Journal of Orthopedics & Rheumatology

Research Article

Is there an Increase in Intra-operative Bleeding during Emergency Hybrid Open-Door Laminoplasty for Posttraumatic Cervical Cord Patients?

Liu G*, Lee BH, Tan JYW, Ng JH and Tan JH

Department of Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore
*Address for Correspondence: Liu G, MBBCh, MSc, FRCS, FRCSEd(Orth), Head, Spine Surgery Division, University Orthopaedics, Hand and Reconstructive Microsurgical Cluster, National University Health System, Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228, Tel: +65 92338520, Fax: +65 67780420; E-mail: gabriel_liu@nuhs.edu.sg
Submission: 04 October 2021; Accepted: 05 November 2021; Published: 10 November 2021
Copyright: © 2020 Liu G, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design: Retrospective Cohort Study
Objectives: There are no reports describing the potential increase in intra-operative blood loss with the use of hybrid open-door laminoplasty in post-traumatic cervical cord injuries.
Summary of background data: Early surgical intervention for traumatic cervical cord injury has demonstrated outcome benefits but is not without complications.
Methods: A retrospective review of patients who underwent open door hybrid laminoplasty by a single surgeon was performed. Patients were divided into 2 groups- Group A: isolated traumatic spinal cord injury without vertebral fracture, Group B: non-traumatic spinal cord injury.
Results: 30 consecutive patients, of whom 8 had isolated traumatic cervical injury, underwent hybrid open-door laminoplasty. A longer mean operative time (254 vs 199 minutes, p=0.005), hospital stay (44.1 vs 11.1 days, p=0.006) and ICU or high dependency unit stay (10.3 vs 1.5 days, p=0.004) was noted in the traumatic patients when compared to the non-traumatic patients. A greater amount of intraoperative blood loss was found in the traumatic patients (median 350 ml; range 110-750) and less in the non-traumatic patients (median 130 ml; range 50-400, p=0.032). Patients in both groups showed post-operative neurological recovery with a JOA score improvement of 1.9 ± 3.1 (p=0.14) in the traumatic group and 1.4 ± 1.7 (p=0.001) in the non-traumatic group.
Conclusions: Emergency open-door hybrid laminoplasty can be performed in patients with traumatic spinal cord injury. While early surgical decompression for post-traumatic patients improves neurological outcomes, a higher intra-operative bleeding should be anticipated in post-traumatic patients