Hemostats in Spine Surgery: Literature Review and Expert Panel Recommendations

Abstract

Bleeding in spine surgery is a common occurrence but when bleeding is uncontrolled the consequences can be severe due to the potential for spinal cord compression and damage to the central nervous system. There are many factors that influence bleeding during spine surgery including patient factors and those related to the type of surgery and the surgical approach to bleeding. There are a range of methods that can be employed to both reduce the risk of bleeding and achieve hemostasis, one of which is the adjunct use of hemostatic agents. Hemostatic agents are available in a variety of forms and materials and with considerable variation in cost, but specific evidence to support their use in spine surgery is sparse. A literature review was conducted to identify the pre-, peri-, and postsurgical considerations around bleeding in spine surgery. The review generated a set of recommendations that were discussed and ratified by a wider expert group of spine surgeons. The results are intended to provide a practical guide to the selection of hemostats for specific bleeding situations that may be encountered in spine surgery.

The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries

“…More excessive bleeding may negatively affect the visualization during endoscopic spinal procedures. Similar to other surgeries, several options are available for us to use for achieving better hemostasis control during endoscopic spinal surgery, including radiofrequency ablation probes or various types of hemostatic agents, such as bone wax, gelatin foam, or human gelatine-thrombin matrix sealant [ 40 ]. The manual control pressure of the saline irrigation for a brief period is also an advantage in full-endoscopic spine surgery.…”

Surgical Versus Conservative Management for Treating Unstable Atlas Fractures: A Multicenter Study

“…The goal for treatment of unstable atlas fractures is to reduce fracture displacement, maintain stabilization, and heal the bony fracture. Various surgical options for treating unstable atlas fractures with ligament tears have been recently described with advanced surgical techniques and good radiological outcomes [ 7 - 9 , 13 , 17 - 20 ]. However, in these times of favorable results by surgery, it still remains debatable whether surgery or conservative management should be used for unstable atlas fractures.…”

Short Peptide Nanofiber Biomaterials Ameliorate Local Hemostatic Capacity of Surgical Materials and Intraoperative Hemostatic Applications in Clinics

“…Hemostasis is the first crucial step in each neurosurgical procedure, which is almost mandatory to keep a clean operative field in situ and effectively decrease potential blood loss and post‐operative complication. [ 160 ] Although the medico‐economic data in one French hospital showed that neurosurgery (including spine surgery) was the greatest consumer of surgical hemostats and had a great deal of expenditure for advanced hemostatic techniques, [ 161 ] local hemostatic materials were quite limited to be used for surgical and traumatic bleedings in cranial cavity or spinal cord. Previous studies evidenced that RADA16 peptide hydrogel promoted nerve fiber growth and enhanced the functional recovery of acute brain injury in the behavioral detection system of intracerebral hemorrhage (ICH).…”