Blood loss in adult spinal surgery

  • Serena S. Hu


Spinal surgery in adults can vary from simple to complex and can also have variable anticipated surgical blood loss. There are several factors that can put patients at increased risk for greater intraoperative blood loss. These factors, including a review of the literature, will be discussed.


Adult Blood loss 


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  1. 1.
    Allen BL, Ferguson RL (1988) The Galveston experience with L-rod instrumentation for adolescent idiopathic scoliosis. Clin Orthop 229:59–69PubMedGoogle Scholar
  2. 2.
    Ani N, Keppler L, Biscup RS, Steffee AD (1991) Reduction of high-grade slips with VSP instrumentation. Spine 16(6S): S203–310Google Scholar
  3. 3.
    Boachie-Adjei O, Bradford DS (1991) The Cotrel-Dubousset system — results in spinal reconstruction. Early experience in 47 patients. Spine 16:1155–1160PubMedGoogle Scholar
  4. 4.
    Boachie-Adjei O, Do T, Rawlins BA (2002) Partial lumbosacral kyphosis reduction, decompression and posterior lumbosacral transfixation in high-grade isthmic spondylolisthesis. Spine 27:E161–E168CrossRefPubMedGoogle Scholar
  5. 5.
    Carson JL, Altman DG, Duff A et al (1999) Risk of bacterial infection associated with allogenic blood transfusion among patients undergoing hip fracture repair. Transfusion 39:694–700CrossRefPubMedGoogle Scholar
  6. 6.
    Cha CW, Deible C, Muzzonigro T et al (2002) Allogeneic transfusion requirements after autologous donations in posterior lumbar surgeries. Spine 27:99–104CrossRefPubMedGoogle Scholar
  7. 7.
    Chang KW, McAfee PC (1989) Degenerative spondylolisthesis and degenerative scoliosis treated with a combination segmental rod-plate and transpedicular screw instrumentation system. J Spinal Disord 1:247–256Google Scholar
  8. 8.
    Danisa OA, Turner D, Richardson WJ (2000) Surgical correction of lumbar kyphotic deformity: posterior reduction “eggshell’ osteotomy. J Neurosurg [Suppl 1] 92:50–56PubMedGoogle Scholar
  9. 9.
    Dietrich W, Spath P, Zuhlsdorf M et al (2001) Anaphylactic reactions to aprotinin reexposure in cardiac surgery. Anesthesiology 95:64–71CrossRefPubMedGoogle Scholar
  10. 10.
    Goodnough LT, Marcus RE (1992) Effect of autologous blood donation in patients undergoing elective spine surgery. Spine 17:172–175PubMedGoogle Scholar
  11. 11.
    Goodnough LT, Rudnick S, Price TH et al (1989) Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy. N Engl J Med 321:1163–1168PubMedGoogle Scholar
  12. 12.
    Gurr KR, McAfee PC (1988) Cotrel-Dubousset instrumentation in adults: a preliminary report. Spine 13:510–519PubMedGoogle Scholar
  13. 13.
    Hur SR, Huizenga BA, Major M (1992) Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine 17: 867–870PubMedGoogle Scholar
  14. 14.
    Islam NC, Wood KB, Transfeldt EE et al (2001) Extensions of fusions to the pelvis in idiopathic scoliosis. Spine 26:166–173CrossRefPubMedGoogle Scholar
  15. 15.
    Johnson RG, Murphy M, Miller M (1989) Fusions and transfusions: an analysis of blood loss and autologous replacement during lumbar fusions. Spine 14:358–362PubMedGoogle Scholar
  16. 16.
    Kaneda K, Fujiya N, Satoh S (1986) Results with Zielke instrumentation for idiopathic thoracolumbar and lumbar scoliosis. Clin Orthop 205:195–203PubMedGoogle Scholar
  17. 17.
    Lagrone MO, Bradford DS, Moe JH et al (1988) Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am 70: 569–580PubMedGoogle Scholar
  18. 18.
    Möller H, Hedlund R (2000) Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis. Spine 25:1716–1721CrossRefPubMedGoogle Scholar
  19. 19.
    Murphy P, Heal JM, Blumberg N et al (1991) Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions. Transfusion 31:212–217CrossRefPubMedGoogle Scholar
  20. 20.
    Nahtomi-Shick O, Kostuik JP, Winters BD et al (2001) Does intraoperative fluid management in spine surgery predict intensive care unit length of stay? J Clin Anesth 13:208–212CrossRefPubMedGoogle Scholar
  21. 21.
    Nuttall GA, Horlocker TT, Santrach PJ et al (2000) Predictors of blood transfusion in spinal instrumentation and surgery. Spine 25:596–601CrossRefPubMedGoogle Scholar
  22. 22.
    Nuttall GA, Horlocker TT, Santrach PJ et al (2000) Use of the surgical blood order equation in spinal instrumentation and fusion surgery. Spine 25:602–605CrossRefPubMedGoogle Scholar
  23. 23.
    Ogiela DM, Chan DP (1986) Ventral derotation spondylodesis. Spine 11:18–22PubMedGoogle Scholar
  24. 24.
    Ponder RC, Dickson JH, Harrington PR, Erwin ED (1975) Results of Harrington instrumentation and fusion in the adult idiopathic scoliosis patient. J Bone Joint Surg Am 57: 797–801PubMedGoogle Scholar
  25. 25.
    Popovsky M, Davenport RD (2001) Transfusion-related acute lung injury: femme fatale? Transfusion 41:312–315CrossRefPubMedGoogle Scholar
  26. 26.
    Simpson MB, Georgopolous G, Eilert RE (1993) Intraoperative blood salvage in children and young adults undergoing spinal surgery with predeposited autologous blood: efficacy and cost effectiveness. J Pediatr Orthop 13:777–780PubMedGoogle Scholar
  27. 27.
    Swank S, Lonstein JE, Moe JH et al (1981) Surgical treatment of adult scoliosis. J Bone Joint Surg Am 63: 268–287PubMedGoogle Scholar
  28. 28.
    Triulzi DJ, Vanek K, Ryan DH et al (1992) A clinical and immunologic study of blood transfusion and postoperative bacterial infection in spinal surgery. Transfusion 32:517–524CrossRefPubMedGoogle Scholar
  29. 29.
    Urban MD, Beckman J, Gordon M, Urquart B, Boachie-Adjei O (2001) The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery. Spine 26:1152–1157CrossRefPubMedGoogle Scholar
  30. 30.
    Winter RB, Lonstein JE (1989) Adult idiopathic scoliosis treated with Luque or Harrington rods and sublaminar wiring. J Bone Joint Surg Am 71: 1308–1313PubMedGoogle Scholar
  31. 31.
    Zheng F, Cammisa FP, Sandhu HS et al (2002) Factors predicting hospital stay, operative time, blood loss and transfusion in patients undergoing revision posterior lumbar spine decompression, fusion and segmental instrumentation. Spine 27:818–824CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • Serena S. Hu
    • 1
  1. 1.Department of Orthopedic SurgeryUniversity of California San FranciscoSan FranciscoUSA

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