Coagulopathies associated with major spinal surgery.

Coagulation disorders occurring during major spinal surgery may be more common than previously thought. Patients who develop clinical disseminated intravascular coagulation (DIC) during spinal surgery represent one extreme of this process. The etiology of the coagulopathy seems to be unrelated to age, gender, or etiology of the spinal deformity, e.g., idiopathic, congenital, neuromuscular, or degenerative. Acute bleeding diathesis may occur during or shortly after surgery and may be difficult to control. The consumptive coagulopathy is not a self-limiting process. Preoperative, intraoperative, and postoperative monitoring of coagulation studies in patients with prolonged spinal procedures may help to identify those patients at risk for fulminant DIC and allow for prompt therapeutic intervention. In the presence of active hemorrhage or in those patients who cannot tolerate large volume transfusion, cryoprecipitate is the replacement product of choice for fibrinogen replacement.