Minimizing Blood Loss in Spine Surgery

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Anesthesiology

Background:

• Spine surgery volume and complexity are increasing.
• Intraoperative blood loss is a significant concern in spinal procedures.
• Effective blood loss management is crucial for patient outcomes.

Purpose of the Study:

• To review and summarize current literature on minimizing blood loss in spine surgery.
• To outline guidelines, outcomes, techniques, and indications for various blood loss management modalities.
• To provide a comprehensive overview of perioperative blood management strategies.

Main Methods:

• Broad narrative review of peer-reviewed literature.
• Systematic search for guidelines, outcomes, techniques, and indications.
• Synthesis of evidence on multiple blood loss minimization modalities.

Main Results:

• Consensus exists on discontinuing anticoagulants, aspirin, NSAIDs, and herbal supplements preoperatively.
• Preoperative autologous blood donation with erythropoietin and iron is discussed for high-risk patients.
• Intraoperative techniques include positioning, normothermia, tranexamic acid (TXA), bipolar electrocautery, hemostatic agents, and hypotensive anesthesia.
• Strong evidence supports TXA for reducing blood loss and transfusion needs in spine surgery.

Conclusions:

• Multiple tools are available for minimizing blood loss during spine surgery.
• Combining techniques in a multimodal approach is cost-effective.
• Perioperative blood loss management is a pivotal research area in spine surgery.