Table 3.
Blood loss data from studies on spinal fusions for cerebral palsy. P posterior spinal fusion, A anterior spinal fusion, P/a posterior spinal fusion with some cases having anterior spinal fusion, H-rod Harrington rod system, L-rod Luque rod system, DDAVP desmopressin acetate
| 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 blood volume | Comments |
|---|---|---|---|---|---|---|
| Bulman et al. [15] 1996/(1988–1993) | P/a 1325 (350–4000) | 15 | Luque-Galveston (15) plus anterior release, disk excision, arthrodesis (7) | 1325/14.5=91 | - | Same day procedures; blood loss for total approach |
| P/a 1240 (300–3400) | 15 | Unit rod (15) plus anterior release, disk excision, arthrodesis (4) | 1240/15=83 | - | ||
| Sponseller et al. [64] 1986/1982–1984 | P 1681 (hypotensive anesthesia) | 20 | H-rod/L-rod, 1 or 2 with spinous process wiring, iliac crest bone graft; anterior release 2 weeks pre posterior fusion in 21–13 with Dwyer instrumentation | 1681/15=112 | - | Blood loss only for posterior procedures |
| P 2200 (normotensive anesthesia) | 14 | 2200/15=147 | - | |||
| Swank et al. [66] 1989/(1981–1985) | P 1760 (600–3000) | 10 | Luque or Luque-Galveston, autogenous iliac crest bone graft | 1760/12=147 | - | |
| A 906 (200–3600) | 21 | Anterior fusion, Zielke system | 906/5=181 | - | Two week interval between anterior and posterior stages | |
| P 2040 (600–6490) | - | Posterior fusion, Luque system, autogenous iliac crest bone graft | 2040/14=146 | - | ||
| Allen, Ferguson [2] 1982/(1977–1980) | P 2086 (550–3900, both) | 7 | Luque rods to L5 or above | 2086/10.7=195 | - | - |
| 2267 | 3 | Luque rods to pelvis. Both with iliac crest autografts | 2267/14.7=154 | - | ||
| Gersoff, Renshaw [28] 1988/(1979–1983) | P 2125 | 33 | Luque rod, bone bank bone graft | 2125/14=152 | - | Hypotensive anesthesia not used. No anterior approaches |
| Lonstein, Akbarnia [41] 1983/(1948–1979) | I: A 1919 | 3 | 1919/7=274 | 58% EB volume | Group I - double balances curves | |
| P 2215 | 41 | Harrington system, autogenous iliac crest bone graft | 2215/13=170 | 79% EB volume | ||
| II: A 1803 | >25 | Dwyer or Zielke systems | 1803/7=258 | 54% EB volume | Group II - large unbalanced thoraco-lumbra or lumbar curves | |
| P 2629 | 99 | Harrington system, multiple other methods | 2629/15=175 | 84% EB volume | Some posterior fusions without instrumentation | |
| Bonnett et al. [13] (1976)/(1960–1972) | P 2230 | 10 | Harrington rod system | 2230/7.4=301 | - | Many revisions subsequently needed with both approaches. Eventually recommended both anterior and posterior—improved results. |
| A 1500 | 18 | Dwyer anterior fusion system only | 1500/5.5=273 | - | ||
| Dias et al. [17] (1996)/(1988–1991) | P 2149 | 31 | Unit rod to pelvis local autogenous bone graft plus bone back allograft. T1 to sacrum | 2149/17=126 | - | 7 patients had anterior release with rib graft 1 week before posterior fusion |
| Theroux et al. [68] (1997)/ | Not reported | 21 | Unit rod fusion T1 to sacrum | - | DDAVP group | - |
| Median loss 148% (range 57–425) EBV | ||||||
| Placebo group | ||||||
| Median loss 111% (range 65–240) EBV |