Antifibrinolytics Reduced Blood Loss in Study of Adult Spinal Deformity Surgery

2014 ◽  
Vol 14 (2) ◽  
pp. 19-20
Author(s):  
M. Mosley ◽  
T. Cheriyan
2018 ◽  
Vol 100 (9) ◽  
pp. 758-764 ◽  
Author(s):  
Ryan P. Pong ◽  
Jean-Christophe A. Leveque ◽  
Alicia Edwards ◽  
Vijay Yanamadala ◽  
Anna K. Wright ◽  
...  

2019 ◽  
Vol 19 (9) ◽  
pp. S171
Author(s):  
Andrew B. Harris ◽  
Varun Puvanesarajah ◽  
Micheal Raad ◽  
Corinna Zygourakis ◽  
A. Jay Khanna ◽  
...  

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Michael Y. Wang

Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws.Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body.Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation.Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.


Spine ◽  
2007 ◽  
Vol 32 (20) ◽  
pp. 2265-2271 ◽  
Author(s):  
Gbolahan O. Okubadejo ◽  
Keith H. Bridwell ◽  
Lawrence G. Lenke ◽  
Jacob M. Buchowski ◽  
David D. Fang ◽  
...  

2016 ◽  
Vol 16 (10) ◽  
pp. S264
Author(s):  
Eric O. Klineberg ◽  
Stacie Nguyen ◽  
Michael P. Kelly ◽  
Shay Bess ◽  
Christopher I. Shaffrey ◽  
...  

2020 ◽  
Vol 20 (9) ◽  
pp. S121
Author(s):  
Alexandra Soroceanu ◽  
Justin K. Scheer ◽  
Themistocles S. Protopsaltis ◽  
Munish C. Gupta ◽  
Peter G. Passias ◽  
...  

Spine ◽  
2015 ◽  
Vol 40 (8) ◽  
pp. E443-E449 ◽  
Author(s):  
Austin Peters ◽  
Kushagra Verma ◽  
Kseniya Slobodyanyuk ◽  
Thomas Cheriyan ◽  
Christian Hoelscher ◽  
...  

2020 ◽  
Vol 32 (3) ◽  
pp. 423-431 ◽  
Author(s):  
Hiroki Ushirozako ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Tatsuya Yasuda ◽  
...  

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”


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