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Gupta MC, Lenke LG, Gupta S, Farooqi AS, Asghar JK, Boachie-Adjei O, Cahill PJ, Erickson MA, Garg S, Newton PO, Samdani AF, Shah SA, Shufflebarger HL, Sponseller PD, Sucato DJ, Bumpass DB, McCarthy RE, Yaszay B, Pahys JM, Ye J, Kelly MP. Perioperative Complications and Health-related Quality of Life Outcomes in Severe Pediatric Spinal Deformity. Spine (Phila Pa 1976) 2023; 48:1492-1499. [PMID: 37134134 DOI: 10.1097/brs.0000000000004696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/03/2023] [Indexed: 05/04/2023]
Abstract
STUDY DESIGN Prospective multicenter cohort study. OBJECTIVE To evaluate perioperative complications and mid-term outcomes for severe pediatric spinal deformity. SUMMARY OF BACKGROUND DATA Few studies have evaluated the impact of complications on health-related quality of life (HRQoL) outcomes in severe pediatric spinal deformity. METHODS Patients from a prospective, multicenter database with severe pediatric spinal deformity (minimum of 100 degree curve in any plane or planned vertebral column resection (VCR)) with a minimum of 2-years follow-up were evaluated (n=231). SRS-22r scores were collected preoperatively and at 2-years postoperatively. Complications were categorized as intraoperative, early postoperative (within 90-days of surgery), major, or minor. Perioperative complication rate was evaluated between patients with and without VCR. Additionally, SRS-22r scores were compared between patients with and without complications. RESULTS Perioperative complications occurred in 135 (58%) patients, and major complications occurred in 53 (23%) patients. Patients that underwent VCR had a higher incidence of early postoperative complications than patients without VCR (28.9% vs. 16.2%, P =0.02). Complications resolved in 126/135 (93.3%) patients with a mean time to resolution of 91.63 days. Unresolved major complications included motor deficit (n=4), spinal cord deficit (n=1), nerve root deficit (n=1), compartment syndrome (n=1), and motor weakness due to recurrent intradural tumor (n=1). Patients with complications, major complications, or multiple complications had equivalent postoperative SRS-22r scores. Patients with motor deficits had lower postoperative satisfaction subscore (4.32 vs. 4.51, P =0.03), but patients with resolved motor deficits had equivalent postoperative scores in all domains. Patients with unresolved complications had lower postoperative satisfaction subscore (3.94 vs. 4.47, P =0.03) and less postoperative improvement in self-image subscore (0.64 vs. 1.42, P =0.03) as compared to patients with resolved complications. CONCLUSION Most perioperative complications for severe pediatric spinal deformity resolve within 2-years postoperatively and do not result in adverse HRQoL outcomes. However, patients with unresolved complications have decreased HRQoL outcomes.
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Affiliation(s)
- Munish C Gupta
- Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center New York, New York, NY
| | - Sachin Gupta
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ali S Farooqi
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jahangir K Asghar
- Department of Orthopaedic Surgery, Miami Children's Hospital Miami, Miami, FL
| | | | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark A Erickson
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Sumeet Garg
- Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Peter O Newton
- Department of Orthopaedic Surgery, Rady Children's Hospital - San Diego, San Diego, CA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Philadelphia, Philadelphia, PA
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE
| | - Harry L Shufflebarger
- Department of Orthopaedic Surgery, Paley Orthopedic and Spine Institute at St. Mary's Medical Center, West Palm Beach, FL
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Daniel J Sucato
- Texas Scottish Rite Hospital for Children, Department of Orthopaedic Surgery, Dallas, TX
| | - David B Bumpass
- Department of Orthopaedic Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - Richard E McCarthy
- Department of Orthopaedic Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - Burt Yaszay
- Department of Orthopaedic Surgery, Seattle Children's Hospital, Seattle, WA
| | - Joshua M Pahys
- Department of Orthopaedic Surgery, Shriners Hospitals for Children Philadelphia, Philadelphia, PA
| | - Jichao Ye
- Sun Yat-sen Memorial Hospital, Guangzhou, China
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO
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Rittipoldech CA, Limsomwong P, Thamrongskulsiri N. Ultrasonic Bone Scalpel versus Conventional Technique for Thoracolumbar Spinal Decompression: A Prospective Randomized Controlled Trial. Rev Bras Ortop 2023; 58:e706-e711. [PMID: 37908536 PMCID: PMC10615604 DOI: 10.1055/s-0043-1768627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/27/2022] [Indexed: 11/02/2023] Open
Abstract
Objective The purpose of the present study is to compare intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications in thoracolumbar spinal decompression using ultrasonic bone scalpels (UBSs) with conventional procedures. Methods Forty-two patients who underwent decompressive laminectomy and pedicular screw fusion with a surgical level of 1-5 levels between February 1, 2020, and June 30, 2022, in a single institution were evaluated for eligibility, and 11 were excluded due to a history of spinal surgery ( n = 3), spinal tumor ( n = 3), and spinal infection ( n = 5). A total of 31 patients were randomly divided into the UBS group ( n =15) and the conventional group ( n =16). Intraoperative blood loss, operating time, laminectomy time, hospital length of stay, and complications were recorded. Results Intraoperative blood loss and laminectomy time were significantly lower in the UBS group (656.0 ± 167.6 ml, 54.5 ± 27.4 minutes, respectively) than in the conventional group (936.9 ± 413.2 ml, 73.4 ± 28.1 minutes, respectively). Overall operation time, hospital length of stay, and complications were all similar between the groups. Conclusion The UBS is a useful instrument for procedures performed near the dura mater or other neural tissue without excessive heat or mechanical injury. This device is recommended for various spinal surgeries in addition to high-speed burrs and Kerrison rongeurs.
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Bansal P, Kumar V, Vatkar AJ, Gaurav A, Dhatt SS. Ultrasonic Bone Scalpel versus Conventional Methods for Osteotomy in Posterior Surgery for Cervical Spondylotic Myelopathy: A Review and Meta-Analysis. Asian Spine J 2023; 17:964-974. [PMID: 37690990 PMCID: PMC10622811 DOI: 10.31616/asj.2022.0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 09/12/2023] Open
Abstract
Posterior methods for cervical myelopathy include laminoplasty and laminectomy with/without fusion. A more recent innovation in these treatments is the use of an ultrasonic bone shaver for osteotomy. In this study, we examined the perioperative results after laminectomy/laminoplasty between conventional methods (rongeur/high-speed drill) vs. piezosurgery-based instruments. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed and the search was performed on four databases (PubMed, Scopus, EMBASE, and Google Scholar). Seven comparative studies were chosen after thorough screening by the authors and a meta-analysis was performed between piezosurgery and conventional technique to ascertain intraoperative and postoperative results after laminectomy/laminoplasty. The analysis includes four retrospective cohort studies and three randomized controlled trials published between 2015 and 2022. The mean age ranged from 55.5 to 64.2 years. Blood loss was significantly reduced in the piezosurgery group, other findings were not significant. On subgroup analysis, laminoplasty dramatically reduced blood loss and the rate of iatrogenic dural rips in the piezosurgery group. The use of ultrasonic bone shaver for osteotomy in cervical spondylotic myelopathy is related to significantly decreased blood loss and no significant increase in postoperative drainage, operative time, complication rate, and functional outcomes as compared to traditional techniques. We noticed significantly reduced blood and rate of dural tears in the laminoplasty subgroup with the use of ultrasonic bone shaver, which was not mirrored in the laminectomy subgroup. Careful intraoperative handling of the instrument can help prevent iatrogenic dural tears and nerve damage.
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Affiliation(s)
- Parth Bansal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh,
India
| | - Vishal Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar,
India
| | | | - Ankit Gaurav
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh,
India
| | - Sarvdeep Singh Dhatt
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh,
India
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Renjith K, Eamani NK, Raja DC, Shetty AP. Ultrasonic bone scalpel in spine surgery. J Orthop 2023; 41:1-7. [PMID: 37216021 PMCID: PMC10199212 DOI: 10.1016/j.jor.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
Background Spine surgery has always been considered technically demanding even in the hands of the most experienced surgeon on account of close proximity of vital soft tissue structures. Technical advancements over the last few decades have been crucial for the progress of this complex speciality which not only increased the surgical accuracy, but patient safety as well. Ultrasonic devices are one such innovation based on piezoelectric vibrations, patented by Fernando Bianchetti, Domenico Vercellotti, and Tomaso Vercellotti in 1988. Methods We did an extensive literature search on ultrasonic devices and their applications in the field of spine surgery. Results We present the various ultrasonic bone devices available including their physical, technologic and clinical aspects in spine surgery. We also attempt to cover the limitations and future advances of Ultrasonic bone scalpel (UBS) in particular, which would be interesting and informative for any spine surgeon who is novice in this field. Conclusion UBS has been found to be safe and effective in all forms of spine surgeries offering distinct advantages over conventional instruments, although limited by an inherent learning curve.
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Affiliation(s)
- K.R. Renjith
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt Ltd, Coimbatore, India
| | - Naresh Kumar Eamani
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt Ltd, Coimbatore, India
| | - Dilip Chand Raja
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt Ltd, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre & Hospital Pvt Ltd, Coimbatore, India
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Li D, Hong DH. Transverse Split Laminoplasty: A Novel Anatomy Preserving Technique. Cureus 2023; 15:e36519. [PMID: 37090339 PMCID: PMC10121262 DOI: 10.7759/cureus.36519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/25/2023] Open
Abstract
Laminoplasty is a technique often used in spine surgery as a way of restoring a patient's normal anatomy and posterior tension band (PTB). In pediatric patients, this is an important consideration given their intrinsic relative ligamentous laxity and significant potential for future growth. Conventional laminoplasty re-approximates the bone removed at each vertebral segment, relying on the lamina to heal through osteogenesis and the soft tissue of the PTB to heal from a sharp division. Ligamentous healing of the PTB constitutes the formation of a scar that is biologically and biomechanically inferior to the tissue it has replaced. Herein, the authors present two pediatric cases in which the novel technique of transverse split laminoplasty was used to approach intradural pathology and subsequently reconstruct the spine, while maximizing preservation of the PTB, with excellent post-surgical outcomes.
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Affiliation(s)
- Daphne Li
- Pediatric Neurosurgery, Advocate Lutheran General Hospital, Park Ridge, USA
- Neurosurgery, Loyola University Medical Center, Maywood, USA
| | - David H Hong
- Pediatric Neurosurgery, Lehigh Valley Health Network, Allentown, USA
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Piazza AM, McAnulty JF, Early P, Guevar J. Craniectomies for dogs with skull multilobular osteochondrosarcoma using the Misonix bone scalpel: cadaveric evaluation and retrospective case series. Top Companion Anim Med 2023; 53-54:100772. [PMID: 36990178 DOI: 10.1016/j.tcam.2023.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/11/2022] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES To evaluate the Misonix bone scalpel (MBS) for craniotomies in dogs and describe clinical findings and surgical experience in three dogs with large multilobular osteochondrosarcoma (MLO) of the skull. STUDY DESIGN Cadaver evaluation and retrospective case series. ANIMALS One canine cadaver; three client-owned dogs. METHODS Craniotomies of different sizes and at different locations were performed with MBS. Dural tear and bone discoloration were recorded. Clinical, imaging, and surgical findings of dogs diagnosed with MLO and where MBS was used for craniectomies were retrospectively included. RESULTS Cadaveric evaluation identified MBS as an efficient tool for rapid craniectomies (> 5minutes) albeit dural tears and some small foci of bone discoloration were observed. Craniectomies could be performed without complications in three dogs with MLO without dural tear or bone discoloration. .Excision was in complete in all cases. The short-term outcome was good, and the long-term outcome was fair to good. CONCLUSION Piezoelectric bone surgery with the Misonix bone scalpel is an alternative technology to perform craniectomies in dogs. It was not associated with complications in 3 dogs diagnosed and surgically treated for MLO. Dural tears and suspected bone necrosis can occur. Great care should be taken when using CT to establish disease free surgical osteotomy.
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Paediatric Spinal Deformity Surgery: Complications and Their Management. Healthcare (Basel) 2022; 10:healthcare10122519. [PMID: 36554043 PMCID: PMC9778654 DOI: 10.3390/healthcare10122519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.
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Lang Z, Wang Q, Wu X, Liu Y, He D, Fan M, Shi Z, Tian W. Drilling Speed and Bone Temperature of a Robot-assisted Ultrasonic Osteotome Applied to Vertebral Cancellous Bone. Spine (Phila Pa 1976) 2021; 46:E760-E768. [PMID: 33394989 DOI: 10.1097/brs.0000000000003902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An experimental investigation of a robot-assisted ultrasonic osteotome applied to vertebral cancellous bone. OBJECTIVE The aim of this study was to investigate the effect of various ultrasonic parameter settings on temperature in the drilling site and penetration time and determine the most suitable parameters for efficient and safe robot-based ultrasonically assisted bone drilling in spinal surgery. SUMMARY OF BACKGROUND DATA A robot-assisted ultrasonic osteotome device may be safe and effective for spinal drilling. METHODS Sixty specimens of bovine vertebral cancellous were randomly assigned to one of six groups, which varied by mode of ultrasonic vibration (L-T and L) and feed rate (one percent [0.8 mm/s], two percent [1.6 mm/s], and three pecent [2.4 mm/s]). Maximum temperature in the drilling site and penetration time was recorded. RESULTS Maximum temperature in the drilling site decreased as output power increased for L-T and L modes, was significantly lower for L-T compared to L mode at each feed rate and power setting, was significantly different at feed rates of 1.6 mm/s versus 0.8 mm/s and 2.4 mm/s versus 0.8 mm/s for L-T mode at an output power of 60 W and 84 W, but was not influenced by feed rate for L mode. Penetration time did not significantly improve as output power increased for both L-T and L modes, was significantly decreased with increased feed rates, but was not significantly different between L-T and L modes. CONCLUSION The optimal parameters for applying a robot-assisted ultrasonic osteotome to vertebral cancellous bone are L-T mode, maximum output power of 120 W, and maximum feed rate of 2.4 mm/s.Level of Evidence: 4.
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Affiliation(s)
- Zhao Lang
- Department of Spine Surgery, Beijing Ji Shui Tan Hospital, Beijing, China
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Garg S, Thomas J, Darland H, Kim E, Kittelson J, Erickson M, Carry P. Ultrasonic Bone Scalpel (USBS) Does Not Reduce Blood Loss During Posterior Spinal Fusion (PSF) in Patients with Adolescent Idiopathic Scoliosis (AIS): Randomized Clinical Trial. Spine (Phila Pa 1976) 2021; 46:845-851. [PMID: 34100838 DOI: 10.1097/brs.0000000000003990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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 -8 mL/level, 95% CI: -16.4 to 0.3 mL/level, P = 0.0575]. There was no difference in curve correction [adjusted mean difference: -1.7%, 95% CI: -7.0 to 3.6%, P = 0.5321] or operative time [adjusted mean difference: -3.55 minutes, 95% CI: -22.45 to 15.46 min, P = 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. CONCLUSION 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 high-volume 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.Level of Evidence: 1.
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Affiliation(s)
| | | | | | - Eun Kim
- Children's Hospital Colorado, Aurora, CO
| | - John Kittelson
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
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BECCHETTI F, NASTO LA, KOTZEVA S. Blood loss management in pediatric spinal surgery for scoliosis. MINERVA ORTHOPEDICS 2021; 72. [DOI: 10.23736/s2784-8469.20.04050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
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George S, Ramchandran S, Mihas A, George K, Mansour A, Errico T. Topical tranexemic acid reduces intra-operative blood loss and transfusion requirements in spinal deformity correction in patients with adolescent idiopathic scoliosis. Spine Deform 2021; 9:1387-1393. [PMID: 33844193 DOI: 10.1007/s43390-021-00337-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the effectiveness of the use of topical tranexamic acid (tTXA) in spinal deformity correction in AIS patients METHODS: Sixty consecutive operative AIS patients were reviewed from a single institution and divided into two groups with similar demographics. Standardized peri-operative blood salvage techniques were utilized in all 60 patients. In the latter 30 patients, tTXA soaked sponges (1 g mixed in 500 ml Normal Saline) was utilised for wound packing during the entire surgical procedure compared to dry sponges as used in the former 30 patients. Both the groups were compared for the magnitude of deformity corrected, EBL per level fused, total EBL, blood transfused, drain output and peri-operative events. RESULTS Sixty AIS patients (mean age 14.4 yrs, 43 females, mean BMI 21.5, mean levels 10.7) were included. Both groups achieved similar change in Coronal Cobb correction. The EBVL (Estimated blood volume loss) % lost in the topical TXA group was 38% less than the control group (11.2 vs. 18.3%, p = 0.006). Similarly, the EBL/level was significantly lower in the topical TXA group (41 ± 30 ml vs. 57 ± 26 ml, p = 0.03). Three of 30 patients in the control group required at least 1 unit of blood transfusion, whereas only 1 patient in the topical TXA group required transfusion (10 vs. 3.3%, p = 0.001). No differences were noted in post-operative drain output, change in hemoglobin levels, and peri-operative complication rates. CONCLUSION When used as an adjunct to the conventional blood salvage techniques in spinal deformity correction procedures, the use of tTXA resulted in reduced operative blood loss, and blood transfusion requirements.
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Affiliation(s)
- Stephen George
- Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children's Hospital, Miami, FL, 33155, USA
| | - Subaraman Ramchandran
- Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children's Hospital, Miami, FL, 33155, USA.
| | - Alexander Mihas
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Kevin George
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ali Mansour
- Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children's Hospital, Miami, FL, 33155, USA
| | - Thomas Errico
- Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children's Hospital, Miami, FL, 33155, USA
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Mihas A, Ramchandran S, Rivera S, Mansour A, Asghar J, Shufflebarger H, George S. Safe and effective performance of pediatric spinal deformity surgery in patients unwilling to accept blood transfusion: a clinical study and review of literature. BMC Musculoskelet Disord 2021; 22:204. [PMID: 33607982 PMCID: PMC7896412 DOI: 10.1186/s12891-021-04081-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric deformity surgery traditionally involves major blood loss. Patients refusing blood transfusion add extra clinical and medicolegal challenges; specifically the Jehovah's witnesses population. The objective of this study is to review the safety and effectiveness of blood conservation techniques in patients undergoing pediatric spine deformity surgery who refuse blood transfusion. METHODS After obtaining institutional review board approval, we retrospectively reviewed 20 consecutive patients who underwent spinal deformity surgery and refused blood transfusion at a single institution between 2014 and 2018. We collected pertinent preoperative, intraoperative and most recent clinical and radiological data with latest follow-up (minimum two-year follow-up). RESULTS Twenty patients (13 females) with a mean age of 14.1 years were identified. The type of scoliotic deformities were adolescent idiopathic (14), juvenile idiopathic (1), neuromuscular (3) and congenital (2). The major coronal Cobb angle was corrected from 55.4° to 11.2° (80% correction, p < 0.001) at the latest follow-up. A mean of 11.4 levels were fused and 5.6 levels of Pontes osteotomies were performed. One patient underwent L1 hemivertebra resection and three patients had fusion to pelvis. Estimated blood loss, percent estimated blood volume loss, and cell saver returned averaged 307.9 mL, 8.5%, and 80 mL, respectively. Average operative time was 214 min. The average drop in hemoglobin after surgery was 2.9 g/dL. The length of hospital stay averaged 5.1 days. There were no intraoperative complications. Three postoperative complications were identified, none related to their refusal of transfusion. One patient had in-hospital respiratory complication, one patient developed a late infection, and one patient developed asymptomatic radiographic distal junctional kyphosis. CONCLUSIONS Blood conservation techniques allow for safe and effective spine deformity surgery in pediatric patients refusing blood transfusion without major anesthetic or medical complications, when performed by an experienced multidisciplinary team. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alexander Mihas
- Florida International University Herbert Wertheim College of Medicine, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Subaraman Ramchandran
- Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
| | - Sebastian Rivera
- Department of Orthopedic Surgery, Jackson Memorial Hospital, University of Miami, 1611 NW 12th Avenue, Miami, FL, 33136, USA
| | - Ali Mansour
- Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
| | - Jahangir Asghar
- Cantor Spine Institute, 3000 Bayview Drive Suite 200, Fort Lauderdale, FL, 33306, USA
| | - Harry Shufflebarger
- Paley Orthopedic and Spine Institute at St. Mary's Medical Center, 901 45th Street, West Palm Beach, FL, 33407, USA
| | - Stephen George
- Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA
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A Surgical Approach to Orbitotomy Using the Bone Scalpel: A Case Report. J Neuroophthalmol 2020; 40:e62-e64. [PMID: 32282509 DOI: 10.1097/wno.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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