title: Blood Loss Reduction During Surgical Correction of Adolescent Idiopathic Scoliosis Utilizing an Ultrasonic Bone Scalpel.
abstract: METHODS
  Retrospective review of prospectively collected data.
  
  
  OBJECTIVE
  To evaluate blood loss associated with posterior spinal fusion in adolescent idiopathic scoliosis patients performed with and without the use of an ultrasonic bone scalpel (UBS).
  
  
  BACKGROUND
  After using an ultrasonic-powered bone-cutting device with recent Food and Drug Administration approval for use in the spine, the authors perceived a reduction in bone bleeding associated with the cut boney surfaces.
  
  
  METHODS
  The first 20 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion using the UBS by a single surgeon were compared with 2 control groups: 1) the 20 most recent prior cases of the same surgeon before beginning use of the bone scalpel; and 2) 20 cases of the same surgeon before using the bone scalpel matched based on Cobb angle magnitudes. Both cases and controls had Ponte-type posterior apical releases; none had an anterior procedure. Patient demographic and surgical data were analyzed using analysis of variance (p < .05).
  
  
  RESULTS
  Preoperatively, the UBS group was similar to both control groups in terms of primary and secondary curve magnitudes, number of levels fused, number of levels with Ponte release, antifibrinolytic use, and patient age (p > .05). The UBS group had significantly less estimated blood loss (EBL) (550 ± 359 mL), Cell Saver blood transfused (94 ± 146 mL), and EBL per level fused (48 ± 30 mL) than the most recent controls (EBL: 799 ± 376 mL; Cell Saver: 184 ± 122 mL; EBL/level fused: 72 ± 28 mL) and Cobb-matched controls (EBL: 886 ± 383 mL; Cell Saver: 198 ± 115 mL; EBL/level fused: 78 ± 30 mL) (p < .05). Surgical times were equivalent and there were no dural tears in any group.
  
  
  CONCLUSIONS
  The use of an ultrasonic bone scalpel to perform the bone cuts associated with facetectomies and apical Ponte-type posterior releases resulted in significantly less bleeding compared with cuts made with standard osteotomes and rongeurs, limiting overall blood loss by 30% to 40%.
authors.affiliation: Rady Children's Hospital, 3020 Children's Way, Suite 410, San Diego, CA 92123, USA.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Bartley
authors.affiliation: Rady Children's Hospital, 3020 Children's Way, Suite 410, San Diego, CA 92123, USA.
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.affiliation: Rady Children's Hospital, 3020 Children's Way, Suite 410, San Diego, CA 92123, USA. Electronic address: pnewton@rchsd.org.
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
keywords: Adolescent idiopathic scoliosis; Blood loss; Ultrasonic bone scalpel