Feuer Grant, Katiyar Prerana, Reyes Justin L, Taber Caroline, Coury Josephine R, Hassan Fthimnir M, Lombardi Joseph M, Shawky Abdelgawaad Ahmed, Daniels Alan H, Lenke Lawrence G, Sardar Zeeshan M
Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Och Spine Hospital, New York, NY, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Spine Deform. 2025 Jun 4. doi: 10.1007/s43390-025-01098-9.
The purpose of this systematic review was to identify the efficacy of cell salvage in adult and pediatric spinal surgery.
A comprehensive systematic review of four biomedical databases was conducted to identify study articles of interest. Articles from original studies were compiled for the composition of this manuscript. Spinal surgery is becoming increasingly common in both the United States and around the world. As such, spine surgeons typically make use of many methods to manage blood loss including intra-operative hypotension, use of crystalloid and colloid fluid resuscitation, anti-fibrinolytics, allogenic blood transfusions, and autologous transfusions. Allogenic blood is a common method to maintain blood volume throughout surgery but carries risks including transfusion reactions, immunosuppression, and transmission of viral blood-borne illnesses. Autologous blood products, like intra-operative cell saver or cell salvage (CS), offer a way to return the patient's own blood. However, CS remains controversial at this time. Some studies have found it to be efficacious in avoiding allogenic transfusion, while others have found that the results are no different in those who did not utilize CS. Some studies have even found that those who receive CS are more likely to require allogenic transfusions. This systematic review seeks to examine all the available literature on the use of CS in spinal surgery.
Currently, the role of CS is controversial in spinal surgery with studies reporting variable benefit. Many articles suggest that CS is only financially viable at higher volumes of blood loss and in more complex surgeries. Moreover, research regarding cost-effectiveness is lacking and is complicated by geographic factors. A multi-center large-scale randomized clinical trial could lead to the development of a model wherein the utility of CS could be assessed across a range of spinal surgeries, and could lead to the development of guidelines driving an individualized approach to the use of CS in spine surgery.
本系统评价旨在确定细胞回收在成人及小儿脊柱手术中的疗效。
对四个生物医学数据库进行全面的系统评价，以确定感兴趣的研究文章。从原始研究中选取的文章被汇编成本手稿。脊柱手术在美国和全球范围内都越来越普遍。因此，脊柱外科医生通常会采用多种方法来控制失血，包括术中低血压、使用晶体液和胶体液复苏、抗纤溶药物、异体输血和自体输血。异体输血是在整个手术过程中维持血容量的常用方法，但存在输血反应、免疫抑制和病毒性血源性疾病传播等风险。自体血制品，如术中细胞回收器或细胞回收（CS），提供了一种回输患者自身血液的方法。然而，CS目前仍存在争议。一些研究发现它在避免异体输血方面有效，而另一些研究则发现未使用CS的患者结果并无差异。一些研究甚至发现接受CS的患者更有可能需要异体输血。本系统评价旨在审查所有关于CS在脊柱手术中应用的现有文献。
目前，CS在脊柱手术中的作用存在争议，研究报告的益处各不相同。许多文章表明，CS只有在失血量较大和手术更复杂的情况下在经济上才可行。此外，关于成本效益的研究缺乏，并且受到地理因素的影响。一项多中心大规模随机临床试验可能会促成一个模型的开发，通过该模型可以在一系列脊柱手术中评估CS的效用，并可能促成制定指导方针，推动在脊柱手术中个性化使用CS的方法。
