Postoperative Radiographic Early-Onset Adjacent Segment Degeneration after Single-Level L4–L5 Posterior Lumbar Interbody Fusion in Patients without Preoperative Severe Sagittal Spinal Imbalance

STUDY DESIGN: Retrospective study. PURPOSE: To investigate the relationship between preoperative total spinal sagittal alignment and the early onset of adjacent segment degeneration (ASD) after single-level posterior lumbar interbody fusion (PLIF) in patients with normal sagittal spinal alignment. OVERVIEW OF LITERATURE: Postoperative early-onset ASD is one of the complications after L4–L5 PLIF, a common surgical procedure for lumbar degenerative disease in patents without severe sagittal imbalance. A better understanding of the preoperative characteristics of total spinal sagittal alignment associated with early-onset ASD could help prevent the condition. METHODS: The study included 70 consecutive patients diagnosed with lumbar degenerative disease who underwent single-level L4–L5 PLIF between 2011 and 2015. They were divided into two groups based on the radiographic progression of L3–L4 degeneration after 1-year follow-up: the ASD and the non-ASD (NASD) group. The following radiographic parameters were preoperatively and postoperatively measured: sagittal vertebral axis (SVA), thoracic kyphosis (TK), lumbar lordosis, pelvic tilt, and pelvic incidence (PI). RESULTS: Eight of the 70 patients (11%) experienced ASD after PLIF (three males and five females; age, 64.4±7.7 years). The NASD group comprised 20 males and 42 females (age, 67.7±9.3 years). Six patients of the ASD group showed decreased L3–L4 disc height, one had L3–L4 local kyphosis, and one showed both changes. Preoperative SVA, PI, and TK were significantly smaller in the ASD group than in the NASD group (p <0.05). CONCLUSIONS: A preoperative small SVA and TK with small PI were the characteristic alignments for the risk of early-onset ASD in patients without preoperative severe sagittal spinal imbalance undergoing L4–L5 single-level PLIF.

Application of Intraoperative Autotransfusion in Urological Cancer Surgery / 대한비뇨기과학회지

OBJECTIVE: We applied intraoperative autotransfusion (IAT) as a method of decreasing or avoiding homologous blood transfusions during urological cancer surgery and assessed the availability of the IAT. PATIENTS AND METHODS: IAT was performed in 7 patients with bladder cancer who underwent retropubic radical cystectomy (Cx group) and in 4 patients with prostate cancer who underwent radical prostatectomy (Px group). Blood shed in operation fields was collected and processed with an IAT device. The volume of blood loss, homologous blood transfused, and autologous blood transfused during surgery were assessed. RESULTS: In the Cx group, intraoperative blood loss ranged from 1,086 to 2,673 ml (mean: 1,757 ml), and homologous blood transfusions ranged from 0 to 1,000 ml (mean: 457 ml). Autologous blood was processed by IAT device and the amount transfused ranged from 380 to 980 ml (mean: 607 ml). Two patients did not require homologous blood transfusion. In the Px group, intraoperative blood loss ranged from 1,160 to 1,550 ml (mean: 1,356 ml). Autologous blood was processed by IAT device and the amount transfused ranged from 540 to 990 ml (mean: 745 ml). None of the patients required homologous blood transfusion. CONCLUSION: IAT is a feasible method of reducing or avoiding homologous blood transfusion in radical cystectomy and retropubic radical prostatectomy.