Minimizing Blood Loss in Spine Surgery

Abstract

Study Design: Broad narrative review. Objective: To review and summarize the current literature on guidelines, outcomes, techniques and indications surrounding multiple modalities of minimizing blood loss in spine surgery. Methods: A thorough review of peer-reviewed literature was performed on the guidelines, outcomes, techniques, and indications for multiple modalities of minimizing blood loss in spine surgery. Results: There is a large body of literature that provides a consensus on guidelines regarding the appropriate timing of discontinuation of anticoagulation, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements prior to surgery. Additionally, there is a more heterogenous discussion the utility of preoperative autologous blood donation facilitated by erythropoietin and iron supplementation for healthy patients slated for procedures with high anticipated blood loss and for whom allogeneic transfusion is likely. Intraoperative maneuvers available to minimize blood loss include positioning and maintaining normothermia. Tranexamic acid (TXA), bipolar sealer electrocautery, and topical hemostatic agents, and hypotensive anesthesia (mean arterial pressure (MAP) <65 mm Hg) should be strongly considered in cases with larger exposures and higher anticipated blood loss. There is strong level 1 evidence for the use of TXA in spine surgery as it reduces the overall blood loss and transfusion requirements. Conclusion: As the volume and complexity of spinal procedures rise, intraoperative blood loss management has become a pivotal topic of research within the field. There are many tools for minimizing blood loss in patients undergoing spine surgery. The current literature supports combining techniques to use a cost- effective multimodal approach to minimize blood loss in the perioperative period.

Fatal venous air embolism during lumbar spondylolisthesis surgery

“…Although blood loss is the common cause of acute haemodynamic instability in spine surgery,[ 1 ] in our case a normal haemoglobin level after blood transfusion does not support this diagnosis. Other probable differential diagnoses include dural traction leading to vasovagal response.…”

Intraoperative blood loss in oncological spine surgery

“…36 Due to the increased overall perioperative risk associated with ABTs in spine surgery, as well as the intraoperative anesthesiological challenges in fluid and coagulation management, various strategies have aimed to decrease intraoperative blood loss in oncological spine surgery. 37 The literature shows that preoperative embolization 38,39 and use of antifibrinolytic agents, 40,41 or even rare invasive approaches, such as aortic balloon occlusion, 42,43 applied to decrease intraoperative blood loss. For adaptation of the surgical strategy by using minimally invasive or staged surgical approaches, embolization is the preoperative procedure that is most widely used at high-volume oncological spine centers, and a large retrospective review by Nair et al demonstrated that preoperative embolization can be safely applied.…”

Predictors of perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

“…Intraoperative methods to control blood loss include positioning to reduce intraabdominal pressure, the use of tranexamic acid and the use of topical anti brinolytic agents. Moreover, modi ed anesthesia techniques such as core temperature control and hypotensive anesthesia have shown promising results in safely reducing blood loss [30][31][32].…”