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Li CJ, Vaile JR, Gal JS, Park CH, Burnett GW. Analgesic options for anterior approach to scoliosis repair: a scoping review. Spine Deform 2023; 11:1031-1040. [PMID: 37233950 DOI: 10.1007/s43390-023-00699-6] [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: 01/22/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE The ideal analgesic regimen for the anterior approach to scoliosis repair is not clearly defined. The purpose of the study was to summarize and identify gaps in the current literature specific to the anterior approach to scoliosis repair. METHODS A scoping review was conducted in July 2022 utilizing PubMed, Cochrane, and Scopus databases guided by the PRISMA-ScR framework. RESULTS The database search generated 641 possible articles, 13 of which met all inclusion criteria. All articles focused on the effectiveness and safety of regional anesthetic techniques, while a minority also provided both opioid and non-opioid medication frameworks. CONCLUSION Continuous Epidural Analgesia (CEA) is the most well-studied intervention for pain control in anterior scoliosis repair, but other, more novel regional anesthetic techniques offer safe and effective potential alternatives. More research is indicated to compare the effectiveness of different regional techniques and perioperative medication regimens specific to anterior scoliosis repair.
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Affiliation(s)
- Chris J Li
- Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - John R Vaile
- Sidney Kimmel Medical College, Thomas Jefferson University, 833 Chestnut Street, Philadelphia, PA, 19107, USA
| | - Jonathan S Gal
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Chang H Park
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative & Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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Perioperative Outcomes of Open Anterior Vertebral Body Tethering and Instrumented Posterior Spinal Fusion for Skeletally Immature Patients With Idiopathic Scoliosis. J Pediatr Orthop 2023; 43:143-150. [PMID: 36746139 DOI: 10.1097/bpo.0000000000002320] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Correcting adolescent idiopathic scoliosis (AIS) without fusion can be achieved with anterior vertebral body tethering (AVBT). However, little is known about the perioperative outcomes, pain control, and clinical outcomes in patients undergoing AVBT compared with instrumented posterior spinal fusion (IPSF). METHODS In this retrospective cohort study, we compared pediatric patients with AIS who underwent either AVBT or IPSF. Inclusion criteria were based on the AVBT group, which included primary thoracic idiopathic scoliosis, Risser ≤1, curve magnitude 40 to 70 degrees, age 9 to 15, no prior spine surgery, index surgery between 2014 and 2019, and minimum 2-year follow-up. Patient demographics, perioperative metrics, pain visual analog scale scores, opiate morphine equivalent usage, cost data, and radiographic outcomes were compared. RESULTS We identified 23 patients who underwent AVBT and 24 matched patients in the IPSF group based on inclusion criteria. Patients undergoing AVBT and PSF were similar in age (12±1 y vs. 13±1 y, P =0.132) and average follow-up time (3.8±1.6 y vs. 3.3±1.4 y, P =0.210). There were 23 female patients (87%) in the AVBT group and 24 female (92%) patients in the IPSF group. Intraoperatively, estimated blood loss (498±290 vs. 120±47 mL, P <0.001) and procedure duration (419±95 vs. 331±83 min, P =0.001) was significantly greater in the IPSF group compared with AVBT. Length of stay was lower in the AVBT group compared with PSF (4±1 vs. 5±2 d, P =0.04). PSF patients had significantly greater total postoperative opiate morphine equivalent use compared with AVBT (2.2±1.9 vs. 5.6±3.4 mg/kg, P <0.001). Overall direct costs following PSF and AVBT were similar ($47,655+$12,028 vs. $50,891±$24,531, P =0.58). Preoperative radiographic parameters were similar between both the groups, with a major thoracic curve at 51±10 degrees for AVBT and 54±9 degrees for IPSF ( P =0.214). At the most recent follow-up, IPSF patients had greater curve reduction to a mean major thoracic curve of 11±7 degrees (79%) compared with 19±10 degrees (63%) in AVBT patients ( P =0.002). Nine patients (39%) required revision surgery following AVBT compared with 4 patients(17%) following IPSF ( P =0.09). CONCLUSIONS In a select cohort of patients, AVBT offers decreased surgical time, blood loss, length of stay, and postoperative opiate usage compared with IPSF. Although IPSF resulted in greater deformity correction at 2-year follow-up, the majority of patients who underwent AVBT had ≤35 major curves and avoided fusion. There is optimism for AVBT as a treatment option for select AIS patients, but long-term complications are still being understood, and the risk for revision surgeries remains high. LEVEL OF EVIDENCE Level III.
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Haber L, Starring H, Newcomb N, Larson AN, Desai B, Roybal J, Fant W, Milbrandt T, Boeyer M, Marks M, Newton P, Samdani A, Miyanji F, Hoernschemeyer D. Drain options after vertebral body tethering. Spine Deform 2023; 11:367-372. [PMID: 36219390 DOI: 10.1007/s43390-022-00595-5] [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: 06/27/2022] [Accepted: 09/17/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Since the introduction of vertebral body tethering (VBT) for adolescent idiopathic scoliosis (AIS), a variety of post-operative chest drainage systems have been utilized. Most surgeons use formal chest tubes with a Pleur-evac, while others use smaller bulb suction drains (e.g., Blake drain). In addition, some centers utilize pleural closure. This multicenter study evaluates whether drain type or pleural closure impact perioperative and 90 day complication rates. METHODS A retrospective review was conducted from three institutions with established VBT programs. All preoperative, perioperative and 90 day postoperative data were analyzed to determine differences in outcomes between three cohorts: standard chest tube (SCT), standard chest tube with pleural closure (SCTPC) and 10 French Bulb drain (BD). RESULTS 104 patients were identified for the study. 57 SCT, 25 SCTPC and 22 BD. All data are listed in order: SCT, SCTPC, BD. Length of stay (3.7, 4.3, 3.0 days) was less in the BD group (p = 0.009); post-operative drainage (460, 761, 485 cc) was less in the SCT and BD groups (p < 0.001); intra-operative estimated blood loss (EBL) 146, 382, 64 cc was less in the BD group (p < 0.001). No significant difference in number of days (3.2, 3.2, and 2.8 days) drainage was in place, groups (p = 0.311). Complication profile was similar with 2 chest tube reinsertions in the SCT and one hemothorax that resolved spontaneously in BD group. CONCLUSIONS In this series of 104 patients, SCT, SCTPC and BD all had a similar safety profile. All three methods were safe and effective in managing post-operative chest drainage after thoracic VBT. In the series, BD group had significantly shorter LOS than both groups that used chest tubes. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Lawrence Haber
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Hunter Starring
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA.
| | - Nicholas Newcomb
- University of Queensland-Ochsner Clinical School, New Orleans, LA, USA
| | - A Noelle Larson
- Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bhumit Desai
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Jessica Roybal
- Department of Pediatric Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Whitney Fant
- Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Todd Milbrandt
- Department of Pediatric Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Melanie Boeyer
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA
| | | | - Peter Newton
- Division Orthopedics and Scoliosis, Rady Children's Hospital, San Diego, CA, USA
| | - Amer Samdani
- Department of Pediatric Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, PA, USA
| | - Firoz Miyanji
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Dan Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, MO, USA
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Courvoisier A, Baroncini A, Jeandel C, Barra C, Lefevre Y, Solla F, Gouron R, Métaizeau JD, Maximin MC, Cunin V. Vertebral Body Tethering in AIS Management-A Preliminary Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020192. [PMID: 36832321 PMCID: PMC9955337 DOI: 10.3390/children10020192] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/30/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Vertebral Body Tethering (VBT) is a recently developed surgical technique for the treatment of progressive and severe scoliosis in patients with significant growth potential. It has been used since the first exploratory series, which showed encouraging results on the progressive correction of the major curves. This study reports on a retrospective series of 85 patients extracted from a French cohort, with a follow-up at a minimum of two years after a VBT with recent screws-and-tether constructs. The major and compensatory curves were measured pre-operatively, at the 1st standing X-ray, at 1 year, and at the last available follow-up. The complications were also analyzed. A significant improvement was observed in the curve magnitude after surgery. Thanks to growth modulation, both the main and the secondary curves continued to progress over time. Both the thoracic kyphosis and lumbar lordosis remained stable over time. Overcorrection occurred in 11% of the cases. Tether breakage was observed in 2% of the cases and pulmonary complications in 3% of the cases. VBT is an effective technique for the management of adolescent idiopathic scoliosis patients with residual growth potential. VBT opens an era of a more subtle and patient-specific surgical management of AIS that considers parameters such as flexibility and growth.
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Affiliation(s)
- Aurélien Courvoisier
- TIMC, University Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, 38000 Grenoble, France
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043 Grenoble, France
- Correspondence: ; Tel.: +33-6-74-82-56-61
| | - Alice Baroncini
- Department of Orthopaedics, RWTH Uniklinik Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Clément Jeandel
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043 Grenoble, France
| | - Clémentine Barra
- Service d’Orthopédie Pédiatrique, Hôpital Femme Mère Enfant, Hôpitaux civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Yan Lefevre
- Service d’Orthopédie Pédiatrique, CHU de Bordeaux, Pl. Amélie Raba Léon, 33000 Bordeaux, France
| | - Federico Solla
- Service d’Orthopédie Pédiatrique, Fondation Lenval, 57 Avenue de la Californie, 06200 Nice, France
| | - Richard Gouron
- Service d’Orthopédie Pédiatrique, CHU d’Amiens, Université Picardie Jules Verne, Chemin du Thil, CS 52501, CEDEX 1, 80025 Amiens, France
| | - Jean-Damien Métaizeau
- Service d’Orthopédie Pédiatrique, Centre Hospitalier Universitaire F.Mitterrand Dijon-Bourgogne, 14 Rue Paul Gaffarel, 21000 Dijon, France
| | - Marie-Christine Maximin
- Grenoble Alps Scoliosis and Spine Center, Grenoble Alps University Hospital, Bvd de la Chantourne, CEDEX 09, 38043 Grenoble, France
| | - Vincent Cunin
- Service d’Orthopédie Pédiatrique, Hôpital Femme Mère Enfant, Hôpitaux civils de Lyon, 59 Bd Pinel, 69500 Bron, France
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