Fatal Intraoperative Hemorrhage During Spinal Fusion Surgery for Osteogenesis Imperfecta

Sperry, Kris

doi:10.1097/00000433-198903000-00014

Cited by 29 publications

(13 citation statements)

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“…Previous case reports discussed specific surgical and anesthetic implications of OI including hyperthermia, 20,21,22 coagulopathy 11,12 difficult airway, 25 Our retrospective analysis is the largest series to date documenting perioperative anesthesia challenges by OI type, and it includes for the first time a predominance of more severe OI types. As we analyzed our data, it became apparent that challenges were more frequent in the severe OI Types (Figure 1).…”

Section: Discussionmentioning

confidence: 98%

“…Previous case reports discussed specific surgical and anesthetic implications of OI including hyperthermia, coagulopathy difficult airway, and iatrogenic fractures, but a comprehensive analysis of multiple perioperative anesthetic challenges in a large cohort has not been described. There have been two large OI research reports to date.…”

Section: Discussionmentioning

confidence: 99%

“…Collagen is the most abundant protein of bone, skin, and tendon extracellular matrices, and mutations result in connective tissue disorders manifesting as skeletal fragility, as evidenced by skeletal deformity, joint hypermobility, scoliosis, and growth deficiency. 9,10 Typical extra-skeletal manifestations with variable presentation include blue sclera, dentinogenesis imperfecta, hearing impairment, 3 coagulopathy, 11,12 aortic root dilatation, 13 intrinsic and extrinsic lung abnormalities, [2][3][4] and possible neurologic sequelae such as basilar invagination. 3,14 Early surgical reinforcement of long bones and surgical fracture repair has become standard treatment in pediatric OI patients.…”

Section: Introductionmentioning

confidence: 99%

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Anesthesia in children with osteogenesis imperfecta: Retrospective chart review of 83 patients and 205 anesthetics over 7 years

Rothschild

Goeller

Voronov

et al. 2018

Pediatric Anesthesia

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Summary Background Osteogenesis imperfecta is the collective term for a heterogeneous group of connective tissue syndromes characterized by bone fragility with multisystem involvement and perioperative implications. Aims Literature review of anesthetic management of patients with osteogenesis imperfecta revealed a paucity of data on the incidence of perioperative challenges. We sought to determine the rates of these challenges in our study cohort. Methods Data were collected in a specialty orthopedic hospital from 2008 to 2015 for 83 osteogenesis imperfecta patients undergoing 205 surgeries: 203 orthopedic surgeries and 2 mid‐face reconstructive surgeries. Airway management, intravenous access, surgical blood loss, use of peripheral nerve blockade and/or neuraxial techniques, presence of perioperative fracture, and peak intraoperative temperature were evaluated and analyzed. Results Difficult airway was encountered in 3/205 (1.5%) cases and perioperative fracture in 2/205 (1%) cases. Neuraxial anesthesia was attempted in 64/205 cases with an 87.5% success rate. All peripheral nerve block attempts (33/205 cases) were successful. Difficult intravenous catheter placement was noted in 8/205 (4%) cases. Estimated blood loss >10% of estimated blood volume was considered significant, and occurred in 35/205 (17%) cases. Significant blood loss occurred more often in severe osteogenesis imperfecta types: 18/76 (23.7%) in Type III and 11/65 (16.9%) in Type IV, whereas only 4/47 (8.5%) occurred in mild Type I. In our 205 case cohort, osteogenesis imperfecta Type III had 5.6 times the odds [(95% CI = 1.8‐17.2) P = 0.003] of having an anesthetic complication as compared to osteogenesis imperfecta Type I. Conclusion Patients with osteogenesis imperfecta undergo frequent anesthetic exposures, but anesthetic challenges in our series were uncommon. Odds of challenges are greater in severe osteogenesis imperfecta Type III, with significant blood loss and difficulty placing intravenous catheters more likely encountered in the more severe types.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anesthesia in children with osteogenesis imperfecta: Retrospective chart review of 83 patients and 205 anesthetics over 7 years

Rothschild

Goeller

Voronov

et al. 2018

Pediatric Anesthesia

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“…On the other hand, surgery of the spine in OI is hazardous [16] and difficult due to the extreme bone fragility. Therefore, Benson et al [2] recommended spinal fusion at a young age with or without instrumentation.…”

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confidence: 99%

Operative treatment of severe scoliosis in osteogenesis imperfecta: results of 20 patients after halo traction and posterior spondylodesis with instrumentation

Janus¹,

Finidori

Engelbert

et al. 2000

European Spine Journal

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“…In patients with OI and severe kyphoscoliosis, which occurred in this case, late loss of correction of thoracic kyphosis was the main complication reported. 9 Other problems that were encountered included uncontrollable hemorrhage during surgery, 16 excessive blood loss, 9 and late pseudarthrosis. 9 Although patients treated with posterior spinal fusion using Harrington instrumentation or Luque instrumentation showed better correction of the curve in scoliosis than those who were not instrumented, late loss of correction was still a problem.…”

Section: Discussionmentioning

confidence: 99%

All Pedicle Screw Fixation Technique in Correcting Severe Kyphoscoliosis in an Osteogenesis Imperfecta Patient

Pan

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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Spinal deformity in patients with osteogenesis imperfecta demonstrates a high prevalence. The surgical treatment of this problem had numerous difficulties, which included breakage of bone, dislodgement of implants, and late loss of correction. We reported the correction of severe kyphoscoliosis in a patient with osteogenesis imperfecta using 3-rod all pedicle screw fixation technique. In this case, the 2 main goals of spinal operation, stabilization and correction of spinal curvatures, were achieved. The Cobb angles of scoliosis and thoracic kyphosis were corrected from 110 degrees to 68 degrees and from 107 degrees to 39 degrees, respectively. One and a half years after the operation, spinal radiographs showed no loss of correction, either on coronal or sagittal planes. The predicted forced vital capacity, predicted forced expiratory volume in 1 second and vital capacity of the lung of the patient had improved 2-fold. The usage of pedicle screw, with its conical core and cylindrical thread design, and 3-rod technique in fixation, together with cyclic intravenous bisphosphonate administration and halo-gravity traction preoperatively, contributed to the success in this case.

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Fatal Intraoperative Hemorrhage During Spinal Fusion Surgery for Osteogenesis Imperfecta

Cited by 29 publications

References 0 publications

Anesthesia in children with osteogenesis imperfecta: Retrospective chart review of 83 patients and 205 anesthetics over 7 years

Anesthesia in children with osteogenesis imperfecta: Retrospective chart review of 83 patients and 205 anesthetics over 7 years

Operative treatment of severe scoliosis in osteogenesis imperfecta: results of 20 patients after halo traction and posterior spondylodesis with instrumentation

All Pedicle Screw Fixation Technique in Correcting Severe Kyphoscoliosis in an Osteogenesis Imperfecta Patient

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