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Shen F, Ding J, Wang Y, Yin C, Han Z, Ren X, Li Y, Wang T. Topical hemostatic agents in spinal surgery. Spine J 2024; 24:933-946. [PMID: 38219838 DOI: 10.1016/j.spinee.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Spinal surgery can be associated with significant intraoperative blood loss which may lead to various complications. As the number of patients undergoing spinal surgery increases over time, accurate and effective hemostasis becomes critically important. Despite various surgical hemostatic techniques, conventional interventions such as compression, suture, ligation, and heat-generating cautery, are not suitable for osseous and epidural venous plexus bleeding during spinal procedures. Therefore, a variety of hemostatic agents have been developed to promote hemostasis. As they differ in terms of mechanism, form, application and potential adverse reactions, it is important to understand the natural features of existing agents. Here we comprehensively review currently available topical hemostatic agents from different sources and summarize their mechanisms of action, applications, and current or potential utilization in spinal surgery. We found hemostatic agents from different sources exert hemostatic actions through different mechanisms. In addition, topical hemostatic agents play various roles in spinal surgery including as hemostatic agent, dura mater repair, drug-carrier, skin closure, and fibrosis prevention. Compressive neurological complications are the most common complications of these hemostatic agents. Therefore, optimal use in spinal environments should match their features, indications, and efficacy with clinical conditions.
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Affiliation(s)
- Feng Shen
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Jian Ding
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Yuelei Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Chuqiang Yin
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Zengshuai Han
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Xianfeng Ren
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Yanhui Li
- School of Mechanical and Electrical Engineering, Qingdao University, No. 308 Ningxia Road, Shibei District, Qingdao, Shandong Province, China
| | - Ting Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China.
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Huec JL, AlEissa S, Bowey A, Debono B, El-Shawarbi A, Fernández-Baillo N, Han K, Martin-Benlloch A, Pflugmacher R, Sabatier P, Vanni D, Walker I, Warren T, Litrico S. Hemostats in Spine Surgery: Literature Review and Expert Panel Recommendations. Neurospine 2022; 19:1-12. [PMID: 35378578 PMCID: PMC8987560 DOI: 10.14245/ns.2143196.598] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/10/2022] [Indexed: 01/05/2023] Open
Abstract
Bleeding in spine surgery is a common occurrence but when bleeding is uncontrolled the consequences can be severe due to the potential for spinal cord compression and damage to the central nervous system. There are many factors that influence bleeding during spine surgery including patient factors and those related to the type of surgery and the surgical approach to bleeding. There are a range of methods that can be employed to both reduce the risk of bleeding and achieve hemostasis, one of which is the adjunct use of hemostatic agents. Hemostatic agents are available in a variety of forms and materials and with considerable variation in cost, but specific evidence to support their use in spine surgery is sparse. A literature review was conducted to identify the pre-, peri-, and postsurgical considerations around bleeding in spine surgery. The review generated a set of recommendations that were discussed and ratified by a wider expert group of spine surgeons. The results are intended to provide a practical guide to the selection of hemostats for specific bleeding situations that may be encountered in spine surgery.
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Affiliation(s)
- J.C. Le Huec
- Spine Unit, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France,Corresponding Author J.C. Le Huec https://orcid.org/0000-0002-0463-6706 Spine Unit, Polyclinique Bordeaux Nord Aquitaine, Université Bordeaux, 33000, Bordeaux, France
| | - S. AlEissa
- King Saud bin Abdulaziz University for Health Sciences Riyadh, Riyadh, Saudi Arabia
| | - A.J. Bowey
- Department of Orthopaedic Spinal Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - B. Debono
- Paris-Versailles Spine Center (Centre Francilien du Dos), Ramsay Santé - Hôpital Privé de Versailles, Versailles, France
| | | | - N. Fernández-Baillo
- Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - K.S. Han
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A. Martin-Benlloch
- Department of Orthopaedic Surgery, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - R. Pflugmacher
- Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Germany
| | - P. Sabatier
- Department of Neurosurgery, Clinique des Cèdres, Cornebarrieu, France
| | - D. Vanni
- G-spine 4, Spine Surgery Division, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - I. Walker
- Triducive Partners Limited, Hertfordshire, UK
| | - T. Warren
- Triducive Partners Limited, Hertfordshire, UK
| | - S. Litrico
- Department of Spine Surgery, Pasteur II Hospital, Centre Hospitalo-Universitaire de Nice, Nice, France
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Incidental Durotomy During Endoscopic Stenosis Lumbar Decompression: Incidence, Classification, and Proposed Management Strategies. World Neurosurg 2020; 139:e13-e22. [DOI: 10.1016/j.wneu.2020.01.242] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/13/2022]
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Double-Layer TachoSil Packing for Management of Incidental Durotomy During Percutaneous Stenoscopic Lumbar Decompression. World Neurosurg 2018; 120:448-456. [DOI: 10.1016/j.wneu.2018.09.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022]
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Huang Y, Feng L, Zhang Y, He L, Wang C, Xu J, Wu J, Kirk TB, Guo R, Xue W. Hemostasis mechanism and applications of N-alkylated chitosan sponge. POLYM ADVAN TECHNOL 2017. [DOI: 10.1002/pat.4003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yuchen Huang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes; Guangzhou 510632 China
- Department of Biomedical Engineering; Jinan University; Guangzhou 510632 China
| | - Longbao Feng
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes; Guangzhou 510632 China
- Department of Biomedical Engineering; Jinan University; Guangzhou 510632 China
| | - Yi Zhang
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes; Guangzhou 510632 China
- Department of Biomedical Engineering; Jinan University; Guangzhou 510632 China
| | - Liumin He
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes; Guangzhou 510632 China
- Department of Biomedical Engineering; Jinan University; Guangzhou 510632 China
| | - Changyong Wang
- Department of Advanced Interdisciplinary Studies; Institute of Basic Medical Sciences and Tissue Engineering Research Center, Academy of Military Medical Sciences; Beijing 100850 China
| | - Jiake Xu
- School of Pathology and Laboratory Medicine; University of Western Australia; Perth WA 6009 Australia
| | - Jianping Wu
- 3D Imaging and Bioengineering Laboratory, the Department of Mechanical Engineering; Curtin University; Perth WA Australia
| | - Thomas Brett Kirk
- 3D Imaging and Bioengineering Laboratory, the Department of Mechanical Engineering; Curtin University; Perth WA Australia
| | - Rui Guo
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes; Guangzhou 510632 China
- Department of Biomedical Engineering; Jinan University; Guangzhou 510632 China
| | - Wei Xue
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes; Guangzhou 510632 China
- Department of Biomedical Engineering; Jinan University; Guangzhou 510632 China
- Key Laboratory of Functional Protein Research of Guangdong Higher Education Institute; Guangzhou 510632 China
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