Purpose Previous studies have established the safety and efficacy of tranexamic acid (TXA) in reducing blood loss after total joint arthroplasty and spinal fusion surgery; however, literature regarding the effectiveness of intraoperative TXA in children with cerebral palsy (CP) is limited. The aim of this study was to investigate the safety and efficacy of intraoperative TXA in reducing blood loss and transfusion requirements for children with CP undergoing a proximal femoral varus derotational osteotomy (VDRO). Methods This is a retrospective review of 258 children with CP who underwent VDRO performed at the author’s institution between 2004 and 2017. In all, 36 subjects underwent VDRO surgery with administration of intravenous TXA and 222 subjects underwent VDRO without administration of TXA. Outcome measures including blood loss, transfusion requirements and venous thromboembolic events were compared between groups using t-tests and chi-squared tests. Results No significant differences were seen in the rates of transfusion between groups for the entire hospitalization (TXA group: 11.1% versus No TXA group: 19.8%), intraoperatively (TXA: 2.8% versus No TXA: 9.0%) or postoperatively (TXA: 8.3% versus No TXA: 14.4%). Intraoperative estimated blood loss (TXA: 144.4 mL versus No TXA: 159.0 mL) and percentage blood loss (TXA: 8.9% versus No TXA: 9.2%) were similar between groups. No major thromboembolic complications events occurred in either group. Conclusion The use of TXA was not associated with thromboembolic complications in this series of children with CP undergoing VDRO surgery. Though there was a trend toward lower rates of intraoperative and postoperative blood transfusion with TXA use in these patients, the differences were not significant, possibly due to low estimated blood loss in both groups and sample size. Level of evidence III- retrospective comparative study
Study Design
This study is a repeated measures design to measure the lumbar spine’s response to common backpack loads in children with idiopathic low back pain (ILBP) using upright MRI.
Objective
The purpose of this study is to analyze the lumbar spine’s response to backpack loads with upright MRI in ILBP children in order to compare their results to previously published normal child data under the same conditions. We hypothesize that typical backpack loads will have a different effect on the lumbar spine of normal and ILBP children.
Summary of Background Data
Research in normal children shows that backpack loads compress the lumbar IVDs, increase lumbar coronal deformity, and increase pain.
Methods
Fifteen pediatric and adolescent patients with ILBP were selected. Patients were excluded if a spinal deformity, an underlying pathology, or known injury was identified. A 0.6T upright MRI scanner imaged the subjects while supine and standing wearing 0 kg, 4 kg, and 8 kg backpacks. IVD height, lumbar lordosis, lumbar coronal deformity, and pain score were recorded after each condition and compared using ANOVAs. We compared the above variables between ILBP and normal subjects using generalized least squares models.
Results
The cohort’s mean age was 13 ± 3 years. The 4 kg and 8 kg backpacks only compressed the L5-S1 IVD relative to upright with no load. Subjects experienced increasing pain with increasing load. Load had no effect on lumbar lordosis or lumbar coronal deformity. Compared to normal children, ILBP children experience significantly less disc compression at T12-L1 to L4-5, less lumbar lordosis, and more pain with increasing load.
Conclusions
In ILBP children, increasing backpack load compresses only the L5-S1 IVD. Compared to normal children, ILBP children experience less lumbar IVD compression, less lumbar lordosis, and more pain due to increasing load suggesting altered mechanisms for load tolerance in ILBP children.
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