# Estimated Blood Loss in Surgery for Thoracolumbar Fracture With Diffuse Idiopathic Skeletal Hyperostosis Using Percutaneous Pedicle Screws Compared to Surgery for Femoral Trochanteric Fractures

## TL;DR

The study compares blood loss in spinal surgery for thoracolumbar fractures with DISH using percutaneous screws to hip surgery for femoral fractures in elderly patients.

## Contribution

The study provides a novel comparison of estimated blood loss in two different surgical procedures involving elderly patients.

## Key findings

- Estimated blood loss was comparable between thoracolumbar and femoral surgeries.
- Hidden blood loss was significantly less in thoracolumbar surgeries using percutaneous screws.
- In thoracolumbar surgeries, hidden blood loss accounted for 71% of total estimated blood loss on day one.

## Abstract

Introduction: Long posterior spinal stabilization is often needed for thoracolumbar fractures with diffuse idiopathic skeletal hyperostosis (DISH). Recently, surgery using percutaneous pedicle screws (PPS) has become more frequent. However, hidden blood loss (HBL) cannot be ignored in surgeries using PPS. The aim of this study was to measure estimated blood loss (EBL) including HBL in surgeries using PPS for thoracolumbar fractures with DISH, by comparing with EBL including HBL in surgeries for femoral trochanteric fractures, a common trauma among elderly people.

Materials and methods: Twenty-two patients who underwent surgery using PPS for thoracolumbar fracture with DISH were included (group D). Sixty-six patients with trochanteric fractures of the femur were matched to group D for age, sex, anticoagulant use, height, and weight and used as controls (group F). We evaluated intraoperative blood loss (IBL), EBL on the first and seventh postoperative days, and HBL on the first postoperative day. EBL was calculated based on hemoglobin values. IBL was collected from surgical records. HBL was calculated as the difference between EBL on the first postoperative day and IBL. Each variable was compared between groups.

Results: EBL was not significantly different between the two groups on either postoperative day one or day seven. IBL was significantly greater in group D than in group F. HBL was significantly less in group D than in group F. In group D, HBL accounted for 71 (%) of EBL on day one, whereas in group F, it accounted for 92 (%).

Discussion: Despite that surgery using PPS for thoracolumbar fractures with DISH requires fusions covering several vertebral levels, EBL was the same as in surgery for trochanteric fractures of the femur, and therefore, acceptable for elderly patients.

Conclusions: EBL in surgery for thoracolumbar fracture with DISH using PPS is comparable to that for trochanteric fractures of the femur.