Source:

Bosch
P
,
Kenkre
TS
,
Londino
JA
, et al
.
Coagulation profile of patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion
.
J Bone Joint Surg Am
.
2016
;
98
(
20
):
e88(1
9)
; doi.
https://doi.org/10.2106/JBJS.16.00114

Researchers from the University of Pittsburgh conducted a prospective observational study of adolescent patients with idiopathic scoliosis undergoing posterior spinal fusion to better understand intraoperative hemostasis. Patients with adolescent idiopathic scoliosis were eligible if they presented for posterior spinal fusion at the study hospital between 2012–2014, had no history of frequent bleeding, and had normal screening coagulation laboratory values. At the time of their spinal fusion procedure, participants had coagulation studies (platelet count, prothrombin time [PT], partial thromboplastin time [PTT], D-dimer, fibrin degradation products [FDP], etc.) drawn at incision, at 1-hour intervals during the procedure, and at a closure. Fibrinolysis was measured using a disseminated intravascular coagulation (DIC) score based on PT, D-dimer, and FDP values, where higher scores represent a higher fibrinolytic state. Demographics and surgical data, such as length of the case, number of spinal levels fused, estimated blood loss, and intraoperative and/or postoperative blood products transfused, were obtained from the medical record.

Researchers compared coagulation laboratory values and DIC score at each time interval among participants who did and did not receive blood transfusions. They also measured change in these measures over time between groups. Researchers also assessed whether there was an association between coagulation values and estimated blood loss per spinal level fused by comparing patients in the upper quartile of estimated blood loss per level with the remaining cohort.

Of 100 patients screened, 58 were enrolled and included in analysis. Participants had a mean age of 13.5 years and 80% were female. There was a mean of 11.1 spinal levels fused, a median estimated blood loss of 645 mL, and 47% of patients received blood products.

Among all participants, there was no significant change in coagulation laboratory values from incision to closure. Also, coagulation studies did not differ among participants who did and did not receive a blood transfusion, except that PT and PTT increased significantly more in the transfused group, and the mean change in DIC score from incision to maximal score was also significantly higher in the transfused group. There was no significant difference in coagulation studies between patients in the upper quartile of estimated blood loss per level and the remaining cohort, except for a higher mean change in PT in the high estimated blood loss group.

The researchers conclude that fibrinolysis during posterior spinal fusions for adolescent idiopathic scoliosis may be associated with the need for blood transfusion.

Dr. Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Scoliosis operations can be long and bloody; many patients require a transfusion. One proposed cause of excessive blood loss during scoliosis surgery is a consumptive coagulopathy stemming from activation of...

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