Our Summary

This research paper studied blood loss during a type of back surgery known as Posterior Spinal Fusions (PSF) in adolescents with a type of scoliosis. The researchers noticed that there is a lot of “hidden” blood loss (HBL) - blood loss that happens but isn’t immediately obvious - in these procedures. Their study aimed to compare the estimated blood loss during the operation and after the operation to find out how much of the blood loss was “hidden”.

The study included 67 patients over a three-year period. The researchers used a special method to estimate the blood loss during the operation and a formula to estimate the total blood loss (both during and after the operation).

They found that the total estimated blood loss was higher than the blood loss estimated during the operation. This means that there was a significant amount of “hidden” blood loss that happened after the wound was closed. The “hidden” blood loss was higher in older patients, patients with higher body mass index (BMI), and surgeries that took longer.

The study also found that only 4% of the patients needed a blood transfusion, and these patients had higher “hidden” blood loss. The researchers concluded that for these types of surgeries, there’s more “hidden” blood loss after the wound is closed than blood loss during the operation.

FAQs

  1. What is “hidden” blood loss during Posterior Spinal Fusions surgery?
  2. Did the study find any factors that contributed to higher “hidden” blood loss in patients?
  3. According to the study, what percentage of patients required a blood transfusion due to “hidden” blood loss during PSF surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric scoliosis surgery is to be aware of the potential for hidden blood loss after the operation. It’s important to monitor for signs of blood loss such as increased heart rate, low blood pressure, and pale skin. It’s also important to follow any post-operative instructions carefully, including monitoring for signs of infection and seeking medical attention if any concerning symptoms arise. Additionally, maintaining a healthy lifestyle and following any prescribed physical therapy or rehabilitation exercises can help promote a successful recovery.

Suitable For

Patients who are typically recommended for pediatric scoliosis surgery are adolescents with moderate to severe scoliosis that is causing significant curvature of the spine and potential health issues. In particular, patients with progressive scoliosis that is not responding to non-surgical treatments such as bracing may be recommended for surgery. Patients with scoliosis that is affecting their breathing, mobility, or overall quality of life may also be candidates for surgery. Additionally, patients with specific types of scoliosis, such as neuromuscular scoliosis or congenital scoliosis, may be recommended for surgery to correct the curvature and prevent further complications.

Timeline

Before pediatric scoliosis surgery:

  1. Patient is diagnosed with scoliosis through physical examination and imaging tests.
  2. Patient and their family meet with a pediatric orthopedic surgeon to discuss treatment options.
  3. Patient undergoes pre-operative tests and evaluations to ensure they are healthy enough for surgery.
  4. Patient and their family receive pre-operative instructions and guidance on what to expect during and after surgery.

After pediatric scoliosis surgery:

  1. Patient is admitted to the hospital and prepared for surgery, which typically lasts several hours.
  2. Surgery is performed, during which the spine is straightened and stabilized using rods, screws, and/or other hardware.
  3. Patient is closely monitored in the recovery room before being transferred to a hospital room.
  4. Patient may experience pain and discomfort, which is managed with pain medication.
  5. Patient begins physical therapy and rehabilitation to regain strength and mobility.
  6. Patient is discharged from the hospital and continues with follow-up appointments to monitor their recovery and progress.

What to Ask Your Doctor

  1. What is the success rate of pediatric scoliosis surgery in terms of correcting the curvature of the spine?
  2. What are the potential risks and complications associated with pediatric scoliosis surgery?
  3. How long is the recovery process after pediatric scoliosis surgery and what kind of physical limitations should be expected?
  4. Will physical therapy be necessary after pediatric scoliosis surgery and for how long?
  5. How often will follow-up appointments be needed after pediatric scoliosis surgery?
  6. What kind of long-term effects or complications should be monitored for after pediatric scoliosis surgery?
  7. What is the estimated blood loss during the operation and how is it managed?
  8. How is “hidden” blood loss monitored and managed after pediatric scoliosis surgery?
  9. What factors can influence the amount of “hidden” blood loss in pediatric scoliosis surgery?
  10. When is a blood transfusion necessary after pediatric scoliosis surgery and how is it determined?

Reference

Authors: Kolz JM, Neal KM. Journal: Orthop Traumatol Surg Res. 2022 Oct;108(6):103216. doi: 10.1016/j.otsr.2022.103216. Epub 2022 Jan 31. PMID: 35093565