Novel application of pre-operative vertebral body embolization to reduce intraoperative blood loss during a three-column spinal osteotomy for non-oncologic spinal deformity

2015 ◽  
Vol 22 (4) ◽  
pp. 765-767 ◽  
Author(s):  
Alexander Tuchman ◽  
Vivek A. Mehta ◽  
William J. Mack ◽  
Frank L. Acosta
Keyword(s):  
Blood Loss ◽  
Vertebral Body ◽  
Spinal Deformity ◽  
Intraoperative Blood Loss ◽  
Spinal Osteotomy

scholarly journals Anesthesia for surgery in a patient with Knist's dysplasia for severe scoliotic deformity

2020 ◽  
Vol 10 (3) ◽  
pp. 299-308
Author(s):  
Igor V. Smirnov ◽  
Grigorij E. Rojtberg ◽  
Leonid E. Tsypin ◽  
Vladimir V. Lazarev
Keyword(s):  
Surgical Treatment ◽  
Tracheal Intubation ◽  
Blood Loss ◽  
Spinal Deformity ◽  
Abdominal Cavity ◽  
Sensorineural Deafness ◽  
Intraoperative Blood Loss ◽  
Airway Patency ◽  
Scoliotic Deformity ◽  
Kniest Dysplasia

Kniest dysplasia is a disease that is inherited in an autosomal dominant manner. It manifests itself as dwarfism, scoliotic deformity of the spine, impaired joint mobility, muscle weakness, visual impairment, and sensorineural deafness. As a result of disproportionate trunk shortening, lumbar hyperlordosis and kyphoscoliosis develop, leading to internal organs (respiratory, cardiovascular system) disorders, disability, and reduced life expectancy. A case of surgical treatment of a patient with Kniest dysplasia for severe kyphoscoliotic spinal deformity is described. Posterior corrective cross-rod transpediculocorporal screw spondylodesis T3-L5 with bone autoplasty was performed. While planning anesthesia, difficult tracheal intubation was evaluated on the LEMON scale of 7 points high-risk. While performing tracheal intubation, endoscopic techniques were used: videolaryngoscope, intubation bronchoscope, enabling success. Management of intraoperative blood loss was conducted by a complex of measures: laying the patient in the prone position with the release of the abdominal cavity, normothermia, intraoperative hemodilution of azlactone-balanced polyionic solutions to achieve the target hematocrit in the range of 24%26%, and controlled hypotension with blood pressure decreased by 30% from the original hardware blood reinfusion during surgery. Also, on the first postoperative day, fusing tranexamic acid, correcting anemia and deficiency of blood coagulation factors donor components contributed to the success. Discussion. When planning surgery and anesthesia, it is necessary to consider the risk of developing malignant hyperthermia, predicting difficult intubation, and complying with the algorithm to ensure airway patency and prevent massive intraoperative blood loss. With a comprehensive approach to patient management, it is possible to achieve rapid rehabilitation and discharge for outpatient treatment. Surgical treatment for rapidly progressing severe kyphoscoliathical spinal deformity can change the quality and duration of life in patients with Kniest syndrome.

scholarly journals Spinal Canal Decompression for Stage III Kummell’s Disease With “Compressing the Posterior Wall of the Vertebral Body” Guided by Intraoperative Ultrasonography - a Preliminary Clinical Study

2021 ◽  
Author(s):  
Guangqing Cao ◽  
Jidong Zhang ◽  
Cheng Zhang ◽  
Howard J Ginsberg ◽  
Manuel Fuetsch ◽  
...  
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Real Time ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Operating Time ◽  
Posterior Wall ◽  
Intraoperative Ultrasonography ◽  
Stage Iii ◽  
Intraoperative Blood Loss

Abstract Background: There is a lot of controversy regarding the treatment of patients with stage III Kummell’s disease (KD). The purpose of this study is to determine feasibility, efficacy and safety of spinal canal decompression via “compressing the posterior wall of the vertebral body”, guided by real time intraoperative ultrasonography guidance for patients with stage III KD.Methods: We conducted a retrospective study of 11 patients with stage III KD associated with neurological deficits who underwent surgical treatment in The Second Hospital, Cheeloo College of Medicine, Shandong University, from September 2017 to January 2019. All patients underwent spinal canal decompression using a special L-shaped compressor (angular compressor) guided by real time ultrasonography to squeeze and compress the posterior wall of vertebral body, supplemented by internal fixation and posterior fusion. The primary goal was to determine feasibility, safety and efficacy. Therefore, operating time, Intraoperative blood loss, complications and JOA score, local Cobb angle, ODI score of pre- and post-operative were evaluated.Results: 11 patients (4 males and 7 females) with an average age of 70.2±3.2 years (63-76 years) were included in the study. Mean follow-up period was 17.4 months (12-24 months). Mean operating time was 151±18 min and mean intraoperative blood loss was 202±40ml. Before and after surgery, the local Cobb angle (34.3 °±5.4 °, 11.0 °±4.6 °, respectively), JOA score (12.8±2.1, 22.1±1.9, respectively) and ODI scores (71.4±6.4, 25.5±5.2, respectively) significantly improved (P <0.05). As a complication, one patient developed CSF leakage after surgery, while in another case transient MEP signal change occurred intraoperatively without neurological deficit after surgery.Conclusion: Spinal canal decompression by tamping the retropulsed vertebral body anteriorly, guided by intraoperative ultrasonography can effectively relieve neural compression, significantly shorten operation time, reduce intraoperative blood loss, and have fewer complications for patients with stage III KD, compared with previously reported data. In our opinion, it therefore represents a low risk, minimally invasive, yet effective treatment strategy in this selected group of patients.Trial registration: This study was retrospectively registered in Chinese Clinical Trial Registry.Unique Identifying number: ChiCTR2000040490.

245. Predicting massive intraoperative blood loss in adult spinal deformity surgery

2020 ◽  
Vol 20 (9) ◽  
pp. S121
Author(s):  
Alexandra Soroceanu ◽  
Justin K. Scheer ◽  
Themistocles S. Protopsaltis ◽  
Munish C. Gupta ◽  
Peter G. Passias ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Intraoperative Blood Loss ◽  
Spinal Deformity Surgery

THE FEASIBILITY OF FAST TRACK PROTOCOL FOR ELDERELY PATIENTS WITH COLORECTAL CANCER

2016 ◽  
pp. 26-29
Author(s):  
D. . Zitta ◽  
V. . Subbotin ◽  
Y. . Busirev
Keyword(s):  
Colorectal Cancer ◽  
Colorectal Surgery ◽  
Blood Loss ◽  
Elderly Patients ◽  
Fast Track ◽  
Randomized Study ◽  
Conventional Group ◽  
Intraoperative Blood Loss ◽  
Elective Colorectal Surgery ◽  
Complications Rate

Fast track protocol is widely used in major colorectal surgery. It decreases operative stress, shortens hospital stay and reduces complications rate. However feasibility and safety of this approach is still controversial in patients older than 70 years. The AIM of the study was to estimate the safety and effectiveness of fast track protocol in elderly patients with colorectal cancer. MATERIALS AND METHODS. Prospective randomized study included 138 elective colorectal resectionfor cancer during period from 1.01.10 till 1.06.15. The main criteria for the patients selection were age over 70 years and diagnosis of colorectal cancer. 82 of these patients received perioperative treatment according to fast track protocol, other 56 had conventional perioperative care. Patients underwent following procedures: right hemicolectomy (n=7), left hemicolectomy (n=12), transverse colectomy (n=1), sigmoidectomy (n=23), abdomeno-perineal excision (n=19) and low anterior resection of rectum (n=76). Following data were analized: duration of operation, intraoperative blood loss, time offirst flatus and defecation, complications rates. RESULTS. Mean age was 77,4 ± 8 years. There were no differences in gender, co morbidities, body mass index, types of operations between groups. Duration of operations didn't differ significantly between 2 groups. Intraoperative blood loss was higher in conventional group. The time of first flatus and defecation were better in FT-group. There was no mortality in FT-group vs 1,8 %o mortality in conventional group. Complications rate was lower in FT-group: wound infections 3,6% vs 9 %, anastomotic leakage 4,8 %o vs 9 %o, ileus 1,2 vs 5,4 %o, peritonitis 2,4 %o vs 3,6%o, bowel obstruction caused by the adhesions 6 % vs 5,3 %. Reoperation rate was similar 4,8 % vs 3,6 %. CONCLUSION. Fast track protocol in major elective colorectal surgery can be safely applied in elderly patients. The application of fast track protocol in elderly patients improves the restoration of bowel function and reduces the risk of postoperative complication.

Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

2019 ◽  
Vol 31 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Signe Elmose ◽  
Mikkel Ø. Andersen ◽  
Else Bay Andresen ◽  
Leah Yacat Carreon
Keyword(s):  
Placebo Group ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Operative Time ◽  
Decompressive Surgery ◽  
Lumbar Spine Surgery ◽  
Intraoperative Blood Loss ◽  
Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

scholarly journals Efficacy evaluation of three-dimensional printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Yuan-Wei Zhang ◽  
Xin Xiao ◽  
Wen-Cheng Gao ◽  
Yan Xiao ◽  
Su-Li Zhang ◽  
...  
Keyword(s):  
3D Printing ◽  
Blood Loss ◽  
Three Dimensional ◽  
Operation Time ◽  
Varus Deformity ◽  
Conventional Group ◽  
Intraoperative Blood Loss ◽  
Cubitus Varus ◽  
Guide Plate ◽  
Significant Difference

Abstract Background This present study is aimed to retrospectively assess the efficacy of three-dimensional (3D) printing assisted osteotomy guide plate in accurate osteotomy of adolescent cubitus varus deformity. Material and methods Twenty-five patients (15 males and 10 females) with the cubitus varus deformity from June 2014 to December 2017 were included in this study and were enrolled into the conventional group (n = 11) and 3D printing group (n = 14) according to the different surgical approaches. The operation time, intraoperative blood loss, osteotomy degrees, osteotomy end union time, and postoperative complications between the two groups were observed and recorded. Results Compared with the conventional group, the 3D printing group has the advantages of shorter operation time, less intraoperative blood loss, higher rate of excellent correction, and higher rate of the parents’ excellent satisfaction with appearance after deformity correction (P < 0.001, P < 0.001, P = 0.019, P = 0.023). Nevertheless, no significant difference was presented in postoperative carrying angle of the deformed side and total complication rate between the two groups (P = 0.626, P = 0.371). Conclusions The operation assisted by 3D printing osteotomy guide plate to correct the adolescent cubitus varus deformity is feasible and effective, which might be an optional approach to promote the accurate osteotomy and optimize the efficacy.

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