Reducing the need for opioid analgesics and preventing their adverse effects	Multimodal approach	Common use of opiates	Anesthesiologist, neurosurgeon
Rehabilitation stage (in hospital)
Massage, physiotherapy Accelerating the rehabilitation process	Upon first hours after surgery and recovery from post-anesthetic depression	After transferring to the post-surgery ward	Physiotherapist, massage therapist
Verticalization Prevention of thromboembolic and hypostatic complications	Within the first 12 h after surgery	On the 2nd day after surgery (more than 24 h)	Neurosurgeon, physiotherapy specialist
Physiotherapy Using physiotherapeutic techniques to improve tissue microcirculation in the area of surgery, reducing postoperative edema to expand the range of motion	On the 1st day after surgery	On the 2nd day after surgery (more than 24 h)	Neurosurgeon, physiotherapist
Sitting down Improving patient comfort, accelerating rehabilitation	1–2 days after surgery	10–14 days after surgery	Neurosurgeon, physiotherapy specialist
Rehabilitation stage (in a specialized rehabilitation hospital)
Complex of rehabilitation measures Walking, massage, and physiotherapy	Yes	Yes	Expert in rehabilitation, physiotherapist
Outpatient-ambulatory stage
Dynamic observation Study of neurological and orthopedic status to determine the recovery of working capacity	Yes	Yes	Neurosurgeon, neurologist