Purpose: The administration of tranexamic acid (TXA) has been shown to be beneficial in reducing blood loss during surgery for adolescent idiopathic scoliosis (AIS), but optimal dosing has yet to be defined. This retrospective study compared high versus low dose TXA as part of a Patient Blood Management strategy for reducing blood loss in patients undergoing posterior spine fusion surgery. Methods: Clinical records were reviewed for 223 patients with AIS who underwent posterior spinal fusion of five or more levels during a six-year time period. We compared normalized blood loss, total estimated blood loss (EBL), and the need for transfusion between patients receiving high dose TXA (loading dose of ≥30 mg/kg) versus low dose TXA (loading dose <30 mg/kg). Both groups received maintenance TXA infusions of 10 mg/kg/hr until skin closure. Results: Patient demographics, curves, and surgical characteristics were similar in both groups. The high dose TXA group had a 36% reduction in normalized blood loss (1.8 cc/kg/level fused versus 2.8 cc/kg/level fused, p<0.001) and a 37.5% reduction in total EBL (1000 cc versus 1600 cc, p<0.001). Patients in the high dose group had a 48% reduction in PRBC transfusion, with only 19% receiving a transfusion of PRBC compared to 67% in the low dose group (p<0.001). Conclusion: When combined with other proven Patient Blood Management strategies, the use of high dose TXA compared to low dose TXA may be beneficial in reducing blood loss for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery. Level of Evidence: Level III, retrospective cohort

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Study Design Retrospective Comparative Study, Level III. Objective In patients with scoliosis >90°, cranio-femoral traction (CFT) has been shown to obtain comparable curve correction with decreased operative time and blood loss. Routine intraoperative CFT use in the treatment of AIS <90° has not been established definitively. This study investigates the effectiveness of intraoperative CFT in the treatment of AIS between 50° and 90°, comparing the magnitude of curve correction, blood loss, operative time, and traction-related complications with and without CFT. Methods 73 patients with curves less than 90° were identified, 36 without and 37 with cranio-femoral traction. Neuromuscular scoliosis and revision surgery were excluded. Age, preoperative Cobb angles, bending angles, and curve types were recorded. Surgical characteristics were analyzed including number of levels fused, estimated blood loss, operative time, major curve correction (%), and degree of postoperative kyphosis. Results Patients with traction had significantly higher preoperative major curves but no difference in age or flexibility. Lenke 1 curves had significantly shorter operative time and improvement in curve correction with traction. Among subjects with 5 to 8 levels fused, subjects with traction had significantly less EBL. Operative time was significantly shorter for subjects with 5-8 levels and 9-11 levels fused. Curves measuring 50°-75° showed improved correction with traction. Conclusion Intraoperative traction resulted in shorter intraoperative time and greater correction of major curves during surgical treatment of adolescent idiopathic scoliosis less than 90°. Strong considerations should be given to use of intraoperative CFT for moderate AIS.

Case: We present a case of dysplasia epiphysealis hemimelica (DEH) involving the posteromedial distal femur in a 4-year-old girl. The patient underwent lesion resection with internal fixation of the articular cartilage followed by autologous chondrocyte implantation (ACI) to restore the articular surface and epiphysis. At the 7-year follow-up, the patient had no pain or difficulty with participation in sports. Advanced imaging showed a stable articular surface with evidence of durable cartilage integration. Conclusion: DEH is a rare disease often treated by resection. In cases where the articular surface of the knee is involved, we have demonstrated that augmentation with ACI can be an effective treatment option.