Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS)

Abstract

Study Design. Randomized Clinical Trial.Objective. The aim of this study was to compare the efficacy of USBS with standard-of-care surgical instruments during posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) by evaluating the difference in estimated blood loss per level fused (EBL/level). Summary of Background Data. PSF surgery for AIS is often associated with high blood loss. Use of an ultrasonic bone scalpel (USBS) has been proposed to reduce blood loss during scoliosis surgery. Methods. This was a single-blinded (patient-blinded), randomized, controlled superiority trial. We randomized 66 patients with AIS undergoing PSF to the control group (osteotome) or the experimental group (USBS). The primary outcome was intraoperative EBL/level obtained from red blood cell salvage reports. One-year follow-up was available for 57 of 62 (92%) of patients.Results. EBL/level averaged 35 and 39 mL/level in the experimental and control groups, respectively [adjusted mean difference USBS -osteotome À8 mL/level, 95% CI: À16.4 to 0.3 mL/ level, P ¼ 0.0575]. There was no difference in curve correction [adjusted mean difference: À1.7%, 95% CI: À7.0 to 3.6%, P ¼ 0.5321] or operative time [adjusted mean difference: À3.55 minutes, 95% CI: À22.45 to 15.46 min, P ¼ 0.7089] between groups. Complications requiring change in routine postoperative care were noted in eight patients: two occurred in patients assigned to the experimental group and six occurred in patients assigned to the control group. Conclusions. There was no clinically significant difference in total blood loss, EBL/level, or complications between the two groups. In contrast to reports from other centers, at our highvolume spine center, USBS did not lead to reduced blood loss during PSF for AIS. These results may not be generalizable to centers with longer baseline operative times or higher baseline average blood loss during PSF for AIS.

Ultrasonic Bone Scalpel and Its Role In Spine Surgeries : A Article Review

“…They concluded that UBS is effective in reducing blood loss in AIS and NMS deformity correction surgery. However, Garg et al [37] in their singleblinded randomized control trial had concluded that there was no clinically significant difference in total blood loss, EBL/level, or complications between the AIS undergoing posterior spinal fusion (PSF) and control group. In contrast to reports from other centers, UBS did not lead to reduced blood loss during PSF for AIS.…”

Omurga Deformite Cerrahisinde Kullanılan Ultrasonik Kemik Kesicilerin Etkisi

“…yakın zamanda yayınladığı çalışmaları ile benzer sonuçlar elde etmiştir. 11 Bartley ve ark çalışmalarında ultrasonik kesicilerin cerrahi süreyi kısalttığını bildirmişlerdir. 12 Wahlquist ve ark.…”

“…9,10 Literatürde ultrasonik kemik kesicilerin kanama miktarını azalttığını bildiren çalışmalar olduğu gibi; kan kaybı bakımından etkisiz olduğunu bildiren çalışmalar da mevcuttur. 8,11 Ultrasonik kemik kesicilerin cerrahi süreye etkisi olmadığını bildiren çalışmalar da vardır. 11 Çalışmamızın amacı ultrasonik kemik kesici kullanılarak cerrahi tedavi uygulanan hastalar ile klasik el osteotomlarıyla osteotomi uygulanan hastaları, cerrahi süre ve kan kaybı miktarı bakımından karşılaştırarak literatüre katkı sağlamaktır.…”

“…8,11 Ultrasonik kemik kesicilerin cerrahi süreye etkisi olmadığını bildiren çalışmalar da vardır. 11 Çalışmamızın amacı ultrasonik kemik kesici kullanılarak cerrahi tedavi uygulanan hastalar ile klasik el osteotomlarıyla osteotomi uygulanan hastaları, cerrahi süre ve kan kaybı miktarı bakımından karşılaştırarak literatüre katkı sağlamaktır. Litertürde benzer çalışmalarda kan kaybı miktarı füzyon seviyesi ile ilişkilendirilmiştir.…”

Risk Factors of Total Blood Loss and Hidden Blood Loss in Patients with Adolescent Idiopathic Scoliosis: A Retrospective Study

“…Posterior pedicle screw internal fixation is the main surgical technique for adolescent idiopathic scoliosis (AIS). This surgical technique can greatly improve spine curvature and clinical outcomes, but it usually requires a long surgical incision and multilevel fixation and thus may result in a large amount of blood loss [ 1 , 2 ]. Massive blood loss may prolong the period of incision healing and recovery, increase the risk of infection, and even cause organ failure [ 3 ].…”