Our Summary

This research paper discusses a study that looked at the effectiveness of a blood-saving technique, called blood salvage, during spinal surgery in children. Blood salvage is a method used to decrease the need for blood transfusions from other people (also known as homologous blood transfusion). The researchers used data from children who had spinal surgery over a year to predict what their blood count (hematocrit) would be the day after surgery without using blood salvage. They compared this to the target blood count for a transfusion based on the patient’s condition. Factors taken into account included age, weight, the reason for surgery, the angle of the spine curvature, health status, pre-surgery hemoglobin levels, the number of spinal levels fused, and whether or not the sacrum and thoracic spine were involved.

The study included 147 patients and found that blood salvage could potentially avoid blood transfusions in 17 of them. The effectiveness of blood salvage was influenced by factors such as neuromuscular conditions, the number of spinal levels fused, and body mass index (BMI). However, blood salvage was found to be completely ineffective in patients without neuromuscular diseases who had surgery affecting fewer than 13 spinal levels or more than 13 levels with a pre-surgery BMI of 21 or higher. In all other cases, blood salvage could reduce the need for transfusions from other people.

The study was able to predict the ineffectiveness of blood salvage with 97% accuracy. However, the authors note that more studies need to be done to confirm these findings.

FAQs

  1. What is the role of blood salvage in scoliosis surgery according to this study?
  2. What factors were identified as predictors of the efficacy of blood salvage in the study?
  3. Was the blood salvage technique effective in all types of patients undergoing scoliosis surgery according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about scoliosis surgery is to discuss the potential use of intraoperative blood salvage as a way to decrease the need for homologous blood transfusion during the procedure. It’s important for patients to understand the potential benefits and limitations of this blood-saving strategy, and to discuss any specific factors that may impact its effectiveness in their case, such as surgical indication, number of levels fused, and BMI. Communication with your healthcare team about these factors can help optimize the outcome of your surgery and minimize the need for blood transfusions.

Suitable For

Patients who are typically recommended scoliosis surgery include those with severe curvature of the spine (Cobb’s angle greater than 40-50 degrees), progressive curvature despite bracing, significant pain or discomfort, and cosmetic concerns. Additionally, patients with neuromuscular scoliosis, such as those with cerebral palsy or muscular dystrophy, may also be recommended for surgery to prevent worsening of the curvature and potential complications. Other factors that may influence the recommendation for surgery include the patient’s age, overall health status, and response to conservative treatments.

Timeline

Before scoliosis surgery, a patient typically undergoes a series of medical assessments, imaging tests, and consultations with orthopedic specialists to determine the severity of their condition and the best course of treatment. They may also participate in physical therapy to strengthen their muscles and improve their flexibility in preparation for surgery.

After scoliosis surgery, the patient will likely stay in the hospital for a few days to recover and receive pain management. They will gradually begin physical therapy and rehabilitation to regain strength and mobility in their spine. Follow-up appointments with the surgeon will be scheduled to monitor the healing process and ensure the spine is properly aligned. Over time, the patient will continue to build strength and flexibility through ongoing physical therapy and may need to wear a brace to support the spine during the healing process.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with scoliosis surgery?
  2. How long is the recovery process expected to be after scoliosis surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. Are there any alternative treatments or procedures that could be considered instead of surgery?
  5. What type of scoliosis surgery will be performed and what are the expected outcomes?
  6. How long will I need to stay in the hospital after the surgery?
  7. What is the expected timeline for returning to normal activities and exercise?
  8. Will I need to follow any special precautions or restrictions after the surgery?
  9. How will the surgery impact my daily life and activities in the long term?
  10. Are there any specific lifestyle changes or modifications that I should consider following the surgery?

Reference

Authors: Michelet D, Julien-Marsollier F, Hilly J, Diallo T, Vidal C, Dahmani S. Journal: Anaesth Crit Care Pain Med. 2018 Apr;37(2):141-146. doi: 10.1016/j.accpm.2017.03.003. Epub 2017 May 22. PMID: 28546128