Is there an Increase in Intra-operative Bleeding during Emergency Hybrid Open-Door Laminoplasty for Posttraumatic Cervical Cord Patients?

Abstract

Study Design: Retrospective Cohort Study Objectives: There are no reports describing the potential increase in intra-operative blood loss with the use of hybrid open-door laminoplasty in post-traumatic cervical cord injuries. Summary of background data: Early surgical intervention for traumatic cervical cord injury has demonstrated outcome benefits but is not without complications. Methods: A retrospective review of patients who underwent opendoor hybrid laminoplasty by a single surgeon was performed. Patients were divided into 2 groupsGroup A: isolated traumatic spinal cord injury without vertebral fracture, Group B: non-traumatic spinal cord injury. Results: 30 consecutive patients, of whom 8 had isolated traumatic cervical injury, underwent hybrid open-door laminoplasty. A longer mean operative time (254 vs 199 minutes, p=0.005), hospital stay (44.1 vs 11.1 days, p=0.006) and ICU or high dependency unit stay (10.3 vs 1.5 days, p=0.004) was noted in the traumatic patients when compared to the non-traumatic patients. A greater amount of intraoperative blood loss was found in the traumatic patients (median 350 ml; range 110-750) and less in the non-traumatic patients (median 130 ml; range 50-400, p=0.032). Patients in both groups showed post-operative neurological recovery with a JOA score improvement of 1.9 ± 3.1 (p=0.14) in the traumatic group and 1.4 ± 1.7 (p=0.001) in the non-traumatic group. Conclusions: Emergency open-door hybrid laminoplasty can be performed in patients with traumatic spinal cord injury. While early surgical decompression for post-traumatic patients improves neurological outcomes, a higher intra-operative bleeding should be anticipated in post-traumatic patients. Citation: Liu G*, Lee BH, Tan JYW, Ng JH, Tan JH. Is there an Increase in Intra-operative Bleeding during Emergency Hybrid Open-Door Laminoplasty for Posttraumatic Cervical Cord Patients? J Orthopedics Rheumatol. 2021; 8(1): 5. J Orthopedics Rheumatol 8(1): 5 (2021) Page 02 ISSN: 2334-2846 is a modified muscle-sparing technique of the traditional open-door laminoplasty [13]. The hybrid open-door laminoplasty technique incorporates a C4-6 open-door laminoplasty with instrumentation to reduce laminar door closure, a C3 dome-like osteotomy, and an upper C7 partial laminectomy (Figure 1,2). This technique preserves the semispinalis cervicis muscle attachments at the C2 level and the trapezium muscle attachments at C7, to reduce the incidence of postoperative axial neck pain and cervical kyphosis [14-17]. Statistical analysis was performed using IBM Statistical Package for Social Science (SPSS) Version 24.0 (IBM Corp, 2016). Pearson’s chi-squared analysis and independent t-tests were used to compare the demographic variables and outcome variables between both groups. A p-value of < 0.05 was considered significant in our study.