The Use of Fibrin Adhesive in the Surgical Treatment of Spinal Lesions

Abstract

Advances in anaesthesiology and intensive care therapy as well as improved instrumentation have been responsible for the rapid development of spinal surgery during the past 15 years. Pathological lesions of the spinal column often demand partial or complete resection of the vertebral body, which in turn requires its replacement. The extraordinary vascular supply of the vertebral body and of the spinal canal often results in profuse bleeding in the environs of structure as sensitive as the spinal cord. Electrocoagulation is of limited use, for fear of causing thermal injury. Profuse bleedings, as encountered during tumour resection, require preoperative embolisation. Embolisation considerably reduces the tendency to bleed in such instances. However, bleeding from the epidural venous plexus may be unavoidable, e.g. in spondylitis. In such instances, fibrin adhesive proved to be an excellent means of controlling diffuse bleeding. Fibrin adhesive has proved to be effective in controlling diffuse bleeding during cervical disc surgery, which occasionally necessitates preparation and identification of the vertebral artery. The results and spectrum of applications of fibrin adhesive are presented here.