Blood Loss Following Open Posterior Spinal Fusion in Fractures: Cannulated Vs. Solid Pedicle Screws

Overview

Journal J Pers Med

Date 2023 Jan 21

PMID 36675821

Authors

Pedram Rajabifard

John Edward Cunningham

Michael A Johnson

Henrik Constantin Backer

Peter Turner

Affiliations

Soon will be listed here.

Abstract

We aim to delineate whether there is increased blood loss with the use of cannulated pedicle screws compared to solid pedicle screws in patients undergoing posterior spinal fusion. A single-centre retrospective case-control study was undertaken on patients undergoing PSF for spinal fractures. Cannulated screw fixation was compared with solid screw fixation. Intraoperative blood loss was estimated using pre and postoperative haemoglobin levels, recorded estimated blood loss and cell saver reports. Anticoagulation, blood product administration, operative time and number of levels fused were assessed. A total of 64 cases, 32 in each cohort, were included in the analysis. Overall mean haemoglobin reduction from pre- to post-operative was 2.82 ± 1.85 g/L per screw inserted in the cannulated group, compared to a haemoglobin decrease of 2.81 ± 1.521 g/L per screw inserted in the solid screw group (p = 0.971). Total estimated intraoperative blood loss was 616.3 + 355.4 mL in the cannulated group, compared to 713.6 + 473.5 mL in the solid screw group (p = 0.456). Patients with preoperative thrombocytopenia had a transfusion rate of 0.5 ± 0.71 units/patient compared to 0.04 ± 0.19 units/patient in patients with normal platelet levels (p < 0.005). The differences in blood loss observed between cannulated and solid pedicle screws are non-significant overall. The largest predictor for need of transfusion was pre-operative thrombocytopenia, regardless of the type of screw used.

References

Smorgick Y, Baker K, Bachison C, Herkowitz H, Montgomery D, Fischgrund J . Hidden blood loss during posterior spine fusion surgery. Spine J. 2013; 13(8):877-81. DOI: 10.1016/j.spinee.2013.02.008. View

Verlaan J, Diekerhof C, Buskens E, van der Tweel I, Verbout A, Dhert W . Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine (Phila Pa 1976). 2004; 29(7):803-14. DOI: 10.1097/01.brs.0000116990.31984.a9. View

Yang B, Li H, Wang D, He X, Zhang C, Yang P . Systematic review and meta-analysis of perioperative intravenous tranexamic acid use in spinal surgery. PLoS One. 2013; 8(2):e55436. PMC: 3570541. DOI: 10.1371/journal.pone.0055436. View

Ishii K, Funao H, Isogai N, Saito T, Arizono T, Hoshino M . The History and Development of the Percutaneous Pedicle Screw (PPS) System. Medicina (Kaunas). 2022; 58(8). PMC: 9414999. DOI: 10.3390/medicina58081064. View

Ponkilainen V, Toivonen L, Niemi S, Kannus P, Huttunen T, Mattila V . Incidence of Spine Fracture Hospitalization and Surgery in Finland in 1998-2017. Spine (Phila Pa 1976). 2019; 45(7):459-464. DOI: 10.1097/BRS.0000000000003286. View

Neilipovitz D . Tranexamic acid for major spinal surgery. Eur Spine J. 2004; 13 Suppl 1:S62-5. PMC: 3592185. DOI: 10.1007/s00586-004-0716-2. View

Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B . Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976). 2007; 32(14):1503-7. DOI: 10.1097/BRS.0b013e318067dd24. View

Greinacher A, Selleng S . How I evaluate and treat thrombocytopenia in the intensive care unit patient. Blood. 2016; 128(26):3032-3042. DOI: 10.1182/blood-2016-09-693655. View

Kim B, Dan J, Shin D . Treatment of thoracolumbar fracture. Asian Spine J. 2015; 9(1):133-46. PMC: 4330209. DOI: 10.4184/asj.2015.9.1.133. View

10.

Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U . The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech. 2009; 22(6):417-21. DOI: 10.1097/BSD.0b013e3181870385. View

11.

Elgafy H, Bransford R, McGuire R, Dettori J, Fischer D . Blood loss in major spine surgery: are there effective measures to decrease massive hemorrhage in major spine fusion surgery?. Spine (Phila Pa 1976). 2010; 35(9 Suppl):S47-56. DOI: 10.1097/BRS.0b013e3181d833f6. View

12.

Morcos M, Jiang F, McIntosh G, Johnson M, Christie S, Wai E . Predictors of Blood Transfusion in Posterior Lumbar Spinal Fusion: A Canadian Spine Outcome and Research Network Study. Spine (Phila Pa 1976). 2017; 43(1):E35-E39. DOI: 10.1097/BRS.0000000000002115. View

13.

Wong J, El Beheiry H, Rampersaud Y, Lewis S, Ahn H, De Silva Y . Tranexamic Acid reduces perioperative blood loss in adult patients having spinal fusion surgery. Anesth Analg. 2008; 107(5):1479-86. DOI: 10.1213/ane.0b013e3181831e44. View

14.

Hu S . Blood loss in adult spinal surgery. Eur Spine J. 2004; 13 Suppl 1:S3-5. PMC: 3592187. DOI: 10.1007/s00586-004-0753-x. View

15.

Mobbs R, Sivabalan P, Li J . Technique, challenges and indications for percutaneous pedicle screw fixation. J Clin Neurosci. 2011; 18(6):741-9. DOI: 10.1016/j.jocn.2010.09.019. View

16.

Kumar A, Aujla R, Lee C . The management of thoracolumbar burst fractures: a prospective study between conservative management, traditional open spinal surgery and minimally interventional spinal surgery. Springerplus. 2015; 4:204. PMC: 4418977. DOI: 10.1186/s40064-015-0960-4. View

17.

Li Z, Fu X, Xing D, Zhang H, Zang J, Ma X . Is tranexamic acid effective and safe in spinal surgery? A meta-analysis of randomized controlled trials. Eur Spine J. 2013; 22(9):1950-7. PMC: 3777050. DOI: 10.1007/s00586-013-2774-9. View

18.

Boos N, Webb J . Pedicle screw fixation in spinal disorders: a European view. Eur Spine J. 1997; 6(1):2-18. PMC: 3454634. DOI: 10.1007/BF01676569. View

19.

Bolesta M, Caron T, Chinthakunta S, Vazifeh P, Khalil S . Pedicle screw instrumentation of thoracolumbar burst fractures: Biomechanical evaluation of screw configuration with pedicle screws at the level of the fracture. Int J Spine Surg. 2015; 6:200-5. PMC: 4300899. DOI: 10.1016/j.ijsp.2012.09.002. View