{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,4,16]],"date-time":"2023-04-16T04:14:50Z","timestamp":1681618490309},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>Disseminated intravascular coagulation (DIC) is rarely encountered by spine surgeons outside of deformity or severe trauma cases. The authors report an extraordinarily unique case of refractory DIC after elective resection of multiple en plaque thoracic meningiomas in a patient with neurofibromatosis type 1. A 49-year-old man underwent T1\u20133 laminoplasty and expansile duraplasty for resection of multiple en plaque meningiomas for thoracic myelopathy. Intraoperatively, the patient was found to be in a state of DIC that did not resolve postoperatively despite massive transfusions of blood products. He required subsequent returns to the operating room due to recurrent epidural hematomas with resulting paraplegia. Ultimately, the wound was left open, and a wound vacuum-assisted closure (VAC) was placed to prevent further returns to the operating room. DIC persisted until the administration of recombinant factor VIIa. In this report, the authors review the mechanisms, subtypes, and approaches to treatment of DIC with a focus on the bleeding subtype. If this subtype is refractory to blood product administration (&gt; 24 hours), recombinant factor VIIa is a safe and effective option. A wound VAC can be safely utilized with exposed dura if deemed necessary by the surgeon; however, the volume and characteristics of the output should be closely monitored. The use of unconventional surgical solutions may provide options to mitigate the morbidity associated with refractory DIC in spine surgery.<\/jats:p>","DOI":"10.3171\/2019.7.spine19756","type":"journal-article","created":{"date-parts":[[2019,10,11]],"date-time":"2019-10-11T23:00:52Z","timestamp":1570834852000},"page":"139-143","source":"Crossref","is-referenced-by-count":0,"title":["Disseminated intravascular coagulation in spine surgery: illustrative case review and the paradigms of management"],"prefix":"10.3171","volume":"32","author":[{"given":"Samir","family":"Kashyap","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Riverside University Health System, Riverside; and"},{"name":"Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacey","family":"Podkovik","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Riverside University Health System, Riverside; and"},{"name":"Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vartan","family":"Tashjian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Blood","doi-asserted-by":"publisher","first-page":"2878","DOI":"10.1182\/blood-2008-06-165845","article-title":"D-dimer antigen: current concepts and future prospects","volume":"113","author":"Adam SS","year":"2009","unstructured":"Adam SS, Key NS, Greenberg CS: D-dimer antigen: current concepts and future prospects. 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