Risk factors for Significant Intraoperative Blood Loss During Unilateral Expansive open-door cervical Laminoplasty for Cervical Compressive Myelopathy.

Risk factors for Significant Intraoperative Blood Loss During Unilateral Expansive open-door cervical Laminoplasty for Cervical Compressive Myelopathy.

World Neurosurg. 2018 Apr 03;:

Authors: Meng Y, Wang X, Chen H, Hong Y, Wu T, Wang B, Deng Y, Liu H

Abstract
OBJECTIVE: Unilateral expansive open-door cervical laminoplasty is an effective and safe procedure for cervical compressive myelopathy, but occasionally is accompanied with significant intraoperative blood loss (SIBL). The aim of the present study was to elucidate the risk factors for SIBL in patients undergoing cervical laminoplasty for multilevel cervical compressive myelopathy, and to identify the effect of SIBL on neurological complication.
METHODS: A total of 215 patients who received cervical laminoplasty between January 2010 and August 2016 were enrolled in the study. SIBL was defined as 500ml or more of blood volume during surgery. Patients were subdivided into two groups according to whether they suffered from SIBL (n=26) or not (n=189). Patient characteristics and clinical data were collected. Univariate and multivariable analysis were performed to identify independent risk factors for SIBL.
RESULT: The incidence of SIBL during unilateral expansive open-door cervical laminoplasty was 12.1%. The multivariable logistic regression analysis showed Pavlov ratio (OR=0.002, P=0.009), OPLL (OR=2.677, P=0.038), and number of complete hinge fractures (OR=1.842, P=0.015) were independent risk factors for SIBL during cervical laminoplasty. Patients with SIBL during cervical laminoplasty had higher rate of neurological complication during hospitalization (P=0.012), worsen neurological recovery rate at discharge (P=0.01) and longer postoperative length of stay (P=0.003).
CONCLUSION: This study suggested that Pavlov ratio, OPLL, and number of complete hinge fractures were independent risk factors for SBIL during cervical laminoplasty. SIBL in cervical laminoplasty was associated with greater neurological complication and worsen neurological functional recovery.

PMID: 29625309 [PubMed - as supplied by publisher]

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