Table 1.
Blood loss data from studies on posterior spinal fusions for AIS. C-D Cotrel-Dubousset (instrumentation), H-rod Harrington rod, TSRH Texas Scottish Rite Hospital (instrumentation), L-rod Luque rod
| Study [reference] (date of publication) / (date(s) of surgery) | Estimated blood loss (EBL) (ml) [mean (range)] | Number of procedures | Technique | Estimated blood loss / individual vertebral level in fusion (ml) (EBL/# levels=) | Estimated blood loss / total estimated blood volume (EBL/EBV) | Comments |
|---|---|---|---|---|---|---|
| Shufflebarger et al. [62] (2004)/(1998) | 500 (200–800) | 55 (Lenke5) | Posterior shortening, posterior segmental pedicle screws with 5 mm rods (Moss-Miami) | - | - | No iliac crest graft |
| 627 (350–1500) | 7 (Lenke 6) | - | - | |||
| 675 (500–750) | 3 (Lenke 3c) | - | - | |||
| DuToit et al. [18] (1978)/ | 567 | 27 | Harrington rod | - | - | Use of acute hemodilutional autotransfusion intraoperatively |
| Copley et al. [16] (1999)/(1995–1997) | 608 (hemodilution) | 43 | Posterior fusions, systems not described | 608/10.7=57 | 608/3780=16% | Comparison of hemodilution technique to control group, iliac crest bone graft, multicenter |
| 672 (control) | 43 | 672/10.2=66 | 672/3774=18% | |||
| Guidera et al. [32] (1993)/ | 660 | - | - | 660/7=94 | - | Smaller curves <60º, levels=7 |
| 1696 | 34 | 1696/8.8=193 | - | Larger curves >60º, levels=8.8 | ||
| [numbers per group not listed] | ||||||
| Erwin et al. [20] (1976)/(1966–1972) | 743 | 187 | Harrington-rod, no iliac crest bone graft | - | - | - |
| 840 | 177 | Harrington rod, iliac crest bone graft | - | - | ||
| Harrington and Dickson [33] (1973)/(1961–1972) | 748 (110–3480) | 578 | Harrington rod, iliac crest bone graft | 748/10=75 | - | Hypotensive anesthesia, systolic 85–95 mmHg |
| Youngman and Edgar [71] (1985)/(1974–1982) | 779 (<200–>1400) | 319 | Harrington rod, iliac crest bone graft, multiple ancillary procedures (operation in cast, sublaminar wires, etc) | 779/11.9=65 | - | Induced hypotension, systolic 60–65 mmHg |
| Lawhon et al. [39] (1984)/(1972–1978) | 801 | 120 | Harrington rod technique | - | - | Induced hypotension, mean arterial pressure (diastolic pressure + 1/3 of pulse pressure) less than 90mmHg |
| 1583 | 31 | Harrington rod technique | - | - | Normotensive anesthesia | |
| Siller et al. [63] (1996)/(1991) | 823 (186–1587) | 55 | C-D, iliac crest bone graft | 1084/11.1=98 | - | Hypotensive anesthesia |
| Florentino-Pineda et al. [26] (2004)/(1999–2001) | 893 +/− 220 | 19 | Posterior spinal fusion with segmental instrumentation; allograft only | 893/12=74 | 893/3095=29% | ε-aminocaproic acid group |
| 952 +/− 372 | 17 | 952/12=79 | 952/3153=30% | Control group | ||
| Florentino-Pineda et al. [25] (2001)/(1996–1998) | 988 (+/− 411) | 29 | Multiple instrumentations | 988/12=82 | 988/2973=33% | Pre-operative autologous blood and controlled hypotension (systolic 20% less than pre-induction value) ε-aminocaproic acid (EACA) |
| 1405 (+/− 671) | 31 | 1405/12=117 | 1405/3188=44% | No EACA | ||
| Patel et al. [56] (1985)/(1977–1980) | 1102 (+/− 72) | 27 | H-rod, autologous iliac crest bone grafts | 46 | 1102/3836=29% | Induced moderate hypotensive anesthesia (Systolic blood pressure 20–30 mmHg <preoperative systolic pressure) |
| 1541 (+/− 156) | 22 | 84 | 1541/4186=37% | |||
| Moran et al. [48] (1995)/(1989–1993) | 1113 | 84 | C-D, iliac crest bone graft | - | - | Preoperative autologous blood donation |
| Richards et al. [59] (1994)/(1988–1991) | 1122 (350–4000) | 95 | TSRH | - | - | - |
| Guadagni et al. [30] (1984)/(1979–1982) | 1187 | 30 | H-rod, L-rod with spinous process wiring H-rod | 1187/11=108 | - | - |
| 1543 | 31 | 1543/10=154 | ||||
| McMaster [46] (1991)/(1975–1987) | 1200 a (500–2458) | 156 | H-rod | 1200/11+109 a | - | Same surgeon all cases, Autogenous iliac crest grafts |
| 1490 a (695–2945) | 152 | L-rod | 1490/10.9=137 a | - | ||
| Lenke et al. [40] (1992)/(1985–1988) | 1211 (300–3000) | 95 | C-D, autogenous bone graft iliac crest (occasional ribs) | 1211/11=110 | - | - |
| Albers et al. [1] (2000)/(1991–1995) | 1421 (+/− 881) | 21 | Single rod TSRH, 11 iliac crest bone graft | - | - | - |
| 1801 (+/− 1201) | 24 | Dual rods (TSRH, C-D or Paragon) 17 iliac crest bone graft | - | - | ||
| Lovallo et al. [42] (1986)/(1978–1982) | 1500 (300–4000) | 133 | H-rod, autogenous iliac crest bone graft | 1500/10=150 | - | - |
| Barr et al. [3] (1997)/ | 1571 (550–3300) | 39 | C-D (thoracic) but lumbar pedicle hooks/screws 20 and lumbar hooks only 19 | 1571/~10=157 | - | Double major curves; blood loss same in two approaches |
| Guay et al. [31] (1994)/ | 1971 (+/− 831) | 30 | C-D, autogenous iliac crest bone graft | 1971/9.3=212 | 61.5% | Low normotensive anesthesia |
aBlood loss during and after surgery (post surgery loss negligible)