Introduction:
Fibrin glue is commonly utilized across various medical specialties for purposes such as achieving hemostasis, preventing cerebrospinal fluid (CSF) leakage, and facilitating tissue repair. However, its application in adult spinal deformity (ASD) surgery has not been widely documented. Recently, a completely autologous fibrin glue (CAFG), derived from the patient's own plasma, has found utility in various medical fields. Since October 2022, we have been using CryoSeal® (Asahi Kasei Medical Co. Ltd., Tokyo, Japan), a CAFG, in ASD surgery with the dual objectives of enhancing bone fusion and reducing intraoperative bleeding. This study aims to assess the safety and effectiveness of CAFG in the context of ASD surgery.
Methods:
The study encompassed twenty-six consecutive patients who underwent corrective fusion surgery, extending from the thoracic spine to the pelvis, following preoperative autologous blood donation for ASD treatment. Thirteen patients were assigned to the CAFG group (mean age 75±5.4 years, male/female 4/9), while another thirteen patients constituted the control group (mean age 72±5.5 years, male/female 7/6). The surgical procedure for all patients occurred in two stages: firstly, anterior fusion (XLIF or OLIF) involving 3-4 vertebrae, followed by posterior fusion from the thoracic spine to the pelvis, one week later. The CAFG was applied by spraying it over the posterior bone graft at the culmination of the second surgery. The study variables included mass index (BMI), number of fixed vertebrae, operative time, autologous blood volume, intraoperative blood loss, postoperative blood loss in drainage, estimated perioperative blood loss, complications, and instances of reoperation.
Results:
The mean autologous blood volume was 656±220 mL in the CAFG group and 684±190 mL in the control group. There was no significant difference between the two groups, and the average volume of CAFG applied in the CAFG group was 7.9±2.1 mL. Postoperative complications included 2 cases of proximal junctional kyphosis (PJK) and 1 case of deep vein thrombosis (DVT) in the CAFG group, with 1 case of PJK in the control group. Notably, no postoperative surgical site infections (SSI) were observed in either group. The estimated perioperative blood loss was 1833±448 mL in the CAFG group and 1618±482 mL in the control group (P=0.26).
Discussion:
In contrast to commercially available fibrin glue, CAFG is produced entirely from a patient's autologous plasma, affording the advantage of mitigating the risk of hepatitis virus and HIV infections. Furthermore, it has been reported that CAFG exhibits higher adhesive strength when compared to commercially available fibrin glue. Due to these characteristics, CAFG is expected to be a promising adjunct to promote bone fusion in ASD surgery.