The Efficiency of Simultaneous Systemic and Topical Use of Tranexamic Acid in Spinal Fusion Surgery

Background and Aim Multilevel posterior spinal fusion surgery in adults is associated with significant intra- and postoperative blood loss. Tranexamic acid (TXA) is an antifibrinolytic agent for reducing blood loss and allogenic blood transfusion. The purpose of this study was to evaluate the efficiency of TXA in reducing blood loss and improving hematologic parameters in adult patients undergoing posterior thoracic/lumbar instrumented spinal fusion surgery. Patients and Methods This is a retrospective observational study comparing the intra- and postoperative hemodynamic findings of two groups treated with and without TXA. The study included 112 adult patients receiving elective posterior thoracic/lumbar instrumented spinal fusion surgery. The patients were evaluated in terms of age, gender, type of surgery, intraoperative blood loss, pre- and postoperative hemoglobin (Hb) and hematocrit values, postoperative systemic anticoagulant use, intra- and postoperative use of blood products, and the volume of the drainage fluid as an indicator of postoperative blood loss. The TXA group received preoperative 10 mg/kg intravenous TXA, another dose of 10 mg/kg/h in isotonic solution during the operation, and local administration of TXA before the closure of the surgical site (1g in patients undergoing surgery in ≤3 segments, and 2g in patients undergoing surgery in ≥4 segment group). Results Intra- and postoperative blood loss and need for transfusion were significantly lower in the TXA group. Fifty-three of 112 patients required intra- and postoperative transfusion, and postoperative anticoagulants were given to 25/112 patients. The postoperative Hb level was lower, and the difference of pre- and postoperative Hb values was higher in the non-TXA group (not significant). Conclusion Simultaneous systemic and topical application of TXA is a safe and efficient blood conservation strategy for adult patients undergoing major multilevel spinal surgery.

De-implementation of Urinary Catheters in Neurosurgical Patients During the Operation and on the Ward: a Mixed-methods Study Protocol

BackgroundIndwelling urinary catheters (IDUCS) are frequently routinely inserted during transsphenoidal pituitary gland tumour surgery or spinal fusion surgery despite literature stating that there are no indications for using IDUCS during or after these surgeries. The aim of the study is to reduce the number of inappropriately inserted IDUCs in during or after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery with an operation time of <4 hours. Methods A pragmatic, before-and-after mixed-methods observational study including medical chart analysis, satisfaction surveys with patients and healthcare professionals and multidisciplinary group interviews to assess the effectiveness of and experiences with various non-invasive de-implementation strategies aimed to decrease the number of inappropriate IDUCS inserted during and after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery in a multicentre context. Discussion This paper presents the study protocol of a multi-centred before and after trial that aims to reduce inappropriate IDUC use after transsphenoidal pituitary gland tumour surgery and spinal fusion surgery, and thereby reducing UTIs, shortening hospital stay and increasing patient comfort. The results can be used to de-implement IDUCs after a broad range of surgeries on several wards.Trial registration The study has been submitted to the Dutch Trial Register (NTR).

Etiology, diagnosis, and treatment of iatrogenic spinal deformity

Background: Spinal fusion is a common procedure that provides spinal stability by connecting vertebral segments using a bone graft. Because the spinal alignment is fixed permanently after spinal fusion, a mal-aligned fusion can produce iatrogenic spinal deformity and imbalance with significant disability.Current Concepts: Failure to restore adequate segmental lordosis in lumbar spinal fusion is a common cause of iatrogenic spine deformity. Local and regional spinal deformities can affect the global alignment; accordingly, spinal imbalance can occur when the compensation mechanisms fail. Diagnosis and surgical planning should be made on a thorough analysis of global and spinopelvic parameters on the standing whole-spine radiographs. Surgical treatment includes neural decompression, spinal fusion, and deformity correction. Spinal osteotomy provides a favorable surgical outcome, although the complication rate is high.Discussion and Conclusion: Iatrogenic spine deformity is increasing due to the increased occurrence of spinal fusion surgery. To prevent iatrogenic spine deformity, the index fusion surgery should be performed based on a comprehensive analysis of spinopelvic alignment and balance.