Strategies to reduce blood loss during posterior spinal fusion for neuromuscular scoliosis: a review of current techniques and experience with a unique bipolar electrocautery device.

In this chapter, we review current techniques employed to decrease blood loss and describe the effective use of a unique bipolar electrocautery device in a patient with neuromuscular scoliosis undergoing posterior spinal fusion (PSF). The reduction of blood loss and subsequent elimination of allogeneic blood transfusion is a desired outcome in all surgeries and is a major concern during PSF. In the child or adolescent with neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the inability of the musculature to compress blood vessels, extensive surgical exposure, and the duration of the operation. A multitude of pharmacological, anesthetic, and surgical techniques-including preoperative autologous blood donation and human recombinant erythropoietin, intraoperative blood salvage techniques, and topical and systemic hemostatic agents-are employed to reduce the need for transfusion. Many of these techniques carry their own risks and, thus far, a systematic approach has not been established to decrease the need for transfusion. In the continued pursuit of reducing intraoperative blood loss, other surgical techniques must be developed.