Intraoperative Traction May Be a Viable Alternative to Anterior Surgery in Cerebral Palsy Scoliosis ≥100 Degrees.

BACKGROUND: For large scoliosis, 2 strategies to maximize correction include intraoperative traction and/or anterior release. It is unclear which patients will benefit the most form either approach. The purpose of our study is to compare the radiographic, perioperative clinical outcomes, and health-related quality of life (HRQoL) outcomes of 2 approaches when used in severe neuromuscular scoliosis in the setting of cerebral palsy (CP). METHODS: In total, 23 patients with minimum 2-year follow-up, major curves ≥100 degrees, and in whom treatment included posterior spinal fusion were evaluated. Eighteen were treated with posterior spinal fusion with intraoperative traction and 5 with anterior/posterior spinal fusion (APSF). The baseline characteristics, perioperative outcomes, and preoperative and 2-year follow-up data for HRQoL and radiographic measures were compared. RESULTS: The groups had similar age, sex, nutritional and seizure status, GMFCS level, and change in CPCHILD scores. The groups had similar curve magnitude (120 vs. 105 degrees, P=0.330) and flexibility (28% vs. 40%, P=0.090), but the APSF group had less pelvic obliquity (POB) (24 vs. 42 degrees, P=0.009). There were similar postoperative major curves (37 vs. 40 degrees, P=0.350), but greater correction in POB (33.5 vs. 14 degrees of correction, P=0.007) in the traction group. The APSF group had longer anesthesia times (669 vs. 415 min, P=0.005), but similar hospital stays, intensive care unit and days intubated, estimated blood loss, cell saver, and red blood cells used. Although the APSF group had twice the rate of complications (22% vs. 40%) during the first 90 days postoperatively, this did not reach statistical significance. CONCLUSIONS: Both intraoperative traction and anterior surgery were used to aid correction in severe CP scoliosis. Anterior surgery did not offer superior correction or better HRQoL, and was associated with increased operative times, whereas intraoperative traction was associated with greater correction of POB. Intraoperative traction may be a viable alternative to an anterior release in severe CP scoliosis. LEVEL OF EVIDENCE: Level II.

The use of intraoperative autotransfusion as a second stage of autologous blood use in pediatric orthopaedic surgery

The purpose of this study is to evaluate the use of Intraoperative Autotransfusion (IAT) as a second stage in the use of autologous blood to reduce the need of allogeneic transfusions. We reviewed the medical records of 41 pediatric patients who underwent spinal fusion procedures from September 1991, to August 1993. Our experience with IAT started in August 1992. The group of patients was divided into those who only received preoperative donation autologous blood (53.6 percent) and those who received preoperative donation autologous blood and IAT(46.4 percent). The use of preoperative autologous blood donation in combination with IAT has proven to be a safe method of operative blood loss replacement in pediatric age patients. Exclusive use of autologous blood can reduce or eliminate transfusion reactions and exposure to transfusion transmitted agents and helps to increase the blood reserve at blood banks

The use of autologous blood transfusions in pediatric orthopaedic surgery

En este estudio se revisó los expedientes médicos de 29 pacientes que fueron sometidos a procedimientos de fusión espinal con el propósito de evaluar la efectividad de usar sangre antóloga e depositada previo a la cirugía para reemplazar la pérdida de sangrre operatoria. La edad de los pacientes fluctuó entre 8 y 25 años. Una vez se determinó la fecha de la cirugía, cada paciente comenzó en un suplemento de hierro oral. Las flebotomias fueron efectuadas por los Servicios de Sangre de la Cruz Roja Americana, Capítulo de Puerto Rico. La sangre fue removida 1 unidad cada 6 días si el hematocrito se mantuvo por encima de 34%. La última flebotomía fue efectuada por lo menos 7 días antes de la fecha establecida para la cirugía. La cantidad promedio de sangre donada fue 3.17 unidades (1,427 ml). La sangre fue almacenada utilizando la solución de adenina y salina como preservativo por un período no mayor de 35 días. El valor promedio de hematocrito preoperatorio fue 35%. En 89% de los casos estudiados, los pacientes fueron transfundidos utilizando sangre autóloga solamente. En el resto de los casos se requirió utilizar sangre homóloga donada por los familiares. El uso de sangre autóloga depositada de antemano para reemplazar la pérdida sanguínea intraoperatoria ha demostrado ser un método seguro, sencillo y bien aceptado para los pacientes de edad pediátrica. Esta técnica también reduce la demanda por sangre homóloga ayudando a mantener una reserva adecuada en los bancos de sangre