"Bloodless" Spine Surgery

Winthrop-University Hospital neurosurgeon, Nancy E. Epstein, MD, is one of the few in the region employing "bloodless" surgery techniques when performing lumbar spine surgery on patients who meet strict criteria.

Steadily gaining popularity, "bloodless" surgery is a combination of techniques designed to minimize blood loss and the need for blood transfusions during and after surgery.

Dr. Epstein has successfully used the technique at Winthrop with more than 75 patients. One of them, Bonnie Hendricks, reported that she "felt strong and well going into the operating room." She added: "In the past, when I donated blood before the surgery, I felt fatigued." Another satisfied patient, Patricia Grimm, said, "I was in agonizing pain and immobilized before my surgery. If I had to donate blood, the operation would have been delayed."

Working closely with Winthrop anesthesiologists, Dr. Epstein utilizes normovolemic hemodilution, a strategy involving the drawing of one or more units of the patient's blood just prior to the first surgical incision and immediately replacing it with three-to-four times the volume (normovolemic) of sterile intravenous fluid. This helps maintain optimal blood pressure during the surgery and simultaneously dilutes the blood (hemodilution) so that when the patient bleeds during the operation, fewer red blood cells are lost.

Remaining in continuity with the patient's body through an intravenous line, the removed, concentrated blood is stored at the patient's side, and is returned to the body at the end of the surgery or sooner, if necessary.

Recommended for use by the National Heart, Lung and Blood Institutes, "bloodless" surgery is an approach whose time has come. "In about 80 percent of cases, these patients don't need blood transfusions," said Dr. Epstein. "And they receive the blood that's best for them - their own. Most importantly, they can avoid preoperative anemia, which can occur when a patient donates blood prior to surgery."

For more information, call (516) 354-3401.