case of an emergency.
But blood loss isn't only a concern with
anterior lumbar spinal fusions — bleeding
is a common problem in most spinal proce-
dures. While bleeding isn't a complication in
and of itself, make sure it isn't excessive or
impacting the surgeon's visualization during
the procedure. Ensure that patients under-
going outpatient spinal surgery don't have a
history of blood clotting or coagulation dis-
orders. During the operation, check the
patient's blood pressure frequently to
ensure it's within a safe range.
You can do several things during the case to
minimize blood loss. To help with initial
bleeding, I often use a local anesthetic injec-
tion in the soft tissue, combined with epi-
nephrine, which also helps to prolong analge-
sia. Additionally, during the procedure sur-
geons can use topical hemostatic agents —
human thrombin-based formulas are most
often used — for epidural bleeding. Newer
agents feature specialized applicators to make
their use easier in minimally invasive spine
cases.
3. Have a plan for dural tears
While blood loss is the primary concern dur-
ing spinal surgery, dural tears are a close sec-
ond, especially in more complex cases. This
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