The use of harmonic scalpel in spinal surgery with contraindication to the use of monopolar electrocautery: a case report in a 14-year-old girl with a primary generalized dystonia and a 100° thoracic scoliosis

Abstract

Many techniques are reported to decrease blood loss in children and adolescents undergoing extensive spinal surgeries. The reduction of blood loss and subsequent reduction of allogenic blood transfusion is a desired outcome in such surgical programs. In patients with severe neuromuscular scoliosis, this becomes a greater concern due to a variety of factors such as the need for extensive surgical exposure and the longer intraoperative time [18]. A lot of pharmacological, anesthetic, and surgical techniques including preoperative autologous blood donation [1], human recombinant erythropoietin [17, 27], intraoperative blood salvage techniques, and topical and systemic hemostatic agents [8, 20] are employed to reduce intraoperative and postoperative bleeding. The extensive use of monopolar electrocautery has been proposed as a safe and rapid technique to perform posterior exposure of the spine [18]. No significant differences with operative times, intraoperative blood loss, and postoperative hemoglobin levels have been demonstrated in orthopedic patients using bipolar sealer devices for intraoperative haemostasis [3, 11, 13]. In some patients with implanted pacemaker of brain stimulator, electrocautery has a potential risk of serious implanted hardware dysfunction [2, 6, 19, 24, 25]. In these patients, the use of harmonic scalpel, using high-frequency mechanical vibrations to cut and coagulate at the same time, could be an alternative technique to the use of monopolar electrocautery [14, 16]. We report the case of a 14-year-old girl previously treated for a severe acquired dystonia by pallidal bilateral stimulation. The presence of brain stimulators contraindicated the use of monopolar electrocautery for a requested extensive scoliosis surgery. In this case, the successful use of harmonic scalpel is reported and discussed.