Hidden blood loss in anterior cervical discectomy and fusion with zero-profile anchored spacer for the treatment of cervical radiculopathy.

Objectives: This study aims to evaluate the hidden blood loss (HBL) and its possible risk factors after anterior cervical discectomy and fusion (ACDF) with zero-profile anchored spacer (ZPAS) in patients with cervical radiculopathy.

Patients and methods: Between January 2017 and January 2024, a total of 92 patients (44 males, 48 females; mean age: 73.2±10.0 years; range, 44 to 85 years) who underwent ACDF with ZPAS were retrospectively analyzed. Data collection encompassed baseline demographics including age, sex, height, weight, body mass index (BMI), disease duration, symptomatic laterality, and comorbidities and perioperative parameters such as the American Society of Anesthesiologists (ASA) score, operative levels, surgical time, intraoperative blood loss, and postoperative drainage volume. The HBL was quantified using the Sehat formula. Subsequent multivariate linear regression modeling was employed to identify independent predictors of HBL.

Results: The mean surgical time was 152.6±27.6 min. The mean total blood loss (TBL) and HBL were 334.6±67.7 mL and 268.1±69.0 mL, respectively. Correlation analyses revealed significant associations between HBL and symptomatic laterality, hematocrit (Hct) loss, surgical levels, and surgical time (p<0.05). Multivariate linear regression further confirmed Hct loss, surgical levels, and surgical time as positive predictors of HBL (p<0.05).

Conclusion: Patients with cervical radiculopathy who underwent ACDF with ZPAS perioperatively had significant HBL. More Hct loss, more surgical levels, and longer surgical time were independent risk factors for increased HBL.