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Shen F, Ding J, Wang Y, Yin C, Han Z, Ren X, Li Y, Wang T. Topical hemostatic agents in spinal surgery. Spine J 2024; 24:933-946. [PMID: 38219838 DOI: 10.1016/j.spinee.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Spinal surgery can be associated with significant intraoperative blood loss which may lead to various complications. As the number of patients undergoing spinal surgery increases over time, accurate and effective hemostasis becomes critically important. Despite various surgical hemostatic techniques, conventional interventions such as compression, suture, ligation, and heat-generating cautery, are not suitable for osseous and epidural venous plexus bleeding during spinal procedures. Therefore, a variety of hemostatic agents have been developed to promote hemostasis. As they differ in terms of mechanism, form, application and potential adverse reactions, it is important to understand the natural features of existing agents. Here we comprehensively review currently available topical hemostatic agents from different sources and summarize their mechanisms of action, applications, and current or potential utilization in spinal surgery. We found hemostatic agents from different sources exert hemostatic actions through different mechanisms. In addition, topical hemostatic agents play various roles in spinal surgery including as hemostatic agent, dura mater repair, drug-carrier, skin closure, and fibrosis prevention. Compressive neurological complications are the most common complications of these hemostatic agents. Therefore, optimal use in spinal environments should match their features, indications, and efficacy with clinical conditions.
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Affiliation(s)
- Feng Shen
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Jian Ding
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Yuelei Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Chuqiang Yin
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Zengshuai Han
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Xianfeng Ren
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China
| | - Yanhui Li
- School of Mechanical and Electrical Engineering, Qingdao University, No. 308 Ningxia Road, Shibei District, Qingdao, Shandong Province, China
| | - Ting Wang
- Department of Spine Surgery, Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China.
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Kwon WK, Kelly KA, McAvoy M, Sivakanthan S, Ogunlade J, Yap NKY, Durfy S, Hofstetter CP. Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results. Neurospine 2022; 19:1028-1038. [PMID: 36597639 PMCID: PMC9816588 DOI: 10.14245/ns.2244344.172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Interlaminar endoscopic spine surgery has been introduced and utilized for lumbar lateral recess decompression. We modified this technique and utilized it for bilateral lateral recess stenoses without significant central stenosis. Here we present the surgical details and clinical outcome of ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression (ULBRD). METHODS Prospectively collected registry for full-endoscopic surgeries was reviewed retrospectively. One hundred eighty-two consecutive cases from a single center between September 2015 and March 2021 were reviewed and 57 of them whom underwent ULBRD were enrolled for analysis. Basic patient demographic data, perioperative details, surgeryrelated complications, and clinical outcome were reviewed. The detailed surgical technique is presented as well. RESULTS Among the 57 patients enrolled, 37 were males while the other 20 were females. The mean age was 58.53 ± 14.51 years, and a bimodal age distribution at the age of mid-fifties and mid-sixties or older was noted. The later age-peak was related to coexistence of degenerative scoliosis. The average operative time per lamina was 70.34 ± 20.51 minutes and mean length of stay was 0.56 ± 0.85 days. Four perioperative complications were reported (7.0%) and the overall reoperation rate at the index level within 1 year was 8.8%. The preoperative back/leg visual analogue scale scores and functional outcome scales including EuroQol-5 dimension questionnaire, Oswestry Disability Index presented significant improvement immediately after surgery and were maintained until final follow-up. CONCLUSION ULBRD for bilateral lateral recess stenoses without significant central stenosis resulted in good clinical outcomes with acceptably low perioperative complications rates. Sufficient decompression was achieved with the central ligamentum flavum being preserved.
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Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Katherine A. Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Malia McAvoy
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | | | - John Ogunlade
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Natalie Kai Yi Yap
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Christoph P. Hofstetter
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA,Corresponding Author Christoph Hofstetter Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA 98104, USA ;
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Turkoz D, Demirel C, Sataloğlu H, Cokluk C. Analysing the blood-stemming effect of Ankaferd Blood Stopper in medulla spinalis surgery. Turk J Med Sci 2020; 50:1131-1135. [PMID: 32283888 PMCID: PMC7379454 DOI: 10.3906/sag-2001-249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/07/2020] [Indexed: 11/22/2022] Open
Abstract
Background/aim The aim of this study was to investigate the possible toxicity of the Ankaferd Blood Stopper (ABS) on the neural system. Materials and methods Thirty Sprague Dawley rats were randomized into ABS (n: 15) and control (n: 15) groups. Following the anaesthetic induction, total laminectomy was performed to the lower thoracic, and upper lumbar areas in both groups and medulla spinalis was exposed. Two myelotomies were performed on the medulla spinalis. One millilitre ABS was applied to the incision site in the ABS group, and one millilitre 0.9% saline solution was applied in the control group. Rats were observed for 15 days regarding general behaviour, neurological signs, mobility, and signs of infection. Sixteen days later, all rats were decapitated under anaesthesia. Medulla spinalis was removed en bloc from all rats and was stained with Heamatoxylin & Eosin and luxol fast blue. Results There was no significant difference between the ABS group and the control group regarding oedema, gliosis, the intensity of inflammatory cells, the presence of neuronal degeneration, neuron counts, and myelin degeneration. Conclusion No clinical or histopathological evidence for the neurotoxic effect of the ABS was observed in the present study. Our findings might precipitate the use of ABS on human subjects regarding medulla spinalis surgery.
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Affiliation(s)
- Dursun Turkoz
- Department of Neurosurgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Cem Demirel
- Department of Neurosurgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Hüseyin Sataloğlu
- Department of Neurosurgery, Samsun Training and Research Hospital, Samsun, Turkey
| | - Cengiz Cokluk
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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