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Original Article · Open access

Hidden blood loss in anterior cervical discectomy and fusion versus single-level anterior cervical corpectomy and fusion with adjacent discectomy for two-level cervical spondylotic myelopathy

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Yin-xiao Peng

Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, China

ORCID: 0009-0005-4175-7696

Bo Xiao

Department of Orthopaedics, Pidu District People’s Hospital of Chengdu, Sichuan, China

ORCID: 0009-0005-0443-314X

Rui Zhong

Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, China

ORCID: 0009-0006-4619-5685

Xiao-ping Xu

Department of Orthopaedics, The First Affiliated Hospital of Chengdu Medical College, Sichuan, China

ORCID: 0009-0005-3688-8990

Abstract

Objectives: This study aims to evaluate hidden blood loss (HBL) in patients undergoing anterior cervical surgery for two-level cervical spondylotic myelopathy (CSM) and to compare the HBL between anterior cervical discectomy and fusion (ACDF) and single-level anterior cervical corpectomy and fusion (ACCF) with adjacent discectomy.

Patients and methods: Between January 2019 and December 2023, a total of 100 patients (55 males, 45 females; mean age: 49.4±11.4 years; range, 43 to 84 years) who underwent anterior cervical surgeries were retrospectively analyzed. Data collection encompassed demographic information, laboratory findings, and clinical records. Patients treated with ACDF were classified as Group A, while those receiving ACCF were assigned to Group B. Total blood loss (TBL) was calculated using the Gross formula, and HBL was determined based on TBL, postoperative drainage volume, and intraoperative blood loss.

Results: The most frequently affected segments were C3/4 and C4/5. The mean operative time was 135.5±13.4 min in Group A versus 139.5±12.8 min in Group B, indicating no statistically significant difference (p=0.130). The mean intraoperative blood loss and HBL were 42.5±9.2 mL and 231.5±55.0 mL in Group A, respectively, compared to 53.4±9.02 mL and 262.8±53.3 mL in Group B. Both parameters showed statistically significant intergroup differences (intraoperative blood loss: p<0.001; HBL: p=0.005). Hemoglobin (Hb) loss was significantly lower in Group A than in Group B, demonstrating a statistically significant difference (p<0.001).

Conclusion: In the perioperative period of anterior cervical surgery for two-level CSM (primarily C3/4-C4/5), HBL represents a clinically significant factor which should not be overlooked. Compared to ACDF, greater attention should be paid to postoperative anemia and HBL in patients undergoing ACCF.

Declarations

Author Contributions

Wrote the draft of the manuscript, were major contributors in design and revising: Y.X.P., B.X.; Critically reviewed and revised the manuscript for important intellectual content: X.P.X.; Were involved in collecting data and design of the study; Y.X.P., R.Z.; Approved the final manuscript and agree to be accountable for all aspects of the work: X.P.X.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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