The pattern of blood loss during correction surgery combined with three column osteotomy for adult spine deformity

Abstract

Background: It is of great importance to perform a precise management for blood loss according to stage of surgery. To analyze blood loss during different stages of three column osteotomy (3CO) surgery for scoliosis and to find predictors of blood loss during different stages and to evaluate effectiveness of some blood conservative technique modalities. Methods: A retrospective review was performed for adult spine deformity (ASD) patients who underwent posterior-only correction along with 3CO. Surgical procedure was divided into four stages: Stage A, exposure; Stage B, screw placement; Stage C, osteotomy; Stage D, rod installment and wound closure. EBL was recorded at the end of each stage. Demographic and radiographic data were collected. Results: Highest EBL was observed at neuromuscular scoliosis group, while least at idiopathic. 9 patients experienced massive blood loss (EBL>5000 ml). Multivariate linear regression identified fusion level main curve Cobb angle and use of TXA as influential factors for stage A; fusion level, use of TXA and use of navigation system for stage B; kyphosis and use of bone scalpel for stage C; fusion level and main curve Cobb angle for stage D (P<0.05). Conclusion: Etiology significantly influences blood loss of scoliosis surgery with 3CO. Risk factors of blood loss were varied among different surgical stages. Use of TXA, navigation system and ultrasonic bone scalpel could reduce blood loss.