Fusions and Transfusions

JOHNSON, ROBERT G.; MURPHY, MARK; MILLER, MARK

doi:10.1097/00007632-198904000-00002

Cited by 68 publications

(6 citation statements)

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“…One reasonable explanation was that male usually have a greater baseline level of Hb and body weight. 31 At the same time, the muscle content of male is often larger than that of female, greater muscle and soft tissue damage during PETD may result in more HBL. 12 Our study also found that higher disk degeneration grade is also an independent risk factor for increased HBL.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors

Zhang

Zhao

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Objectives: This study aimed to evaluate hidden blood loss (HBL) and its influencing factors in lumbar disk herniation (LDH) patients treated with percutaneous endoscopic transforaminal discectomy (PETD).Summary of Background Data: PETD is a minimally invasive spine surgery and is widely used to treat LDH. It is generally believed that there is less bleeding during PETD. However, HBL during the perioperative period is always ignored.

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Section: Discussionmentioning

confidence: 99%

Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors

Zhang

Zhao

et al. 2021

Clinical Spine Surgery: A Spine Publication

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“…Standard methods of pedicle screw instrumentation require significant exposure of the posterior bony elements of the spine to provide landmarks from which to guide the placement of instrumentation. Such exposure is associated with significant amounts of blood loss [17], as well as paraspinal muscular injury, which has been associated with postoperative back pain [18, 19]. The accuracy of placement of pedicle screws has been shown to be improved with the use of frameless stereotaxic image guidance in most [2, 3, 21, 23] but not all [13] studies.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

et al. 2010

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BackgroundMinimally invasive percutaneous pedicle screw instrumentation methods may increase the need for intraoperative fluoroscopy, resulting in excessive radiation exposure for the patient, surgeon, and support staff. Electromagnetic field (EMF)-based navigation may aid more accurate placement of percutaneous pedicle screws while reducing fluoroscopic exposure. We compared the accuracy, time of insertion, and radiation exposure of EMF with traditional fluoroscopic percutaneous pedicle screw placement.Methods Minimally invasive pedicle screw placement in T8 to S1 pedicles of eight fresh-frozen human cadaveric torsos was guided with EMF or standard fluoroscopy. Set-up, insertion, and fluoroscopic times and radiation exposure and accuracy (measured with post-procedural computed tomography) were analyzed in each group.ResultsSixty-two pedicle screws were placed under fluoroscopic guidance and 60 under EMF guidance. Ideal trajectories were achieved more frequently with EMF over all segments (62.7% vs. 40%; p = 0.01). Greatest EMF accuracy was achieved in the lumbar spine, with significant improvements in both ideal trajectory and reduction of pedicle breaches over fluoroscopically guided placement (64.9% vs. 40%, p = 0.03, and 16.2% vs. 42.5%, p = 0.01, respectively). Fluoroscopy time was reduced 77% with the use of EMF (22 s vs. 5 s per level; p < 0.0001) over all spinal segments. Radiation exposure at the hand and body was reduced 60% (p = 0.058) and 32% (p = 0.073), respectively. Time for insertion did not vary between the two techniques.ConclusionsMinimally invasive pedicle screw placement with the aid of EMF image guidance reduces fluoroscopy time and increases placement accuracy when compared with traditional fluoroscopic guidance while adding no additional time to the procedure.

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“…Complex multilevel spinal decompression, fusion and osteotomies have been associated with profuse perioperative blood loss and greater use of blood transfusions with subsequent increased risk of coagulation impairment, bloodborne infectious disease transmission, postoperative hematoma formation, shock and pulmonary edema (Johnson et al, 1989;Mirza et al, 2008;Naik et al, 2017). Studies describing the impact of perioperative TXA administration on blood loss and blood transfusion may vary among institutions.…”

Section: Discussionmentioning

confidence: 99%

“…Secondly, due to the retrospective nature of this study, the doses of loading and maintenance dose were not standardized and were instead at the surgeon's discretion, leading to variability in dosing and possible influence over the results. Thirdly, as described by several studies with similar patient population, blood loss is also affected by other variables, such as the number and type of osteotomies performed (posterior column osteotomy, pedicle subtraction osteotomy or vertebral column resection) and the number and type of interbody fusions (posterior or transforaminal) performed (Johnson et al, 1989;Mirza et al, 2008;Naik et al, 2017). Fourthly, the number of subjects included in the data analysis for each group was not similar, resulting in 42 subjects in the control group and 34 in the TXA group.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intravenous Tranexamic Acid in Reducing Perioperative Blood Loss and Blood Product Transfusion Requirements in Patients Undergoing Multilevel Thoracic and Lumbar Spinal Surgeries: A Retrospective Study

et al. 2020

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Introduction: Acute perioperative blood loss is a common and potentially major complication of multilevel spinal surgery, usually worsened by the number of levels fused and of osteotomies performed. Pharmacological approaches to blood conservation during spinal surgery include the use of intravenous tranexamic acid (TXA), an anti-fibrinolytic that has been widely used to reduce blood loss in cardiac and orthopedic surgery. The primary objective of this study was to assess the efficacy of intraoperative TXA in reducing estimated blood loss (EBL) and red blood cell (RBC) transfusion requirements in patients undergoing multilevel spinal fusion.Materials and Methods: This a single-center, retrospective study of subjects who underwent multilevel (≥7) spinal fusion surgery who received (TXA group) or did not receive (control group) IV TXA at The Ohio State University Wexner Medical Center between January 1st, 2016 and November 30th, 2018. Patient demographics, EBL, TXA doses, blood product requirements and postoperative complications were recorded.Results: A total of 76 adult subjects were included, of whom 34 received TXA during surgery (TXA group). The mean fusion length was 12 levels. The mean total loading, maintenance surgery and total dose of IV TXA was 1.5, 2.1 mg per kilo (mg/kg) per hour and 33.8 mg/kg, respectively. The mean EBL in the control was higher than the TXA group, 3,594.1 [2,689.7, 4,298.5] vs. 2,184.2 [1,290.2, 3,078.3] ml. Among all subjects, the mean number of intraoperative RBC and FFP units transfused was significantly higher in the control than in the TXA group. The total mean number of RBC and FFP units transfused in the control group was 8.1 [6.6, 9.7] and 7.7 [6.1, 9.4] compared with 5.1 [3.4, 6.8] and 4.6 [2.8, 6.4], respectively. There were no statistically significant differences in postoperative blood product transfusion rates between both groups. Additionally, there were no significant differences in the incidence of 30-days postoperative complications between both groups.Conclusion: Our results suggest that the prophylactic use of TXA may reduce intraoperative EBL and RBC unit transfusion requirements in patients undergoing multilevel spinal fusion procedures ≥7 levels.

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Fusions and Transfusions

Cited by 68 publications

References 0 publications

Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors

Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors

Minimally invasive percutaneous transpedicular screw fixation: increased accuracy and reduced radiation exposure by means of a novel electromagnetic navigation system

Efficacy of Intravenous Tranexamic Acid in Reducing Perioperative Blood Loss and Blood Product Transfusion Requirements in Patients Undergoing Multilevel Thoracic and Lumbar Spinal Surgeries: A Retrospective Study

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