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Welborn MC, Redding G, Evers P, Nicol L, Bauer DF, Iyer RR, Poon S, Hwang S. Pre-op considerations in neuromuscular scoliosis deformity surgery: proceedings of the half day course at the 58th annual meeting of the Scoliosis Research Society. Spine Deform 2024; 12:867-876. [PMID: 38634998 DOI: 10.1007/s43390-024-00865-4] [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: 01/22/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024]
Abstract
Scoliosis is a common complication of neuromuscular disorders. These patients are frequently recalcitrant to nonoperative treatment. When treated surgically, they have the highest risk of complications of all forms of scoliosis. While recent studies have shown an improvement in the rate of complications, they still remain high ranging from 6.3 to 75% depending upon the underlying etiology and the treatment center (Mohamad et al. in J Pediatr Orthop 27:392-397, 2007; McElroy et al. in Spine, 2012; Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Cognetti et al. in Neurosurg Focus 43:E10, 2017). For those patients who are able to recover from the perioperative period without major complications, several recent studies have shown decreased long-term mortality and improved health-related quality of life in neuromuscular patients who have undergone spine fusion (Bohtz et al. in J Pediatr Orthop 31:668-673, 2011; Ahonen et al. in Neurology 101:e1787-e1792, 2023; Jain et al. in JBJS 98:1821-1828, 2016). It is critically important to optimize patients preoperatively to minimize the risk of post-operative complications and maximize long-term outcomes. In order to do so, one must familiarize themselves with the common complications and their treatment. The most common complications are pulmonary in nature. With reported rates as high as 23-29%, pre-operative optimization should be employed for these patients to minimize the risk of post-operative complications (Sharma et al. in Eur Spine J 22:1230-1249, 2013; Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). The next most common cause of complications are implant related, with 13-23% of patients experiencing an implant-related complication that may require a second procedure (Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Sharma et al. in Eur Spine J 22:1230-1249, 2013) Therefore optimization of bone quality prior to surgical intervention is important to help minimize the risk of instrumentation failure. Optimization of muscle tone and spasticity may help to decrease the risk of instrumentation complications, but may also contribute to the progression of scoliosis. While only 3% of patients have neurologic complication, significant equipoise remains regarding whether or not patients should undergo prophylactic detethering procedures to minimize those risks (Sharma et al. in Eur Spine J 22:1230-1249, 2013). Although only 1.8% of complications are classified as cardiac related, they can be among the most devastating (Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). Simply understanding the underlying etiology and the potential risks associated with each condition (i.e., conduction abnormalities in a patient with Rett syndrome or cardiomyopathies patients with muscular dystrophy) can be lifesaving. The following article is a summation of the half day course on neuromuscular scoliosis from the 58th annual SRS annual meeting, summarizing the recommendations from some of the world's experts on medical considerations in surgical treatment of neuromuscular scoliosis.
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Affiliation(s)
- Michelle C Welborn
- Shriners Children's Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA.
| | - Gregory Redding
- Pulmonary and Sleep Medicine Division, Seattle Children's Hospital, Room O.C. 7.730, 4800 Sand Point Way N E, Seattle, WA, 98105, USA
| | - Patrick Evers
- Doernbecher Children's Hospital, 700 SW Campus Dr, Portland, OR, 97239, USA
| | - Lindsey Nicol
- Shriners Children's Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- Doernbecher Children's Hospital, 700 SW Campus Dr, Portland, OR, 97239, USA
| | - David F Bauer
- Texas Children's Hospital, 6701 Fannin St., Suite 1230.01, Houston, TX, USA
| | - Rajiv R Iyer
- , 100 N. Mario Capecchi Drive, Suite 3850, Salt Lake City, UT, 84113, USA
| | - Selina Poon
- Shriners Children's Southern California, 909 S. Fair Oaks Ave, Pasadena, CA, 91105, USA
| | - Steven Hwang
- Shriners Children's Philadelphia, 3551 N Broad St., Philadelphia, PA, 19140, USA
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Ruythooren F, Moens P. Spinal Muscular Atrophy Scoliosis in the Era of Background Therapies-A Review of the Literature. J Clin Med 2024; 13:3467. [PMID: 38929996 PMCID: PMC11205197 DOI: 10.3390/jcm13123467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Spinal deformities are considered an important complication of neuromuscular disorders such as spinal muscular atrophy (SMA). SMA patients typically develop progressive early-onset scoliosis, which is associated with increased functional decline, discomfort, and respiratory dysfunction. Over the second decade of the twenty-first century, a lot has changed in terms of the therapeutic options available to people with SMA. Specifically, the use of pharmaceutical agents such as nusinersen (Spinraza), onasemnogene abeparvovec (Zolgensma), and risdiplam (Evrysdi) has dramatically changed the landscape for SMA patients. These medications significantly alter motor- and respiratory functioning, as well as the natural progression of spinal deformities. When evaluating these agents and their impact on the development of scoliosis and motor functioning, it is important to consider the timing of treatment initiation. In patients treated after they had already developed symptoms, a shift of phenotype to a less severe subtype has been observed. This results in a delay in the onset of scoliosis for the less severe SMA types and an increase in early-onset scoliosis for the severe types in patients who would typically not live to develop scoliosis. Patients who receive treatment before they develop symptoms achieve almost normal motor functioning and will likely have a significant decrease in scoliosis prevalence or at least delay its onset.
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Affiliation(s)
- Fred Ruythooren
- Department of Orthopaedic Surgery, University Hospitals Leuven-Gasthuisberg, 3000 Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven-Gasthuisberg, 3000 Leuven, Belgium
| | - Pierre Moens
- Department of Orthopaedic Surgery, University Hospitals Leuven-Gasthuisberg, 3000 Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), University Hospitals Leuven-Gasthuisberg, 3000 Leuven, Belgium
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Cetik RM, Ovadia D, Mladenov K, Kruyt MC, Helenius I, Ahonen M, Studer D, Yazici M. Safety and efficacy of growth-friendly instrumentation for early-onset scoliosis in patients with spinal muscular atrophy type 1 in the disease-modifying treatment era. J Child Orthop 2024; 18:26-32. [PMID: 38348442 PMCID: PMC10859117 DOI: 10.1177/18632521231214780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 02/15/2024] Open
Abstract
Purpose To evaluate the safety of growth-friendly instrumentation for early-onset scoliosis (EOS) in patients with spinal muscular atrophy (SMA) type 1 who received disease-modifying treatment (DMT) and analyze short-term efficacy. Methods Retrospective search was conducted between 2017 and 2023. Patients with genetically confirmed SMA type 1 who were surgically treated for spinal deformity and receiving DMTs (nusinersen, risdiplam, or onasemnogene abeparvovec) were included. SMA types 2 and 3 and patients who do not receive DMTs were excluded. Clinical and radiographic data were collected at preoperative, postoperative, and latest follow-up visits. Results Twenty-eight patients (mean follow-up: 16 months (range 2-41)) were included. The mean age at surgery was 60 months (range 29-96). Fifteen were treated with dual magnetically controlled growing rods (MCGR), four with unilateral MCGR and a contralateral guided growth system, three with Vertical Expandable Prosthetic Titanium Rib (VEPTR®) implants, five with self-distracting systems, and one with traditional dual growing rods. The mean amount of correction was 57% (44°± 17) for scoliosis and 83% (13°± 11) for pelvic obliquity. The mean T1-12 height gain during surgery was 31 mm (±16 mm), while the mean T1 S1 height gain was 51 mm (±24 mm), and instrumented growth was observed during follow-up. Five patients (18%) developed six serious adverse events: three surgical site infections, two anchor failures, and one rod fracture, and all required unplanned reoperations. No neurologic complication, difficulty during nusinersen injections, or respiratory decline was recorded. Conclusion We report that spinal deformity in this population can be safely treated with growth-friendly instrumentation, with similar complication rates when compared with SMA type 2.
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Affiliation(s)
- Riza Mert Cetik
- Orthopedics and Traumatology, Pursaklar State Hospital, Ankara, Turkey
| | - Dror Ovadia
- Dana-Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Kiril Mladenov
- Department of Pediatric Orthopaedic Surgery, Children’s Hospital Hamburg-Altona, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Matti Ahonen
- Department of Pediatric Orthopedics and Traumatology, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Daniel Studer
- Department of Orthopedics, University Children’s Hospital Basel (Universitats Kinderspital beider Basel), Basel, Switzerland
| | - Muharrem Yazici
- Department of Orthopedics and Traumatology, Hacettepe University Hospital, Ankara, Turkey
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Jamnik AA, Grigoriou E, Kadado A, Jo CH, Boes N, Thornberg D, Tran DP, Ramo B. Radiographic and clinical outcomes after definitive spine fusion for skeletally immature patients with idiopathic scoliosis. Spine Deform 2024; 12:149-157. [PMID: 37624555 DOI: 10.1007/s43390-023-00757-z] [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: 04/05/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To assess the intermediate-term radiographic and clinical outcomes of skeletally immature idiopathic scoliosis (IS) patients that underwent definitive fusion (DF). METHODS A retrospective review of patients with IS who were Risser 0 with open tri-radiate cartilages at the time of DF with minimum 5-year follow-up. Outcomes included Scoliosis Research Society (SRS)-30 scores, major Cobb angle, pulmonary function tests (PFTs), and unplanned returns to the operating room (UPROR). Adding-on was defined as progression of the major Cobb angle > 5° or tilt of the lowest instrumented vertebra > 5°. RESULTS Thirty-two patients (78% female, mean age 12.2 ± 1.3 years old, mean preoperative major Cobb 64.8° ± 15.9) were included. Of these patients, 20 (62.5%) experienced adding-on and 6 (18.8%) required a revision surgery to correct their progressive spinal deformity. Adding-on was associated with lower 5-year postoperative SRS scores for appearance (3.7 ± 0.7 vs 4.4 ± 0.3, p = 0.0126), mental health (4.2 ± 0.6 vs 4.6 ± 0.3, p = 0.0464), satisfaction with treatment (4.0 ± 0.8 vs 4.7 ± 0.4, p = 0.0140), and total score (4.0 ± 0.4 vs 4.4 ± 0.2, p = 0.0035). The results of the PFTs did not differ between groups. Patients experienced an average of 0.53 UPROR/patient. CONCLUSION DF in skeletally immature patients results in a high rate of adding-on, which adversely affects Health-Related Quality of Life. However, reoperation rates, both planned and unplanned, remain lower when compared to patients undergoing growth-friendly treatment.
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Affiliation(s)
- Adam A Jamnik
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Allen Kadado
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Nathan Boes
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - David Thornberg
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Dong-Phuong Tran
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Brandon Ramo
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
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Ashebo L, Anari JB, Cahill PJ. Update on the Diagnosis and Management of Early-onset Scoliosis. Curr Rev Musculoskelet Med 2023; 16:447-456. [PMID: 37615932 PMCID: PMC10497459 DOI: 10.1007/s12178-023-09848-w] [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] [Accepted: 05/30/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW In this article, we review the most recent advancements in the approaches to EOS diagnosis and assessment, surgical indications and options, and basic science innovation in the space of early-onset scoliosis research. RECENT FINDINGS Early-onset scoliosis (EOS) covers a diverse, heterogeneous range of spinal and chest wall deformities that affect children under 10 years old. Recent efforts have sought to examine the validity and reliability of a recently developed classification system to better standardize the presentation of EOS. There has also been focused attention on developing safer, informative, and readily available imaging and clinical assessment tools, from reduced micro-dose radiographs, quantitative dynamic MRIs, and pulmonary function tests. Basic science innovation in EOS has centered on developing large animal models capable of replicating scoliotic deformity to better evaluate corrective technologies. And given the increased variety in approaches to managing EOS in recent years, there exist few clear guidelines around surgical indications across EOS etiologies. Despite this, over the past two decades, there has been a considerable shift in the spinal implant landscape toward growth-friendly instrumentation, particularly the utilization of MCGR implants. With the advent of new biological and basic science treatments and therapies extending survivorship for disease etiologies associated with EOS, the treatment for EOS has steadily evolved in recent years. With this has come a rising volume and variation in management options for EOS, as well as the need for multidisciplinary and creative approaches to treating patients with these complex and heterogeneous disorders.
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Affiliation(s)
- Leta Ashebo
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA.
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Austein J, Austein F, Lüders KA, Braunschweig L, Tsaknakis K, Lorenz HM, Hell AK. Influence of Paraspinal Growth-Friendly Spinal Implants in Children with Spinal Muscular Atrophy on Parasol Deformity, Rib-Vertebral Angles, Thoracic, and Lung Volumes. Pediatr Neurosurg 2023; 58:185-196. [PMID: 37315541 DOI: 10.1159/000531549] [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: 01/31/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Children with spinal muscular atrophy (SMA) and progressive neuromuscular scoliosis often require early growth-friendly spinal implant (GFSI) treatment for deformity correction with implant fixation either through pedicle screws or bilateral to the spine using ribto pelvis fixation. It has been proposed that the latter fixation may change the collapsing parasol deformity via changes in the rib-vertebral angle (RVA) with a positive effect on thoracic and lung volume. The purpose of this study was to analyze the effect of paraspinal GFSI with bilateral rib-to-pelvis fixation on the parasol deformity, RVA, thoracic, and lung volumes. METHODS SMA children with (n = 19) and without (n = 18) GFSI treatment were included. Last follow-up was before definite spinal fusion at puberty. Scoliosis and kyphosis angles, parasol deformity, and index, as well as convex and concave RVA, were measured on radiographs, whereas computed tomography images were used to reconstruct thoracic and lung volumes. RESULTS In all SMA children (n = 37; with or without GFSI), convex RVA was smaller than concave values at all times. GFSI did not crucially influence the RVA over the 4.6-year follow-up period. Comparing age- and disease-matched adolescents with and without prior GFSI, no effect of GFSI treatment could be detected on either RVA, thoracic, or lung volumes. Parasol deformity progressed over time despite GFSI. CONCLUSION Despite different expectations, implantation of GFSI with bilateral rib-to-pelvis fixation did not positively influence parasol deformity, RVA and/or thoracic, and lung volumes in SMA children with spinal deformity directly and over time.
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Affiliation(s)
- Julia Austein
- Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Friederike Austein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja A Lüders
- Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Lena Braunschweig
- Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany,
| | - Konstantinos Tsaknakis
- Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Heiko M Lorenz
- Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Anna K Hell
- Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany
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Wang Y, Hai Y, Kang N, Yang J, Su Q, Liu Y, Guan L, Meng X. Long-Term Radiographic and Pulmonary Function Outcomes After Dual Growing-Rod Treatment for Severe Early-Onset Scoliosis. J Bone Joint Surg Am 2023:00004623-990000000-00789. [PMID: 37099627 DOI: 10.2106/jbjs.22.01088] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND We evaluated long-term outcomes (radiographic parameters and pulmonary function) at a minimum follow-up of 5 years after use of dual growing rods (DGRs) to treat severe early-onset scoliosis (sEOS). METHODS Among a total of 112 patients who were diagnosed with early-onset scoliosis (EOS) and were treated with DGRs between 2006 and 2015, 52 patients had sEOS, with a major Cobb angle of >80°. Of these patients, 39 with a minimum follow-up of 5 years had complete radiographic and pulmonary function test results and were included. The Cobb angle of the major curve, T1-S1 height, T1-T12 height, and maximum kyphosis angle in the sagittal plane were measured on radiographs. Pulmonary function test results were collected in all patients before the initial operation (preoperatively), 12 months after the initial operation (postoperatively), and at the last follow-up. The changes in pulmonary function and complications during treatment were analyzed. RESULTS The mean age of patients before the initial operation was 7.7 ± 1.2 years, and the mean follow-up period was 75.0 ± 14.1 months. The mean number of lengthenings was 4.5 ± 1.3, and the mean interval between lengthenings was 11.2 ± 2.1 months. The Cobb angle improved from 104.5° ± 18.2° preoperatively to 38.1° ± 10.1° after the initial surgical procedure (postoperatively) and 21.9° ± 8.6° at the final follow-up. The T1-S1 height increased from 25.1 ± 4.0 cm preoperatively to 32.4 ± 3.5 cm postoperatively and to 39.5 ± 4.0 cm at the final follow-up. However, no significant difference was detected between the increased pulmonary function parameters at 1 year and those before the operation (p > 0.05), except for residual volume, whereas pulmonary function parameters had significantly increased at the final follow-up (p < 0.05). During the treatment period, 17 complications occurred in 12 patients. CONCLUSIONS DGRs are effective in treating sEOS in the long term. They allow longitudinal growth of the spine, and the correction of the spinal deformity can provide conditions that make improving pulmonary function possible in patients with sEOS. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yunsheng Wang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China
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Tsukahara K, Mayer OH. Thoracic insufficiency syndrome: Approaches to assessment and management. Paediatr Respir Rev 2022; 44:78-84. [PMID: 35339395 PMCID: PMC9448829 DOI: 10.1016/j.prrv.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
Thoracic insufficiency syndrome (TIS) was described in 2003 as the inability of the thorax to support normal respiration or lung growth. TIS includes a broad and disparate group of typically degenerative thoracospinal conditions. Although TIS arises due to a heterogeneous group of disorders and thus its incidence is not well quantified, general approaches to management and treatment exist. Evolving imaging techniques and measurements of health-related quality of life augment tests of pulmonary function to quantify disease burden, longitudinally and pre- and post-intervention. Intervention is primarily via growth-sparing surgery, for which several device options exist, to preserve vertical growth prior to a definitive spinal fusion at skeletal maturity.
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Affiliation(s)
- Katharine Tsukahara
- The Children's Hospital of Philadelphia, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, United States.
| | - Oscar Henry Mayer
- Perelman School of Medicine at The University of Pennsylvania, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104, United States
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Wang Z, Feng E, Jiao Y, Lin J, Zhao J, Chen W, Shen J. Surgical treatment of spinal deformities in spinal muscular atrophy: a single-center experience from China. 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 2022; 31:3089-3097. [PMID: 35972554 DOI: 10.1007/s00586-022-07347-z] [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: 04/08/2022] [Revised: 07/04/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To report the clinical characteristics and surgical outcomes of scoliosis in patients with spinal muscular atrophy (SMA) from Mainland China. METHODS Nineteen patients were retrospectively analyzed. Demographic, anthropometric and respiratory parameters were collected preoperatively. Surgical program was analyzed. Radiographic data were measured perioperatively. Motor status, ventilation support, sitting ability and respiratory symptoms were evaluated preoperatively and at final follow-up. RESULTS Age at surgery was 17.08 (12.83, 20.08) years. More than 40% of patients were diagnosed with low weight. Pulmonary dysfunction was observed in all patients. All patients received posterior spinal fusion (PSF). Sacroiliac fixation with sacral-2 alar iliac technique was used in 16 patients. Major curve correction rate was 54.87 ± 16.14%. Pelvic obliquity correction rate was 63.84 ± 23.70%. T1-T12 height, space-available-for-lung ratio and thoracic transverse diameter were increased (p < 0.001). Percentage of patients capable of sitting independently increased from 26.32% preoperatively to 73.68% at final follow-up. Cumulative scores of sitting-related items in muscular dystrophy spine questionnaire improved from 19.11 ± 5.40 preoperatively to 26.21 ± 5.20 at final follow-up. Total scores of symptomatic domains in St. George's Respiratory Questionnaire decreased from 4 (2, 12) preoperatively to 1 (0, 3) at final follow-up. CONCLUSIONS SMA patients in China always present severe scoliosis at late adolescence, accompanied with high proportion of low weight and pulmonary dysfunction. PSF is effective for the correction of scoliosis and pelvic obliquity and the improvement of thoracic morphology. Sitting ability and respiratory symptoms were improved postoperatively.
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Affiliation(s)
- Zhen Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Erwei Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yang Jiao
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jiachen Lin
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Junduo Zhao
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Weiyun Chen
- Department of Anesthesiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
| | - Jianxiong Shen
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
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Axente M, Mirea A, Sporea C, Pădure L, Drăgoi CM, Nicolae AC, Ion DA. Clinical and Electrophysiological Changes in Pediatric Spinal Muscular Atrophy after 2 Years of Nusinersen Treatment. Pharmaceutics 2022; 14:pharmaceutics14102074. [PMID: 36297509 PMCID: PMC9611420 DOI: 10.3390/pharmaceutics14102074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
In the new therapeutic era, disease-modifying treatment (nusinersen) has changed the natural evolution of spinal muscular atrophy (SMA), creating new phenotypes. The main purpose of the retrospective observational study was to explore changes in clinical evolution and electrophysiological data after 2 years of nusinersen treatment. We assessed distal compound motor action potential (CMAP) on the ulnar nerve and motor abilities in 34 SMA patients, aged between 1 and 16 years old, under nusinersen treatment, using specific motor scales for types 1, 2 and 3. The evaluations were performed at treatment initiation and 26 months later. There were registered increased values for CMAP amplitudes after 2 years of nusinersen, significantly correlated with motor function evolution in SMA type 1 patients (p < 0.005, r = 0.667). In total, 45% of non-sitters became sitters and 25% of sitters became walkers. For SMA types 1 and 2, the age at the treatment initialization is highly significant (p < 0.0001) and correlated with treatment yield. A strong negative correlation (r = −0.633) was observed for SMA type 1 and a very strong negative correlation (r = −0.813) for SMA type 2. In treated SMA cases, the distal amplitude of the CMAP and motor functional scales are important prognostic factors, and early diagnosis and treatment are essential for a better outcome.
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Affiliation(s)
- Mihaela Axente
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- National University Center for Children Neurorehabilitation “Dr. Nicolae Robanescu”, 44 Dumitru Minca Street, 041408 Bucharest, Romania
| | - Andrada Mirea
- National University Center for Children Neurorehabilitation “Dr. Nicolae Robanescu”, 44 Dumitru Minca Street, 041408 Bucharest, Romania
- Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- Correspondence: (A.M.); (C.S.)
| | - Corina Sporea
- National University Center for Children Neurorehabilitation “Dr. Nicolae Robanescu”, 44 Dumitru Minca Street, 041408 Bucharest, Romania
- Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
- Correspondence: (A.M.); (C.S.)
| | - Liliana Pădure
- National University Center for Children Neurorehabilitation “Dr. Nicolae Robanescu”, 44 Dumitru Minca Street, 041408 Bucharest, Romania
- Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 37 Dionisie Lupu Street, 020021 Bucharest, Romania
| | - Cristina Manuela Drăgoi
- Department of Biochemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Alina Crenguța Nicolae
- Department of Biochemistry, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania
| | - Daniela Adriana Ion
- Department of Pathophysiology, National Institute for Infectious Diseases Prof. Dr. Matei Balș, Carol Davila University of Medicine and Pharmacy, 1 Calistrat Grozovici Street, 021105 Bucharest, Romania
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Xu B, Wei C, Hu X, Li W, Huang Z, Que C, Qiu J, Li C, Xiong H. Scoliosis Orthopedic Surgery Combined With Nusinersen Intrathecal Injection Significantly Improved the Outcome of Spinal Muscular Atrophy Patient: A Case Report. Front Neurol 2022; 13:869230. [PMID: 35547367 PMCID: PMC9082934 DOI: 10.3389/fneur.2022.869230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by pathogenic variation of the survival motor neuron (SMN) 1 gene. Symptoms of SMA include progressive limb muscle weakness, atrophy, and severe scoliosis. Nusinersen is an antisense oligonucleotide that can enhance the production of the SMN protein. Here, we report a case with scoliosis who received orthopedic surgery combined with Nusinersen intrathecal injections. Case Presentation Scoliosis orthopedic surgery followed by Nusinersen intrathecal injections was given to a 16-year-old girl who had thoracic and lumbar scoliosis and type 3 SMA. Surgery was performed for T3-S2 posterolateral fusion (PLF), with a channel left on the vertebral laminae of L3-L4. The balance of the spine and pelvis was significantly improved and the height increased by 9 cm. Lumbar puncture was conducted with local anesthesia under ultrasound and CT guidance through the laminae channel and Nusinersen was successfully injected. Comparing the two approaches, real-time ultrasound guidance for intrathecal Nusinersen injections after spinal surgery is preferred, however, CT guidance is an alternative if the initial puncture procedure is difficult. After the aforementioned multidisciplinary treatment, a good outcome was achieved, as demonstrated by a 2-point increase in RULM and MFM32 scores 2 months later. Conclusion Scoliosis orthopedic surgery combined with Nusinersen intrathecal injection is an effective treatment for SMA patients with scoliosis.
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Affiliation(s)
- Beiyu Xu
- Department of Orthopedic/Spine Surgery, Peking University First Hospital, Beijing, China
| | - Cuijie Wei
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xiao Hu
- Department of Anesthesiology, Peking University First Hospital, Beijing, China
| | - Wenzhu Li
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Peking University First Hospital, Beijing, China
| | - Chengli Que
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jianxing Qiu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Chunde Li
- Department of Orthopedic/Spine Surgery, Peking University First Hospital, Beijing, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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12
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Saudeau É. [Fusionless spine instrumentations in neuromuscular scoliosis]. Med Sci (Paris) 2021; 37 Hors série n° 1:36-39. [PMID: 34878393 DOI: 10.1051/medsci/2021189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Less invasive techniques are now available to treat neuromuscular scoliosis efficiently. Rods can be implanted safely and at an early stage to correct and prevent further spine deformities. These techniques are particularly adapted to children with spinal muscular atrophy. The expansion of rods is possible magnetically or mechanically and enables to follow the spine growth timeline optimally. Of note, a risk a metallosis has been reported for some magnetic rods available on the market.
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13
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Gaume M, Saudeau E, Gomez-Garcia de la Banda M, Azzi-Salameh V, Mbieleu B, Verollet D, Benezit A, Bergounioux J, Essid A, Doehring I, Dabaj I, Desguerre I, Barnerias C, Topouchian V, Glorion C, Quijano-Roy S, Miladi L. Minimally Invasive Fusionless Surgery for Scoliosis in Spinal Muscular Atrophy: Long-term Follow-up Results in a Series of 59 Patients. J Pediatr Orthop 2021; 41:549-558. [PMID: 34411042 DOI: 10.1097/bpo.0000000000001897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of spinal muscular atrophy (SMA) scoliosis has evolved in the last decade, with the emergence of fusionless surgical techniques that allow correction of the deformity before the end of growth spurt. These techniques are expected to delay definitive spine fusion and preserve trunk growth. PURPOSE The aim was to evaluate long-term clinical, radiologic, and respiratory outcomes of a minimally invasive fusionless surgery (MIFLS) in SMA scoliosis. METHODS All children affected with SMA scoliosis who underwent MIFLS in our department from 2011 to 2019 were included. The instrumentation consisted in a bilateral sliding rod construct from T1 to the sacrum, anchored proximally by double-hook claws and distally by iliosacral screws. Clinical, genetic, respiratory and radiographic data were retrospectively reviewed. A patient's satisfaction survey was performed. RESULTS A total of 59 children with genetic confirmation of SMA (9SMA1c, 47SMA2, and 3SMA3) underwent MIFLS at a mean age of 11±1.9 years. All of them were nonwalker at the time of surgery. Twenty-six were treated with intrathecal Nusinersen. Mean follow-up was 5.2 years (2 to 9.6 y). Mean major coronal curve improved from 79±15 to 41±16 degrees and pelvic obliquity decreased from 24±11 to 5.9±4 degrees. Mean space available for lung improved from 77% to 93%. Mechanical or infectious complications occurred in 9 patients, with removal of the implant in 1. 6 children required unplanned surgeries. Postoperative bracing was needed in 13 children. Mean gain weight 3 years after the first surgery was 6 kg. 91.5% of patients had a positive satisfaction of the surgery. There was no significant impact in respiratory function postoperatively. Only 30 children required rod lengthening procedures, with a mean interval between procedures of 1.9 years (0.5 to 3.7 y). No arthrodesis was required at last follow-up in any patient. CONCLUSION Bipolar MIFLS in SMA preserves spinal and thoracic growth without interference with respiratory function. It provides a significant correction of spinal deformity and pelvic obliquity, having a reduced rate of complications. The correction of spinal deformity was maintained at long term, not requiring definitive fusion at the end of growth. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | | | - Marta Gomez-Garcia de la Banda
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Viviane Azzi-Salameh
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Blaise Mbieleu
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | | | - Audrey Benezit
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Jean Bergounioux
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- UMR U1179 (INSERM/UVSQ) Physiopathologie, Biothérapie et Pharmacologie appliquées (END-ICAP), Montigny Le Bretonneaux, France
| | - Aben Essid
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | - Isabelle Doehring
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | - Ivana Dabaj
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
| | - Isabelle Desguerre
- Paediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
| | - Christine Barnerias
- Paediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University
| | | | | | - Susana Quijano-Roy
- Paediatric Neurology and ICU, Raymond Poincaré Hospital, UVSQ, Université Paris-Saclay, Assistance Publique Hôpitaux de Paris (AP-HP), Garches
- Nord-Est-Ile de France Neuromuscular Center at the French Network (FILNEMUS), Euro-NMD ERN (European Neuromuscular Centers Network)
- UMR U1179 (INSERM/UVSQ) Physiopathologie, Biothérapie et Pharmacologie appliquées (END-ICAP), Montigny Le Bretonneaux, France
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