Can we safely reduce blood loss during lumbar pedicle subtraction osteotomy procedures using tranexamic acid or aprotinin? A comparative study with controls.

Study Design: Retrospective, observational study.

Objective: To compare the safety and efficacy of 2 pharmaceutical antifibrinolytic agents, aprotinin and tranexamic acid, in controlling blood loss during lumbar pedicle subtraction osteotomy (PSO) in adults.

Summary Of Background Data: Reconstructive spinal surgeries, in particular lumbar PSOs, have been associated with large blood losses despite interventions (intraoperative blood salvaging, controlled hypotensive anesthesia).

Dysphonia, dysphagia, and esophageal injuries after anterior cervical spine surgery.

Anterior cervical spine surgery is commonly used by spine surgeons to treat numerous pathologic entities. The most common procedures involve decompression of the cervical spine through either diskectomy or corpectomy. Procedures that involve anterior dissection of the neck can lead to various complications, including dysphonia, dysphagia, and esophageal injuries.

Perils of intravascular methylprednisolone injection into the vertebral artery. An animal study.

Background: Intravascular injection of particulate steroids during cervical nerve root blocks has been postulated to be a source of catastrophic neurologic complications that might be avoided with the use of non-particulate steroids. The objective of this study was to compare the effects of direct intravascular injection of particulate and non-particulate steroids on the spinal cord and central nervous system.

Methods: Eleven adult pigs underwent direct injection, under fluoroscopic guidance, into the vertebral artery while under general anesthesia.

Evaluation of total disc arthroplasty: a canine model.

The study reported here was designed to examine the biomechanical and histopathologic properties of total disc arthroplasty (TDA) using a canine model. Thirty-seven dogs were divided into 3 groups (intact spine, fusion, TDA) and sacrificed either at study commencement or at 3 months. Results showed progressive fusion from 0 to 3 months in the fusion group.

Aprotinin may decrease blood loss in complex adult spinal deformity surgery, but it may also increase the risk of acute renal failure.

Study Design: Matched cohort comparison.

Objective: This study examines the potential for aprotinin to conserve blood in adults undergoing long thoracolumbar deformity procedures and characterizes patients at risk for acute renal failure.

Summary Of Background Data: Aprotinin has been shown to reduce intraoperative blood loss and reduce transfusion requirement in pediatric spine and cardiac surgery populations.

Detection of esophageal perforation using intraesophageal dye injection.

Objectives: Esophageal perforation complicating anterior cervical spine surgery is a potentially fatal complication. Early identification and immediate treatment may lower adverse effects for the patient. The purpose of this study is to assess the efficacy of intraesophageal dye injection to detect an esophageal injury and to test two novel techniques.

Complications in orthopedic management of exstrophy.

The objective of this study was to examine the complications associated with the orthopedic management of bladder exstrophy. The records of all patients seen for bladder exstrophy repair at the authors' institution between 1988 and 2002 were examined. Orthopedic complications were found to have occurred in 26 of 624 patients, yielding a complication rate of 4%.

Evaluation of registration methods used in frameless stereotactic surgery for the lumbar and cervical regions of the spine.

Computer-assisted pedicle screw insertion is feasible but has proved to be problematic. The purpose of this study was to detail the accuracy of registration techniques and pedicle screw insertion using a frameless stereotactic system. Two registration techniques were evaluated on a model spine.