Strategies to Reduce Blood Loss
During Posterior Spinal Fusion for
Neuromuscular Scoliosis:
A Review of Current Techniques and Experience with a Unique Bipolar
Electrocautery Device
Amer F. Samdani, M.D.
Staff Surgeon,
Shriners Hospitals for Children,
Philadelphia, Pennsylvania, USA
Andrew Torre-Healy, B.S.
Student,
Drexel University College of Medicine,
Philadelphia, Pennsylvania, USA
JahanGir Asghar, M.D.
Spine Fellow,
Shriners Hospitals for Children,
Philadelphia, Pennsylvania, USA
Andrew M. Herlich, M.D.
Anesthesiologist,
Temple University Hospital,
Philadelphia, Pennsylvania, USA
Randal R. Betz, M.D.
Chief of Staff,
Shriners Hospitals for Children,
Philadelphia, Pennsylvania, USA
In this chapter, we review current techniques employed to decrease blood loss and describe the effective use of a unique bipolar electrocautery device in a patient with neuromuscular scoliosis undergoing posterior spinal fusion (PSF). The reduction of blood loss and subsequent elimination of allogeneic blood transfusion is a desired outcome in all surgeries and is a major concern during PSF. In the child or adolescent with neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the inability of the musculature to compress blood vessels, extensive surgical exposure, and the duration of the operation. A multitude of pharmacological, anesthetic, and surgical techniques-including preoperative autologous blood donation and human recombinant erythropoietin, intraoperative blood salvage techniques, and topical and systemic hemostatic agents-are employed to reduce the need for transfusion. Many of these techniques carry their own risks and, thus far, a systematic approach has not been established to decrease the need for transfusion. In the continued pursuit of reducing intraoperative blood loss, other surgical techniques must be developed.
