Background: Cell Saver technique using intra-operative autologenous transfusion known to conserve homologous blood resources.

Specific indications for use of cell saver in thoracolumbar spinal instrumented fusion not clearly determined.

No previously published literature from Britain to our knowledge.

Objectives: To identify the clinical factors associated with increased risk of intra-operative blood loss.

To analyse the safety and benefits of using cell saver technique.

To determine the cost-effectiveness of use of cell saver technique.

Method: A total of 51 consecutive spinal instrumented fusion cases during last 14 months reviewed.

There was no randomisation; use of cell saver was at surgeon’s discretion.

Cell saver group consisted of 25 patients and control group consisted of 26 cases.

Patients with degenerative scoliosis and tumours excluded.

Demographic data recorded. Clinical notes reviewed to include smoking status, BMI, pre-operative diagnosis, revision surgery, number of levels fused, use of iliac bone graft, pre and post operative haemoglobin, haematocrit and platelets, intra-operative blood loss, amount of blood salvaged, duration of surgery, nature and amount of allogenic blood transfused.

Results: Demographic data including age, weight, smoking and prior surgery were similar between the two groups.

Iliac crest bone graft harvested in 20% of cell saver group and 40% in control group.

Levels of fusion ranged from 1–7 [Mean=2.8] in the cell saver group and 1–4 [Mean=1.9] in the control group.

Study group averaged 4 hrs of surgery, 15 mins longer than control group.

Intra-op blood loss higher in cell saver group (mean=1245 mls vs 800 mls).

Revision surgery did not affect the intra-op blood loss or duration of surgery.

20% in cell saver group and 26% in control group required blood transfusion.

8 units of red cells was transfused cell saver group as against 17 units of red cells plus 2 units of platelets transfused in the control group.

Percentage drop in the post operative haematocrit was 19.1 in cell saver group compared to 36.3 in control group.

Conclusion: 44.38% blood salvaged (35–38% in spinal literature).

Use of cell saver significantly decreased the risk of post-operative need for blood transfusion.

In this study, number of levels of fusion, duration greater than 4 hrs and a low pre-op Hb/Hct were significant parameters in predicting intra-operative blood loss.

If blood loss is less than 700 mls, gains from cell saver is debatable.

In order to determine the effectiveness of part-time bracing in juvenile idiopathic scoliosis (JIS) a retrospective review of thirty-four patients treated with a Charleston bending brace for JIS was undertaken. The patients were analyzed in three groups including:

success;

progression;

progression requiring surgery.

Of twenty-three patients meeting the inclusion criteria, nine achieved success, seven progressed, and seven required surgery. Success correlated with best in brace correction radiograph but not with initial curve magnitude. Part-time bracing is as successful as full-time bracing in JIS and better than the natural history.

In order to determine the effectiveness of part-time bracing in JIS, a retrospective review of thirty-four patients treated with a Charleston bending brace for JIS was undertaken.

Twenty-three patients met the inclusion criteria which included: curves greater than twenty degrees at initiation of bracing, Risser zero, bracewear more than twelve months, completion of the bracing program and Risser greater than or equal to four at final follow-up. Patients were analyzed in three groups, including

success (progression less than five degrees or less);

progression more than five degrees (but not requiring surgery) and

progression requiring surgery.

There were seven boys and sixteen girls with thirty-seven curves analyzed. Age at referral averaged 8.3 years. Average curve at time of bracing was thiry degrees. Length of bracing averaged 4.2 years with follow-up averaging 6.2 years. Nine patients met the criteria for success with seven patients progressing and seven patients requiring surgery. Of all curves, nineteen (51%) were successfully managed in the brace. Magnitude of curvature at initiation of bracing was not related to ultimate success, whereas success did correlate with higher best in brace correction radiographs.

Part-time bracing offers potential psychosocial and compliance benefits considering the length of treatment necessary in patients with juvenile idiopathic scoliosis. Although previous bracing studies have included some JIS patients, no authors have dealt specifically with the part-time bracing for JIS.

Part-time bracing is as successful as full-time bracing in JIS and better than the natural history.