Peri-operative Management and the Role of Minimally Invasive Spine Surgery in a Case of Hemophilia B

• Published in: Journal of minimally invasive spine surgery and technique Vol. 7; no. 1; pp. 189 - 192
• Main Authors: Goparaju, VNR Praveen, Chugh, Amit, Rangnekar, Ameya, Kundnani, Vishal
• Format: Journal Article
• Language: English
• Published: Korean Minimally Invasive Spine Surgery Society 01.04.2022
• Subjects: factor ix; hemophilia b; minimally invasive surgery, spinal fusion; spine; surgical blood loss
• ISSN: 2508-2043; 2508-2043
• DOI: 10.21182/jmisst.2021.00269

Hemophilia A and B are rare X-chromosome-linked recessive bleeding disorders caused by mutations in the genes causing abnormalities of blood clotting factors VIII and IX, respectively. Surgery in these patients will require additional planning and interaction among the surgeon, anesthetist, and a hematologist because they inevitably result in bleeding, excessive blood loss, and other life-threatening complications. The authors present a case 62-year-old male with haemophilia B and progressive neurological claudication. On plain radiographs and MRI the patient had grade 1 spondylolisthesis with lumbar canal stenosis at L4-L5 with a VAS score of 8 and ODI score of 45 and was operated with MIS-TLIF with 22 mm diameter tubular retractor (METRx, Medtronics) and an operating microscope. Pre-operatively, the hematologist opinion was taken and the patient was optimised by maintaining the plasma factor peak level activity according to the WFH guidelines. The patient had uneventful peri-operative period. The total hospital stay is 16 days and a VAS score of 3 and ODI score of 12 after one-year follow-up and without any notable complications. Minimally invasive surgical techniques are a better option in hemophilia patients as these techniques provide the surgeon with an excellent magnification of the operative field, which enables the use of a smaller incision, better hemostasis, and facilitates less traumatic procedures.