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Wolff S, Moreau PE, Miladi L, Riouallon G. Is Minimally Invasive Bipolar Technique a Better Alternative to Long Fusion for Adult Neuromuscular Scoliosis? Global Spine J 2024; 14:1909-1919. [PMID: 36809191 PMCID: PMC11418735 DOI: 10.1177/21925682231159347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones. METHODS Adult cerebral palsy patients requiring spinal correction surgery were included prospectively between 2015 and 2019. The technique involved the use of a double-rod construct anchored proximally by four clawed hooks and distally by iliosacral screws, in a minimally invasive approach. Cobb angle and pelvic obliquity were measured before and after initial surgery and at final follow-up. Complications and functional results were reviewed. This group (P) was compared with a second group (R) of patients who underwent surgery between 2005 and 2015, for whom data were collected retrospectively. RESULTS Thirty-one patients were included in group P, and 15 in group R. The two groups were comparable for demographic data and deformity. At most recent follow-up (3 years for group P [2-6] and 5 years for group R [2-16]), neither correction nor surgical complications differed between the two groups. However, group P had 50% less blood loss and a lower medical complication rate than group R. CONCLUSIONS Our results confirm the effectiveness of this minimally invasive technique for neuromuscular scoliosis in adults. The results were similar to those obtained with the usual techniques, but with fewer medical complications. Confirmation of these results is now required for a longer follow-up period.
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Affiliation(s)
- Stéphane Wolff
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Lotfi Miladi
- Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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2
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Morales Ciancio RA, Lucas J, Tucker S, Ember T, Harris M, Broomfield E. Can postoperative Cobb and pelvic obliquity corrections be predicted using supine traction X-rays in non-ambulatory patients with cerebral palsy fused to L5? A case series study. Spine Deform 2024; 12:1403-1410. [PMID: 38683285 DOI: 10.1007/s43390-024-00880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE This study aimed to determine whether Cobb and pelvic obliquity corrections can be predicted using supine traction radiographs in patients with cerebral palsy (CP) who underwent posterior spinal fusion (PSF) from T2/3 to L5. METHODS From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent PSF using pedicle screws in two quaternary centers with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed. RESULTS A total of 106 patients aged 15.6 ± 0.4 years were included. All patients had significant correction of the Cobb angle (MC), pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL) without loss of correction at the last FU (LFU). Curve flexibility was significantly correlated with Cobb correction (δMC) immediately postoperatively (p < 0.0001, r = 0.8950), followed by the amount of correction in pelvic obliquity under traction (δPOT) (p = 0.0252, r = 0.2174). For correction in PO (δPO), the most significant variable was δPOT (p < 0.0001, r = 0.7553), followed by curve flexibility (p = 0.0059, r = 0.26) and the amount of correction in Cobb under traction (p = 0.0252, r = 0.2174). CONCLUSIONS Cobb and PO corrections can be predicted using supine traction films for non-ambulatory CP patients treated with PSF from T2/3 to L5. The variables evaluated were interconnected, reinforcing preoperative planning for these patients. Comparative large-scale studies on patient-related clinical outcomes are required to determine whether this predicted correction is associated with improved surgical outcomes and reduced complication rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Jonathan Lucas
- Paediatric Spine Department, Evelina London Children Hospital, London, UK
| | - Stewart Tucker
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Thomas Ember
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Mark Harris
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Edel Broomfield
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
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Elmeshneb MA, Hassanin MA, Elnady B, Sleem A, Le GT, Patel MS, Quraishi NA. Surgical complications in neuromuscular scoliosis surgery: systematic review and meta-analysis of the last ten years. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2666-2676. [PMID: 38869648 DOI: 10.1007/s00586-024-08338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/01/2024] [Accepted: 05/26/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Surgical correction of neuromuscular scoliosis is often a challenging and extensive procedure. Due to this complexity and the high disease burden that these patients carry, per and post-operative complications are not uncommon. The purpose of this study was to systematically review and describe the pooled rates of postoperative complications and analyze risk factors for complications in neuromuscular scoliosis surgery described in the literature in the last ten years. METHODS A systematic review of the English literature across multiple databases was conducted using search criteria (neuromuscular scoliosis AND complications) and using PRISMA guidelines (Jan 2012-July 2022). Studies with less than 30 patients and follow-up of < 2 years were excluded. Data extraction and meta-analysis were performed using random mode effect. Statistical analysis was conducted using OpenMeta software. Meta-regression analysis was used to detect risk factors (surgical approach, intraoperative time, intraoperative blood loss, preoperative Cobb angle and patient diagnosis) associated with each complication group. Confidence interval (CI) was set at 95%. RESULTS Twenty-two studies met the inclusion criteria involving 2155 patients. The level of evidence among studies were III (9) and IV (13). The most common primary diagnosis was cerebral palsy (43%) followed by Duchenne muscle dystrophy (20%), myelomeningocele (7.4%), spinal muscle atrophy (7.1%), Rett syndrome (< 2%) and combined other pathologies (20.2%). The pooled incidence rate of wound complications was the highest, amongst all complications, at 13.3% (CI 10.838 to 16.861); closely followed by respiratory complications (11.8%;CI 5.7 to 19.7). Implant failure occurred in 7.1% cases (CI 6.418 to 11.465), gastrointestinal complications was 5.2%; CI 2.4 to 8), pseudarthrosis in (4.6%;CI 2.2 to 6.9) and neurological deficit in 2.9% (CI 1.989 to 6.086). The pooled rate of revision surgery was (9.6%; CI 6.2 to 12.9). Heterogeneity was assessed using I2 test which results were moderately heterogeneous. Meta-regression analysis revealed that the diagnosis of myelomeningocele or Duchenne muscle dystrophy or spinal muscle atrophy were strongly associated with wound and respiratory complications (p = 0.007 and p = 0.005, respectively). CONCLUSION Wound-related (13.3%) and respiratory complications (11.8%) remain the most common complications among studies after corrective surgery for neuromuscular scoliosis. Both are significantly associated with Duchenne muscle dystrophy, spinal muscle atrophy and myelomeningocele.
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Affiliation(s)
- Mostafa Ali Elmeshneb
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, England
- Department of Orthopaedic Surgery, Sohag University, Sohag, Egypt
| | - Mohamed A Hassanin
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, England.
- Department of Orthopaedic and Trauma Surgery, Assiut University, Assiut, Egypt.
| | - Belal Elnady
- Department of Orthopaedic and Trauma Surgery, Assiut University, Assiut, Egypt
| | - Ahmed Sleem
- Department of Orthopaedic Surgery, Sohag University, Sohag, Egypt
| | - Giang Truong Le
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, England
| | - Mohammed Shakil Patel
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, England
| | - N A Quraishi
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, England
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Current trends in surgical magnitude of neuromuscular scoliosis curves: a study of 489 operative patients with non-ambulatory cerebral palsy. Spine Deform 2023; 11:399-405. [PMID: 36272062 DOI: 10.1007/s43390-022-00604-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/09/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE A curve magnitude at which posterior spinal fusion (PSF) is indicated for children with cerebral palsy (CP) scoliosis is not defined. We sought to evaluate whether agreement exists for a curve magnitude at which PSF is undertaken for CP scoliosis and to evaluate outcomes by quartile of curve magnitude and flexibility at time of fusion. METHODS A prospective multicenter pediatric spine database was queried for patients with a Gross Motor Function Classification Scale (GMFCS) IV or V who underwent PSF for CP scoliosis. Demographics, surgical indications, and correlations between curve magnitude, postoperative radiographic outcomes, and Caregiver's Priorities and Child Health Index of Life and Disabilities (CPCHILD) scores were evaluated for patients with at least 2 years of follow-up. RESULTS 489 patients from 15 sites were analyzed. Median major Cobb angle at time of PSF was 87° and significantly varied by site (p < 0.001). Median Cobb angle on flexibility studies was 55° and median percent correction on flexibility studies was 36.3%. Severity of the curve at surgery correlated significantly with lower overall quality of life and CPCHILD score (p < 0.05). Larger residual curves correlated with larger operative curves (p < 0.001) and decreased flexibility on preoperative flexibility studies (p < 0.001), although postoperative CPCHILD scores did not differ by curve size or flexibility at time of fusion or by size of residual curve (p > 0.05). CONCLUSION The median curve magnitude is large and there is substantial variability in curve size of CP scoliosis at time of fusion, although clinical outcomes are not negatively influenced by larger operative magnitudes. Further study should aim to narrow surgical indications by defining unacceptable radiographic outcomes. LEVEL OF EVIDENCE Level III.
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Sarwahi V, Atlas A, Galina J, Hasan S, Dimauro JP, Katyal C, Djukic A, Thornhill B, Lo Y, Amaral TD, Moguilevich M. Ambulatory Neuromuscular Scoliosis Patients Have Superior Perioperative Results Than Nonambulatory Neuromuscular Scoliosis Patients and Can Approach Adolescent Idiopathic Scoliosis Outcomes After Posterior Spinal Fusion. Spine (Phila Pa 1976) 2022; 47:E159-E168. [PMID: 34366412 DOI: 10.1097/brs.0000000000004191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE This study aims to identify differences in perioperative outcomes between ambulatory patients with neuromuscular scoliosis (ANMS) and adolescent idiopathic scoliosis (AIS) following spinal fusion. SUMMARY OF BACKGROUND DATA NMS patients have severe curves with more comorbidities and procedural complexity. These patients require extensive fusion levels, increased blood loss, and suffer increased periop complications. However, NMS patients have a variable severity spectrum, including ambulation status. METHODS Chart and radiographic review of NMS and AIS patients undergoing PSF from 2005 to 2018. NNMS included NMS patients who were completely dependent (GMFCS IV-V). ANMS consisted of community ambulators without significant reliance on wheeled assistive devices (GMFCS I-III). Subanalysis matched by age, sex, levels fused and preoperative Cobb angle was conducted as well. Wilcoxon Rank-Sum, Kruskal-Wallis, χ2, and Fisher exact tests were performed. RESULTS There were 120 patients in the NNMS group, 54 in ANMS and 158 in the AIS group. EBL was significantly lower for ANMS and AIS patients (P < 0.001). Complications within 30 days were similar between ANMS and AIS (P = 1.0), but significantly higher for NNMS (P < 0.001). Two (1.3%) AIS patients, (1.7%) nonambulatory NMS patients, and one (1.9%) ANMS patient required revision surgery (P = 1.0). However, all NMS patients had increased fusion levels, fixation points, and surgery time (P < 0.05). NNMS had significantly longer ICU (P < 0.001), hospital stay (P < 0.001), intraoperative transfusions (P < 0.001), and fewer patients extubated in the OR (P < 0.001) than ANMS and AIS patients. In the subanalysis, ANMS had similar radiographic measurements, EBL, transfusion, surgery time, extubation rate, and complication rate (P > 0.05) to AIS. CONCLUSION Our data show radiographic outcomes, infections, revisions, and overall complications for ANMS were similar to the AIS population. This suggests that NMS patients who ambulate primarily without assistance can expect surgical outcomes comparable to AIS patients with further room for improvement in length of ICU and hospital stay.Level of Evidence: 4.
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Affiliation(s)
- Vishal Sarwahi
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY
| | - Aaron Atlas
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY
| | - Jesse Galina
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY
| | - Sayyida Hasan
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY
| | - Jon-Paul Dimauro
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY
| | - Chhavi Katyal
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
| | - Aleksandra Djukic
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
| | - Beverly Thornhill
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
| | - Yungtai Lo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Terry D Amaral
- Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY
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Kim HS, Kwon JW, Park KB. Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era. Neurospine 2022; 19:177-187. [PMID: 35130428 PMCID: PMC8987549 DOI: 10.14245/ns.2143246.623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/29/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hak Sun Kim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Kwon
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Corresponding Author Kun-Bo Park https://orcid.org/0000-0002-8839-4870 Division of Pediatric Orthopedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea ,
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An intraoperative laterally placed distractor for gradual load sharing correction of severe spastic neuromuscular spinal deformity. Spine Deform 2021; 9:1137-1144. [PMID: 33689155 DOI: 10.1007/s43390-021-00316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To analyze the overall deformity correction for severe neuromuscular scoliosis using laterally placed intra-operative distraction and compare to those receiving standard surgical technique. METHODS This was a retrospective, IRB-approved, cohort study of patients with GMFCS 4 or 5 spastic cerebral palsy with neuromuscular scoliosis, age greater than 10 years, who underwent posterior spinal fusion from 2007 to 2019. All patients had vectored cervical traction with Gardner-Wells tongs, with hips flexed in a relative sitting position. The study cohort underwent intraoperative, laterally placed correction using a distractor placed between two upper ribs and the ipsilateral greater trochanter while the control cohort did not. The 24 study patients were compared to 22 control patients. RESULTS Preoperative comparisons identified significant differences in Cobb angle, preoperative flexibility, and pelvic obliquity with the study group having larger, stiffer deformities with greater obliquity. There were no differences in pre-operative sagittal plane deformity. Mean post-operative upright Cobb angle correction was 67.3° ± 14.8° in the study and 55.3° ± 9.9° in the control group, representing a 66% and 60% correction, respectively. No neurological or other complications were noted from the use of this technique. CONCLUSION The use of a laterally placed distraction device from upper ribs to ipsilateral greater trochanter allowed gradual lateral un-bending of large stiff neuromuscular spine deformities with greater correction than that of standard technique. In this small series, the technique allowed load-sharing during correction, with hips remaining in a functional sitting position, and without neurological complications. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Lin JL, Tawfik DS, Gupta R, Imrie M, Bendavid E, Owens DK. Health and Economic Outcomes of Posterior Spinal Fusion for Children With Neuromuscular Scoliosis. Hosp Pediatr 2021; 10:257-265. [PMID: 32079619 DOI: 10.1542/hpeds.2019-0153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Neuromuscular scoliosis (NMS) can result in severe disability. Nonoperative management minimally slows scoliosis progression, but operative management with posterior spinal fusion (PSF) carries high risks of morbidity and mortality. In this study, we compare health and economic outcomes of PSF to nonoperative management for children with NMS to identify opportunities to improve care. METHODS We performed a cost-effectiveness analysis. Our decision analytic model included patients aged 5 to 20 years with NMS and a Cobb angle ≥50°, with a base case of 15-year-old patients. We estimated costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness from published literature and conducted sensitivity analyses on all model inputs. RESULTS We estimated that PSF resulted in modestly decreased discounted life expectancy (10.8 years) but longer quality-adjusted life expectancy (4.84 QALYs) than nonoperative management (11.2 years; 3.21 QALYs). PSF costs $75 400 per patient. Under base-case assumptions, PSF costs $50 100 per QALY gained. Our findings were sensitive to quality of life (QoL) and life expectancy, with PSF favored if it significantly increased QoL. CONCLUSIONS In patients with NMS, whether PSF is cost-effective depends strongly on the degree to which QoL improved, with larger improvements when NMS is the primary cause of debility, but limited data on QoL and life expectancy preclude a definitive assessment. Improved patient-centered outcome assessments are essential to understanding the effectiveness of NMS treatment alternatives. Because the degree to which PSF influences QoL substantially impacts health outcomes and varies by patient, clinicians should consider shared decision-making during PSF-related consultations.
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Affiliation(s)
- Jody L Lin
- Divisions of Pediatric Hospital Medicine and .,Clinical Excellence Research Center, Stanford University, Stanford, California.,Division of Inpatient Medicine, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah; and
| | | | - Ribhav Gupta
- Division of Biomechanical Engineering, School of Engineering.,Divisions of Infectious Diseases and Geographic Medicine, and
| | | | - Eran Bendavid
- Primary Care and Population Health, Departments of Medicine and
| | - Douglas K Owens
- VA Palo Alto Health Care System, Palo Alto, California.,Stanford Health Policy, Freeman Spogli Institute for International Studies, School of Medicine, and
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Fletcher ND, Bellaire LL, Dilbone ES, Ward LA, Bruce RW. Variability in length of stay following neuromuscular spinal fusion. Spine Deform 2020; 8:725-732. [PMID: 32060807 DOI: 10.1007/s43390-020-00081-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with neuromuscular scoliosis (NMS) who undergo posterior spinal fusion (PSF) often have long, protracted hospital stays because of numerous comorbidities. Coordinated perioperative pathways can reduce length of hospitalization (LOH) without increasing complications; however, a subset of patients may not be suited to rapid mobilization and early discharge. METHODS 197 patients with NMS underwent PSF at a single hospital by two surgeons with a post-operative care pathway emphasizing early mobilization, rapid transition to enteral feeds, and discharge prior to first bowel movement. Average LOH was 4.9 days for all patients. Patients were divided into quartiles (< 3 days, 3-5 days, 5-7 days, > 7 days) based on their LOH, and their charts were retrospectively reviewed for preoperative, intraoperative, and postoperative factors associated with their LOH. RESULTS Age at surgery, gender, the need for tube feeds, and specific underlying neuromuscular disorder were not significant predictors of LOH; however, severely involved cerebral palsy (CP) patients (GMFCS 4/5) were more likely to have extended stays than GMFCS 1-3 patients (p = 0.02). Radiographic predictors of LOH included major coronal Cobb angle (p = 0.002) and pelvic obliquity (p = 0.02). Intraoperative predictors included longer surgical times, greater numbers of levels fused and need for intraoperative or postoperative blood transfusion (p < 0.05). The need for ICU admission and development of a pulmonary complication were significantly more likely to fall into the extended LOH group (p < 0.05). CONCLUSIONS Several variables have been identified as significant predictors of LOH after PSF for NMS in the setting of a standardized discharge pathway. Patients with smaller curves and less complex surgeries were more amenable to accelerated discharge. Conversely, patients with severe CP with large curves and pelvic obliquity requiring longer surgeries with more blood loss may not be ideal candidates. These data can be used to inform providers' and families' post-operative expectations. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
| | - Laura L Bellaire
- American Family Children's Hospital, 1675 Highland Ave., Madison, WI, 53792, USA
| | - Eric S Dilbone
- Department of Orthopaedics, Vanderbilt University, Nashville, TN, USA
| | - Laura A Ward
- Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Robert W Bruce
- Children's Healthcare of Atlanta, 1400 Tullie Rd, Atlanta, GA, 30329, USA
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Caregiver Perceptions and Health-Related Quality-of-Life Changes in Cerebral Palsy Patients After Spinal Arthrodesis. Spine (Phila Pa 1976) 2018; 43:1052-1056. [PMID: 29215495 DOI: 10.1097/brs.0000000000002508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective analysis of a prospective registry. OBJECTIVE Our objective was to prospectively assess caregivers' perceptions regarding changes in the health-related quality of life (HRQL) of patients with cerebral palsy (CP) after spinal arthrodesis. We assessed caregiver perceptions from three perspectives: 1) qualitative assessment of changes in global quality of life, comfort, and health; 2) relative valuation of spine surgery versus other common interventions in CP patients; and 3) quantitative changes in HRQL scores. SUMMARY OF BACKGROUND DATA Studies of children with CP who undergo surgical treatment of spinal deformity have focused largely on radiographic changes. METHODS We queried a multicenter prospective registry of CP patients with level IV or V motor function according to the Gross Motor Function Classification System who were treated with spinal arthrodesis, and whose caregivers completed preoperative and 2-year postoperative qualitative and quantitative HRQL surveys. A total of 212 caregivers and their patients were included in the study. RESULTS At 2-year follow-up, most caregivers reported that patients' global quality of life, comfort, and health were "a lot better" after spinal arthrodesis. Spinal arthrodesis was ranked as the most beneficial intervention in the patients' lives by 74% of caregivers, ahead of hip, knee, and foot surgeries and baclofen pump insertion. Gastrostomy tube insertion was the only intervention ranked superior to spinal arthrodesis in terms of impact. Quantitative HRQL scores improved significantly during 2-year follow-up across various domains. CONCLUSION In qualitative and quantitative HRQL assessments, caregivers reported overall improvement in patients' lives after spinal arthrodesis. Caregivers ranked spine surgery as the most beneficial intervention in the patients' lives, secondary only to gastrostomy tube insertion. LEVEL OF EVIDENCE 2.
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Abstract
Background and purpose - Surveillance of scoliosis in individuals with cerebral palsy (CP) is important for ensuring timely diagnosis and identification of curve progression. We analyzed the incidence of scoliosis in relation to age, sex, and gross motor function in a population-based cohort of individuals with CP. Patients and methods - This was a prospective register study of all 1,025 individuals born 1990-2012 in southern Sweden (1.4 million inhabitants) in the Swedish surveillance program for CP, which included >95% of the total population of people with CP in the area. Annual clinical examinations and radiographic measurement of the Cobb angle of those with a moderate or severe scoliosis were registered. We determined the incidence of scoliosis related to age, sex, and the Gross Motor Function Classification System (GMFCS) level. Results - The inclusion criteria were fulfilled by 962 individuals. The number of people (140/962) with scoliosis increased up to 20-25 years of age. The incidence of scoliosis was related to age and GMFCS level. In individuals at the lowest level of gross motor function (GMFCS V) scoliosis was seen in 10/131 before 5 years of age and at the age of 20 years 75% of these individuals had a Cobb angle ≥40°. No one in the highest level of motor function (GMFCS I) developed a Cobb angle ≥40° Interpretation - Surveillance programs for scoliosis in CP should be based on age and GMFCS level and should be initiated at a young age and continued into adulthood.
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Affiliation(s)
- Gunnar Hägglund
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Department of Orthopaedics, Skane University Hospital, Lund; ,Correspondence:
| | - Katina Pettersson
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås;
| | - Tomasz Czuba
- National Competence Center for Quality Registers, University Hospital, Lund, Sweden
| | - Måns Persson-Bunke
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Department of Orthopaedics, Skane University Hospital, Lund;
| | - Elisabet Rodby-Bousquet
- Lund University, Department of Clinical Sciences, Lund, Orthopedics; ,Centre for Clinical Research, Uppsala University, Region Västmanland, Västerås;
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Comparison of combined anterior-posterior approach versus posterior-only approach in neuromuscular scoliosis: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2213-2222. [PMID: 30039256 DOI: 10.1007/s00586-018-5702-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Neuromuscular scoliosis (NS) is a complicated spinal disorder, and it could be treated through posterior-only approach (POA) or combined anterior-posterior approach (APA), which one is better and how to choose the surgical tactic is still in controversy. So comparing POA with APA parameters in the treatment of NS is meaningful. METHODS Database of PubMed, Embase and Cochrane Library was systematically searched, and the studies, which focus on the comparisons of POA and APA in the treatment of NS, were included. The meta-analysis was performed by RevMan 5.3. RESULTS Seven retrospective studies with 602 patients were included in meta-analysis. In previous analysis, statistically significant differences were observed in the major parameters between APA and POA. However, the results of subgroup meta-analysis, which focused on the correction angle and loss angle to eliminate the influence of different preoperative angles, were tend to no difference between two groups, except loss angle of scoliosis (MD, 6.4; 95% CI - 0.19 to 13) and correction angle of pelvic obliquity (MD, - 3.44; 95% CI - 6.71 to - 0.17). CONCLUSIONS Our meta-analysis suggested that POA was similar to APA in the correction of scoliosis in coronal and sagittal planes. However, APA had advantages in the correction of pelvic obliquity and decreasing the loss of angle between postoperation and follow-up in main scoliosis, whereas POA had advantages in operative time, blood loss, duration of hospital stay and complications. LEVEL OF EVIDENCE Level II. These slides can be retrieved under Electronic Supplementary Material.
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Saito W, Inoue G, Imura T, Nakazawa T, Miyagi M, Shirasawa E, Kuroda A, Uchida K, Takaso M. The Relationship between Preoperative Echocardiographic Evaluation and Spinal Deformity in Patients with Neuromuscular Scoliosis. Spine Surg Relat Res 2018; 2:48-52. [PMID: 31440646 PMCID: PMC6698548 DOI: 10.22603/ssrr.2017-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/21/2017] [Indexed: 11/05/2022] Open
Abstract
Introduction Echocardiography is an important component of perioperative cardiac risk stratification in patients with neuromuscular scoliosis (NMS). However, there are little data regarding the relationship between preoperative echocardiographic findings and spinal deformity. We retrospectively reviewed preoperative echocardiographic data to investigate the relationship between echocardiographic evaluation and spinal deformity in NMS. Methods We reviewed 73 NMS patients (mean age: 13.3 years, male 66%) who underwent spinal correction surgery between 2008 and 2016. Echocardiographic data including ejection fraction (EF), valvar disease, and inferior vena cava diameter were collected from the preoperative exam. Demographic and radiographic data were also collected. Results Preoperative diagnoses included Duchenne muscular dystrophy, Fukuyama congenital muscular dystrophy, other dystrophy, spinal muscular atrophy, and congenital myopathies. Mean Body Mass Index (BMI) was 15.6 kg/m2. Mean major Cobb angle before surgery was 86.6 ± 28.2°. Because of technical difficulty, complete echocardiographic data could only be collected and evaluated in 49.3% of patients. Neither right nor left sided cardiac evaluation could be completed in 20.5%. Patients in whom complete echocardiographic data could not be collected had significantly more extensive thoracic scoliosis with a more rigid curve and hypokyphosis, and were of lower weight and BMI than patients in whom complete data could be collected. Ten cases (13.7%) were diagnosed as having minor heart-related complications immediately after surgery, and they had higher right atrial pressures preoperatively. Conclusions Echocardiography can be technically difficult in NMS patients with extensive spinal deformities. We found that perioperative cardiac function could only be evaluated by echocardiogram in about half of NMS patients undergoing spinal correction surgery. The absence of an adequate preoperative cardiac evaluation could render these patients more susceptible to perioperative heart-related complications. Echocardiography may not be sufficient to evaluate cardiac conditions in children with extensive NMS.
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Affiliation(s)
- Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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Cahill PJ, Samdani AF, Brusalis CM, Blumberg T, Asghar J, Bastrom TP, Pasha S, Refakis CA, Pahys JM, Flynn JM, Sponseller PD. Youth and Experience: The Effect of Surgeon Experience on Outcomes in Cerebral Palsy Scoliosis Surgery. Spine Deform 2018; 6:54-59. [PMID: 29287818 DOI: 10.1016/j.jspd.2017.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 04/12/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Series on the learning curve in spinal deformity surgery have been published, but none has addressed neuromuscular spinal deformity, comprised of arguably the most complex cases. We present the first multi-center analysis of the impact of surgeon experience on neuromuscular spinal deformity surgery. METHODS A multi-center prospective study of spinal deformity surgery for cerebral palsy (CP) with at least 2 years of follow-up provided the dataset for assessment. Surgeons were categorized into one of two groups based on their self-reported first year of practice: an experienced surgeons (ES) group included those with at least 10 years of experience at the time of surgery and a young surgeons (YS) group included those with fewer than 10 years of experience at time of surgery. Groups were compared in multiple pre-operative, operative, and post-operative outcomes. RESULTS The YS group had 8 surgeons who performed 59 surgeries; the ES group had 13 surgeons who performed 103 cases, with one surgeon's cases distributed in both groups. The YS group had a greater proportion of patients with severe mental retardation (89.7% vs. 68.6%, p = .01). Duration of surgery was greater in the YS group (456 vs. 344 minutes, p < .001). The mean number of levels fused was greater in the ES group (15.9 vs. 15.6, p = .024), caused by increased variation in the upper level of fusion among the ES group. No significant differences were found between groups for estimated blood loss, length of hospitalization, or in percentage of Cobb correction. Years of experience of the operating surgeon was inversely correlated with duration of surgery (rho = -0.476, p < .001). CONCLUSIONS In performing scoliosis surgery on CP patients, surgeons with fewer than ten years of practice experience demonstrate significantly greater average operative time and decreased mean number of levels fused, yet produce similar clinical outcomes to more experienced surgeons. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - Christopher M Brusalis
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Todd Blumberg
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Jahangir Asghar
- Division of Spinal Surgery, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
| | - Tracey P Bastrom
- Department of Orthopedics, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA
| | - Saba Pasha
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Christian A Refakis
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | | | - Paul D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD 21218, USA
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Jalanko T, Helenius I, Pakarinen M, Koivusalo A. Gastrointestinal Complications After Surgical Correction of Neuromuscular Scoliosis: A Retrospective Cohort Study. Scand J Surg 2017; 107:252-259. [PMID: 29268665 DOI: 10.1177/1457496917748223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
STUDY DESIGN A retrospective cohort study of consecutively operated neuromuscular scoliosis patients. BACKGROUND AND AIM Surgical correction of neuromuscular scoliosis can be complicated by early gastrointestinal complications, but data on the extent and severity of them is scarce. The aim of the study was to determine the incidence, course, and risk factors of gastrointestinal complications after neuromuscular scoliosis correction. MATERIAL AND METHODS Ninety-one patients (<21 years of age) were consecutively operated on for neuropathic neuromuscular scoliosis during 2000-2011. Patients who developed marked postoperative gastrointestinal complications were identified and clinical, operative, and radiographic records, death certificates, and post-mortem reports were examined. RESULTS The average age at surgery was 14.5 (SD 2.9) and follow-up time was 4.9 (SD 2.3) years. Gastrointestinal complications occurred in 12 (13%) patients and included prolonged paralytic ileus (7%, 6/91), dysphagia (7%, 6/91), and gastroparesis (1%, 1/91). Hospital stay was 22 (SD 11) days in patients with gastrointestinal complications and 16 (SD 20) days in non-complicated patients (p = 0.005). Dysphagia required permanent feeding gastrostomy in one patient whereas other complications were transient and none caused death. The risk factors for postoperative gastrointestinal complications were preoperative main curve correction <30% in traction/bending radiographs (Relative Risk (RR) = 28 (95% Confidence Interval (CI) 4.4-180); p < 0.001), preoperative main curve >90° (RR = 5.5 (95% CI 1.3-23); p = 0.020), disturbance in intraoperative spinal cord monitoring (RR = 6.0 (95% CI 1.1-34); p = 0.043), and intravenous opioid medication over 5 days postoperatively (RR = 7.9 (95% CI 1.8-35), p = 0.006). CONCLUSION Gastrointestinal complications occurred in 13% of patients after neuromuscular scoliosis correction. Marked gastrointestinal complications extended postoperative hospitalization period, but they were transient in majority (92%) of cases and none caused death. Rigid scoliosis was the most significant risk factor for gastrointestinal complications. Gastrointestinal complications appear to be less frequent after posterior only spinal fusion with total pedicle screw instrumentation and Ponte osteotomies.
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Affiliation(s)
- T Jalanko
- 1 Section of Paediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - I Helenius
- 2 Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, University of Turku, Turku, Finland
| | - M Pakarinen
- 1 Section of Paediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - A Koivusalo
- 1 Section of Paediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Saito W, Namba T, Inoue G, Imura T, Miyagi M, Nakazawa T, Shirasawa E, Uchida K, Takaso M. Spinal correction in patients with Fukuyama congenital muscular dystrophy. J Orthop Sci 2017; 22:658-664. [PMID: 28325699 DOI: 10.1016/j.jos.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fukuyama congenital muscular dystrophy (FCMD) is one of the most common congenital progressive muscular dystrophies in Japan. Some patients develop a severe spinal deformity that leads to an unstable sitting position or pain. Since 2008, we have treated FCMD using posterior spinal fusion. This study reports the short-term clinical and radiographic results of posterior spinal correction and fusion in FCMD. METHODS We retrospectively reviewed 11 consecutive FCMD patients, average age 13 years old, treated with posterior spinal instrumentation and fusion between 2008 and 2015. All patients were non-ambulatory and complained about difficulty sitting and/or buttock pain. Posterior spinal correction was performed to halt progression of spinal deformity and improve their sitting balance. Assessment was performed clinically and with radiological measurements at a mean follow up period of 34.5 months. To evaluate functional status of patients after surgery objectively, a Muscular Dystrophy Spine Questionnaire (MDSQ) was obtained at the final follow up. RESULTS The mean height, weight and body mass index of the patients were 144.1 ± 11.8 cm, 26.5 ± 8.7 kg and 12.5 ± 2.6 kg/m2. The average intensive care unit stay was 1.3 days. Five patients had complications related to surgery. The mean preoperative major Cobb angle and pelvic obliquity (PO) were 65.5 ± 41.7° and 31.4 ± 28.9°, respectively, were corrected to 34.4 ± 29.7° and 20.0 ± 18.7° just after the surgery, and were maintained at 35.1 ± 29.9° and 20.5 ± 21.1° at the final follow up. The average MDSQ score was 35.8 ± 13.2 at the final follow up. CONCLUSION Posterior spinal correction and fusion in FCMD achieved good radiographic results and clinical improvement with acceptable perioperative complications. FCMD patients are mentally impaired and physically small, so post-operative observation and close attention to perioperative complications are critical.
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Affiliation(s)
- Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Takanori Namba
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
| | - Takayuki Imura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Toovey R, Harvey A, Johnson M, Baker L, Williams K. Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:690-698. [PMID: 28262923 DOI: 10.1111/dmcn.13412] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
AIM This study aims (1) to evaluate and synthesize the evidence for the postoperative outcomes after scoliosis surgery for children with cerebral palsy (CP), and (2) to identify preoperative risk factors for adverse outcomes after surgery. METHOD Medline, EMBASE, CINAHL, and PubMed were searched for relevant literature. Included studies were assessed for risk of bias using the Cochrane Effective Practice and Organisation of Care tool. Quality of evidence for overall function, quality of life (QoL), gross motor function, caregiver outcomes, deformity correction, and postoperative complications were assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). RESULTS Fifty-one studies met inclusion criteria, including 35 case series designs. Risk of bias was high across all studies. On average good deformity correction was achieved, the trend appears positive for caregiver and QoL outcomes, but there was minimal to no change for gross motor or overall function. Inconsistent measurement limited synthesis. A mean overall complication rate of 38.1% (95% confidence interval 27.3-53.3) was found. The quality of evidence was very low across all functional outcomes. INTERPRETATION Limited high-quality evidence exists for outcomes after scoliosis surgery in children with CP, a procedure associated with a moderately high complication rate. The intervention appears indicated for deformity correction, but currently there is insufficient evidence to make recommendations for this surgery as a way to also improve functional outcomes, caregiver outcomes, and quality of life.
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Affiliation(s)
- Rachel Toovey
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - Michael Johnson
- Orthopaedic Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Louise Baker
- Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
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Robertson J, Baines S, Emerson E, Hatton C. Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31 Suppl 1:11-28. [DOI: 10.1111/jar.12325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Janet Robertson
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
| | - Susannah Baines
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
| | - Eric Emerson
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
- Centre for Disability Research and Policy; University of Sydney; Lidcombe NSW Australia
| | - Chris Hatton
- Centre for Disability Research; Division of Health Research; Faculty of Health and Medicine; Lancaster University; Lancaster UK
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