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Blood Loss Reduction During Surgical Correction of Adolescent Idiopathic Scoliosis Utilizing an Ultrasonic Bone Scalpel

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Abstract

Study Design

Retrospective review of prospectively collected data.

Objectives

To evaluate blood loss associated with posterior spinal fusion in adolescent idiopathic scoliosis patients performed with and without the use of an ultrasonic bone scalpel (UBS).

Summary of Background Information

After using an ultrasonic-powered bone-cutting device with recent Food and Drug Administration approval for use in the spine, the authors perceived a reduction in bone bleeding associated with the cut boney surfaces.

Methods

The first 20 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion using the UBS by a single surgeon were compared with 2 control groups: 1) the 20 most recent prior cases of the same surgeon before beginning use of the bone scalpel; and 2) 20 cases of the same surgeon before using the bone scalpel matched based on Cobb angle magnitudes. Both cases and controls had Ponte-type posterior apical releases; none had an anterior procedure. Patient demographic and surgical data were analyzed using analysis of variance (p <.05).

Results

Preoperatively, the UBS group was similar to both control groups in terms of primary and secondary curve magnitudes, number of levels fused, number of levels with Ponte release, antifibrinolytic use, and patient age (p >.05). The UBS group had significantly less estimated blood loss (EBL) (550 ± 359 mL), Cell Saver blood transfused (94 ± 146 mL), and EBL per level fused (48 ± 30 mL) than the most recent controls (EBL: 799 ± 376 mL; Cell Saver: 184 ± 122 mL; EBL/level fused: 72 ± 28 mL) and Cobb-matched controls (EBL: 886 ± 383 mL; Cell Saver: 198 ± 115 mL; EBL/level fused: 78 ± 30 mL) (p <.05). Surgical times were equivalent and there were no dural tears in any group.

Conclusions

The use of an ultrasonic bone scalpel to perform the bone cuts associated with facetectomies and apical Ponte-type posterior releases resulted in significantly less bleeding compared with cuts made with standard osteotomes and rongeurs, limiting overall blood loss by 30% to 40%.

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References

  1. Newton PO, Marks MC, Bastrom TP, et al. Surgical treatment of Lenke 1 main thoracic idiopathic scoliosis: results of a prospective, multicenter study. Spine (Phila Pa 1976) 2013;38:328–38.

    Article  Google Scholar 

  2. Thompson ME, Kohring JM, McFann K, et al. Predicting excessive hemorrhage in adolescent idiopathic scoliosis patients undergoing posterior spinal instrumentation and fusion. Spine J 2013 Oct 18. pii:S1529-9430(13)01469-1.https://doi.org/10.1016/j.spinee.2013.08.022. [Epub ahead of print].

    Google Scholar 

  3. Horton JE, Tarpley Jr TM, Jacoway JR. Clinical applications of ultrasonic instrumentation in the surgical removal of bone. Oral Surg Oral Med Oral Pathol 1981;51:236–42.

    Article  CAS  Google Scholar 

  4. Sherman JA, Davies HT. Ultracision: the harmonic scalpel and its possible uses in maxillofacial surgery. Br J Oral Maxillofac Surg 2000;38:530–2.

    Article  CAS  Google Scholar 

  5. Parker SL, Kretzer RM, Recinos PF, et al. Ultrasonic bone scalpel for osteoplastic laminoplasty in the resection of intradural spinal pathology: case series and technical note. Neurosurgery 2013;73(1 suppl):61–6.

    Google Scholar 

  6. Al-Mahfoudh R, Qattan E, Ellenbogen JR, et al. Applications of the ultrasonic bone cutter in spinal surgery-our preliminary experience. Br J Neurosurg 2014;28:56–60.

    Article  Google Scholar 

  7. Gilles R, Couvreur T, Dammous S. Ultrasonic orthognathic surgery: enhancements to established osteotomies. Int J Oral Maxillofac Surg 2013;42:981–7.

    Article  CAS  Google Scholar 

  8. Hu X, Ohnmeiss DD, Lieberman IH. Use of an ultrasonic osteotome device in spine surgery: experience from the first 128 patients. Eur Spine J 2013;22:2845–9.

    Article  Google Scholar 

  9. Modi HN, Suh SW, Hong JY, et al. Intraoperative blood loss during different stages of scoliosis surgery: a prospective study. Scoliosis 2010;5:16.

    Article  Google Scholar 

  10. Stubinger S, Kuttenberger J, Filippi A, et al. Intraoral piezosurgery: preliminary results of a new technique. J Oral Maxillofac Surg 2005;63:1283–7.

    Article  Google Scholar 

  11. Vercellotti T, Pollack AS. A new bone surgery device: sinus grafting and periodontal surgery. Compend Contin Educ Dent 2006;27: 319–25.

    PubMed  Google Scholar 

  12. Sanborn MR, Balzer J, Gerszten PC, et al. Safety and efficacy of a novel ultrasonic osteotome device in an ovine model. J Clin Neurosci 2011;18:1528–33.

    Article  Google Scholar 

  13. Pakzaban P. Bone Scalpel Ultrasonic Bone Dissector: applications in spine surgery and surgical technique guide. Farmingdale, NY: Misonix, Inc.; 2013.

    Google Scholar 

  14. Jain A, Njoku DB, Sponseller PD. Does patient diagnosis predict blood loss during posterior spinal fusion in children? Spine (Phila Pa 1976) 2012;37:1683–7.

    Article  Google Scholar 

  15. Zheng F, Cammisa Jr FP, Sandhu HS, et al. Factors predicting hospital stay, operative time, blood loss, and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion, and segmental instrumentation. Spine (Phila Pa 1976) 2002;27:818–24.

    Article  Google Scholar 

  16. Halanski MA, Cassidy JA. Do multilevel Ponte osteotomies in thoracic idiopathic scoliosis surgery improve curve correction and restore thoracic kyphosis? J Spinal Disord Tech 2013;26:252–5.

    Article  Google Scholar 

  17. Monazzam S, Newton PO, Bastrom TP, et al. Multicenter comparison of the factors important in restoring thoracic kyphosis during posterior instrumentation for adolescent idiopathic scoliosis. Spine Deformity 2013;1:359–64.

    Article  Google Scholar 

  18. Shah SA, Dhawale AA, Oda JE, et al. Ponte osteotomies with pedicle screw instrumentation in the treatment of adolescent idiopathic scoliosis. Spine Deformity 2013;1:196–204.

    Article  Google Scholar 

  19. Marks M, Petcharaporn M, Betz RR, et al. Outcomes of surgical treatment in male versus female adolescent idiopathic scoliosis patients. Spine (Phila Pa 1976) 2007;32:544–9.

    Article  Google Scholar 

  20. Doi T, Harimaya K, Matsumoto Y, et al. Peri-operative blood loss and extent of fused vertebrae in surgery for adolescent idiopathic scoliosis. Fukuoka Igaku Zasshi 2011;102:8–13.

    PubMed  Google Scholar 

  21. Hardesty CK, Poe-Kochert C, Son-Hing JP, et al. Obesity negatively affects spinal surgery in idiopathic scoliosis. Clin Orthop Relat Res 2013;471:1230–5.

    Article  Google Scholar 

  22. Ialenti MN, Lonner BS, Verma K, et al. Predicting operative blood loss during spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 2013;33:372–6.

    Article  Google Scholar 

  23. Guay J, Haig M, Lortie L, et al. Predicting blood loss in surgery for idiopathic scoliosis. Can J Anaesth 1994;41:775–81.

    Article  CAS  Google Scholar 

  24. Yagi M, Hasegawa J, Nagoshi N, et al. Does the intraoperative tranexamic acid decrease operative blood loss during posterior spinal fusion for treatment of adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 2012;37:E1336–42.

    Article  Google Scholar 

  25. Verma RR, Williamson JB, Dashti H, et al. Homologous blood transfusion is not required in surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Br 2006;88:1187–91.

    Article  CAS  Google Scholar 

  26. Wick CC, Rezaee RP, Zender CA. Piezoelectric BoneScalpel osteoto- mies in osteocutaneous free flaps. Laryngoscope 2013;123:618–21.

    Article  Google Scholar 

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Authors and Affiliations

  1. Rady Children’s Hospital, 3020 Children’s Way, Suite 410, San Diego, CA, 92123, USA

    Carrie E. Bartley MA, Tracey P. Bastrom MA & Peter O. Newton MD

Authors
  1. Carrie E. Bartley MA
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  2. Tracey P. Bastrom MA
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  3. Peter O. Newton MD
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Corresponding author

Correspondence to Peter O. Newton MD.

Additional information

Author disclosures: CEB (grants from Setting Scoliosis Straight Foundation); TPB (grants from Setting Scoliosis Straight Foundation); PON (grant from Setting Scoliosis Straight Foundation; consulting fee/honorarium from DePuy Spine; support for travel to meetings from DePuy Spine; board membership with POSNA, Harms Study Group Foundation, Scoliosis Research Society, Children’s Specialist Foundation; consultancy for DePuy Spine, Stanford University; employment with Children’s Specialists of San Diego; expert testimony for NorCal, law firm Carroll, Kelly, Trotter, Franzen, and McKenna, law firm Smith, Haughey, Rice and Roegge; grants from National Institutes of Health (Grant R21AR049587), Orthopaedic Research and Education Foundation, POSNA, SRS, Harms Study Group Foundation, DePuy Synthes Spine, Axial Biotech, Biospace/Med/EOS Imaging; payment for lectures including service on speakers bureaus from DePuy Spine; patents from DePuy Synthes Spine; royalties from DePuy Synthes Spine, Thieme Publishing; payment for development of educational presentations from DePuy Synthes Spine; stock/stock options from Nuvasive).

This study was supported in part by a grant from the Setting Scoliosis Straight Foundation.

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Bartley, C.E., Bastrom, T.P. & Newton, P.O. Blood Loss Reduction During Surgical Correction of Adolescent Idiopathic Scoliosis Utilizing an Ultrasonic Bone Scalpel. Spine Deform 2, 285–290 (2014). https://doi.org/10.1016/j.jspd.2014.03.008

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  • DOI: https://doi.org/10.1016/j.jspd.2014.03.008

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