In 2022, spine deformity surgery usually requires a long
incision and temporary retraction of muscles from the spine. This extensive exposure of the spine helps to loosen up the spine (to get better correction), insert pedicle screws to grip
the spine and place the long rods, which moves the spine in space and maintains
the correction in its new position (while the spine fusion develops).
This type of exposure, and the amount of time required for
these surgeries (4-6 hours), creates the opportunity to have significant blood
loss. Does the amount of blood loss in surgery matter? The answer is “yes”. There
is a convincing amount of published research which documents lower complications
and better patient outcomes when the blood loss from surgery is low.
During surgical procedures in the operating rooms there are various
methods to minimize or stop bleeding, from intravenous medications to topical
materials to surgical technique. In
spine deformity surgery, some of these are effective and easy to do, while
others are not as effective or require changes in the execution of surgery.
So how do we minimize blood loss during pediatric spinal
deformity surgery? Here are a few of methods we utilize on a daily basis:
Meticulous surgical
technique: During surgery it is important to identify any and all bleeding. Electrocautery is used to stop the bleeding.
Use of tranexamic
acid: This medication is given by vein, through an IV, during surgery and has
been demonstrated to decrease bleeding.
Topical hemostatic
agents: These materials are applied on the surfaces of muscle and bone
which coagulates bleeding.
Use of red blood cell
scavenging: During surgery we suction blood out of the wound and this type
machine collects, filters and spins down to concentrate the blood. We can then give this concentrated back to
the patient.