Disseminated intravascular coagulation during surgery for scoliosis

Disseminated intravascular coagulation (DIC) was recently observed intraoperatively in two patients who required correction and stabilization of scoliosis with Harrington instrumentation and spinal fusion. Despite negative bleeding history and normal preoperative coagulation parameters, each patient developed sudden massive bleeding soon after decortication of spinous processes and facet joints. Coagulation profile revealed decreased platelets, plasma coagulation factors, and fibrinogen in association with elevated fibrin split products. Cessation of all bleeding occurred within a few hours. There was rapid correction of the coagulation parameters with blood component replacement therapy, indicating that the defibrination was short-lived and had ceased by the end of surgery. A review of the literature revealed six similar cases of DIC occurring during elective orthopedic surgery, four of which involved spinal arthrodesis and/or bone grafts. We suggest that injury secondary to decortication or chipping at bone can serve as a trigger for defibrination. This type of DIC is self-limited, and ends with completion of the operation. The treatment is blood component replacement. Heparin should be avoided.