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Optimizing Minimally Invasive Spine Surgery: A Fully 3D CT O-Arm Navigated Workflow in MIS TLIF
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Blood-loss Management in Spine Surgery
Jesse E Bible1, Muhammad Mirza, Mark A Knaub
1From the Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA.
The Journal of the American Academy of Orthopaedic Surgeons
|January 6, 2018
Summary
Minimizing blood loss in spine surgery is crucial for patient outcomes. Strategies include preoperative planning, antifibrinolytic agents, and careful hemostasis, while intraoperative blood salvage effectiveness is debated.
Area of Science:
- Spine Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Significant perioperative blood loss in spine surgery increases patient morbidity and mortality.
- Effective blood loss management is essential for improving surgical outcomes and patient safety.
Purpose of the Study:
- To review strategies for reducing perioperative blood loss during spine surgery.
- To evaluate the efficacy and cost-effectiveness of intraoperative blood salvage.
- To discuss the risks associated with allogeneic blood transfusions and optimal transfusion thresholds.
Main Methods:
- Review of current literature on blood loss management in spine surgery.
- Analysis of the role of preoperative planning and communication.
- Evaluation of intraoperative techniques including antifibrinolytic agents, anesthesia modifications, hemostasis, and local hemostatic agents.
- Assessment of intraoperative blood salvage and allogeneic transfusion practices.
Main Results:
- Preoperative planning, communication, antifibrinolytic agents, and meticulous surgical hemostasis can significantly reduce blood loss.
- The utility and cost-effectiveness of intraoperative blood salvage are questionable.
- Allogeneic blood transfusion carries risks, including surgical site infection.
Conclusions:
- A multifaceted approach combining preoperative planning, advanced intraoperative techniques, and restrictive transfusion strategies is key to managing blood loss in spine surgery.
- The role of intraoperative blood salvage requires further investigation regarding its clinical benefit and economic viability.
- Maintaining restrictive allogeneic blood transfusion thresholds is recommended to mitigate associated risks.
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