Efficacy of topical versus intravenous tranexamic acid in spinal deformity.

PURPOSE: To compare topical tranexamic acid versus intravenous tranexamic acid in reducing intra- and postoperative blood loss and transfusion rate in deformity patients. MATERIALS AND METHOD: We performed a retrospective cohort study with posterior fusion deformity patients, between 2009 and 2016. Patients were categorized in 4 groups: "No TXA" (n = 35) if the wound was packed with saline soaked sponges, "IV TXA" (n = 37) the patient received 20 mg/kg bolus at the beginning of the surgery followed by continuous infusion of 1 mg/kg/hr until closure, "Topical TXA" (n = 23) the wound was packed with sponges soaked in 6 g of TXA diluted in a 3 L saline solution, or "Combined TXA" (n = 86) the patient received both IV and topical TXA. The primary outcomes were total, intra- and postoperative blood loss, surgical time, postoperative Ht/Hb, transfusion rates, and duration of drain insertion. RESULTS: A total of 181 patients were analyzed (78.6% F, 15.08 yo). No differences were found in total and intraoperative blood loss, surgical time, postoperative Ht/Ht, and transfusion rates. "Combined TXA" group had significantly less postoperative bleeding than "no TXA" group (p = 0.022). IV TXA patients (with o/without topical TXA) removed drains one day earlier than the no TXA group (p = 0.002). There were no complications related to the use of tranexamic acid. CONCLUSION: There is significant decrease in postoperative bleeding in pediatric deformity patients with combined topical and IV tranexamic acid.

Accuracy of a dynamic surgical guidance probe for screw insertion in the cervical spine: a cadaveric study.

STUDY DESIGN: A fresh frozen cadaver study was conducted. OBJECTIVE: To report the cortical breach rate using the dynamic surgical guidance (DSG) probe versus traditional freehand technique for cervical lateral mass, cervical pedicle and cervical laminar screws. METHODS: Nine male fresh frozen cadaveric torsos were utilized for this study. Each investigator was assigned three specimens that were randomized by fixation point, side and order of technique for establishing a screw pilot hole. The technique for screw hole preparation utilized was either a DSG probe in the "on" mode or in the "off" mode using a freehand technique popularized by Lenke et al. Levels instrumented included C1 lateral mass, C2 pedicle screws and lamina screws, and C6-T1 pedicle screws. Fluoroscopy and other navigational assistance were not used for screw hole preparation or screw insertion. All specimens were CT imaged following insertion of all screws. A senior radiologist evaluated all scans and determined that a misplaced screw was a breach of ≥2 mm. RESULTS: A total of 104 drillings were performed, 52 with DSG and 52 without DSG There were 68 total pedicle drillings, 34 in each group. There were 18 drillings in the lamina and lateral mass. There was no significant difference between surgeons or between the left and right side. All breaches were in the pedicle, and none in the lamina or lateral mass. The breach rate for PG "on" was 6/68 = 8.96% (95% CI 3.69, 19.12%). The breach rate for PG "off" was 20/68 = 29.41% (95% CI 19.30, 41.87%). Of the 20 pedicle breaches in the non-DSG group, 7 were lateral and superior, 8 were lateral, 4 medial and 1 inferior. Of the six pedicle breaches in the DSG group, two were lateral/superior, two were lateral and two were medial in the pedicle. CONCLUSIONS: The dynamic surgical guidance probe is a safe tool to assist the surgeon with screw placement in the cervical spine. Additionally, the DSG potentially avoids the cumulative risks associated with fluoroscopy and provides real-time feedback to the surgeon allowing correction at the time of breach. Level of evidence Level IV.

Vertebral Coplanar Alignment Technique Versus Bilateral Apical Vertebral Derotation Technique in Neuromuscular Scoliosis.

STUDY DESIGN: Single-center retrospective analysis of prospectively collected data. OBJECTIVE: Our aim was to compare the correction capacity in 3 planes of the VCA technique versus the AD technique in neuromuscular scoliosis patients. METHODS: We analized patients with neuromuscular scoliosis that underwent posterior spinal fusion from 2013 to 2017 using 2 different techniques for correction: vertebral coplanar alignment (VCA) that takes into consideration the fact that the medial cortex is more resistant than the lateral cortex, with more anchor points for better distribution of forces and ligamentotaxis and the more widely spread apical derotation (AD) technique. Clinical, surgical, and radiographic information of patients operated on with the AD technique were compared to those operated on with the VCA technique in the coronal, sagittal and axial plane at pre-op, immediate post-op, and 2 year follow-up. RESULTS: 64 patients met inclusion criteria, 34 patients underwent the VCA technique and 30 patients underwent the AD technique. The 2 cohorts did not differ in terms of demographics, clinical presentation or preoperative alignment. There were no significant differences in the correction ability between both techniques regarding curve magnitude, apical vertebral rotation, or pelvic obliquity. There was a significant decrease in thoracic kyphosis in the AD group compared to the VCA group in the immediate postop period (4.2 ± 26.6º for VCA and 13.2 ± 21.3º for AD (p = 0.048)). CONCLUSION: Both apical derotation technique and vertebral coplanar alignment allow for correction in the 3 planes for patients with neuromuscular scoliosis. VCA is a less hypokyphosing technique than AD.

Covid-19 y cirugía ortopédica: revisión de la literatura y evidencias / Covid-19 and orthopedic surgery: review of the literature and evidence

Se ha declarado una pandemia ante la propagación de un nuevo virus con alta contagiosidad, llamado síndrome respiratorio agudo severo coronavirus 2 (severe acute respiratory syndrome coronavirus 2, SARS-CoV2). El mundo ha quedado detenido ante la rápida expansión del virus, con una letalidad que en algunos países llega a 15%. En Chile, el gobierno ha tomado medidas rápidas y agresivas que han permitido mantener la curva de contagios a un nivel que permita atender de manera adecuada a la población. Dentro de estas medidas, se contempla la suspensión de cirugías y consultas ambulatorias. Como cirujanos ortopédicos, nos hemos visto afectados por estas medidas, y existe confusión respecto a cuál es la conducta más adecuada. Quisimos hacer esta guía para resumir parte de las evidencias disponibles y orientar a los cirujanos ortopédicos respecto a esta patología. El comportamiento de esta guía es dinámico, dadas las múltiples opiniones, experiencias y evidencias, que surgen diariamente, por lo que recomendamos mantenerlo como referencia, no como certeza.

A pandemic has been declared due to a new highly contagious virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). The world has come to a halt due to the rapid expansion of a virus whose lethality has reached 15% in some countries. In Chile, the government has taken decisive, aggressive measures in an attempt to control disease spread and provide healthcare to those who need it. These decisions include the suspension of elective surgeries and other ambulatory procedures. As Orthopedic surgeons we have been affected by these measures and there is doubt regarding the best course of action. We prepared this guide to summarize available evidence and orient our colleagues regarding this pathology. This guide is meant to be dynamic, as new opinions, evidence and experiences arise every day. Therefore, we advise the reader to keep it as a reference, not an undisputable truth.