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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2017 | Original Article

Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

Authors: Yang Yang, Liangming Zhang, Bin Liu, Mao Pang, Peigen Xie, Zihao Chen, Wenbin Wu, Feng Feng, Limin Rong

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2017

Abstract

Background

Hidden haemorrhage has been proved to be significant in joint surgery. However, when referring to lumbar interbody fusion, it is often ignored because of its invisibility. This randomized controlled study aimed to calculate and compare hidden haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion (MIS-TLIF and open TLIF). Meanwhile, its clinical significance was also analyzed.

Materials and methods

A total of 41 patients were included in this study, then they were randomized to receive MIS-TLIF or open TLIF, 21 and 20, respectively. For each case, total volume loss of red blood cell (RBC) was calculated by Gross' formula based on perioperative haematocrit change, then perioperative visible volume loss of RBC was calculated through haemorrhage volume and weight. After deducting it from total volume loss of RBC, hidden volume loss of RBC was obtained. Absolute amount of hidden haemorrhage and its ratio upon total haemorrhage, as well as indicators assessing clinical outcomes, including visual analogue scale (VAS) for back and leg, Oswestry disability index (ODI), interbody fusion rate and complication incidence were compared and analyzed.

Results

Mean hidden volume loss of RBC in MIS-TLIF was significantly reduced compared with open TLIF (166.7 versus 245.6 ml). Besides, both mean total and visible volume loss of RBC in MIS-TLIF were also statistically less than those in open TLIF (355.3 versus 538.6 ml; 188.6 versus 293.0 ml). While mean ratio of hidden haemorrhage upon total haemorrhage was 46.7% for MIS-TLIF and 44.5% for open TLIF, respectively, showing no statistical significance. At one week postoperatively, more significant improvements of VAS for back and leg, as well as ODI were seen in MIS-TLIF compared with open TLIF. While at final follow-up of at least 2 years, all parameters continued to improve and revealed no statistical difference between both surgeries. Similar interbody fusion rate and complication incidence were observed in both series.

Conclusions

Besides reduced visible haemorrhage and improved clinical outcomes, MIS-TLIF also owns the superiority of less hidden haemorrhage, offering another advantage over open TLIF.

Level of evidence

Level II.

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Title: Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion
Authors: Yang Yang
Liangming Zhang
Bin Liu
Mao Pang
Peigen Xie
Zihao Chen
Wenbin Wu
Feng Feng
Limin Rong
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2017
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-017-0464-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Hidden and overall haemorrhage following minimally invasive and open transforaminal lumbar interbody fusion

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

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