Risk Factors for Development and Progression of Scoliosis After Pediatric Cardiothoracic Operations

Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis

INTRODUCTION

Open heart surgery is the most common treatment for congenital heart disease. Thoracotomy, sternotomy, or a combination of both are the main approaches used in open heart surgeries. In cardiac surgery, there have been concerns that these surgeries increase the likelihood of spinal deformities. Therefore, this systematic review and meta-analysis provided updated evidence on the prevalence of spinal deformities following congenital heart surgery.

METHOD

EMBASE, Medline, ScienceDirect, and Google Scholar were used to search for studies published until 2022. We include randomized clinical trials and observational studies that reported the prevalence of spinal deformities (scoliosis and kyphosis) after congenital heart surgery among participants without these deformities before surgery. Two independent reviewers independently screened literature identified from the databases. Two reviewers independently conducted screening of studies identified during the search, data extraction, and quality assessment of the included studies.

RESULTS

In total, 688 studies were screened; 13 retrospective and one prospective cohort studies were included, encompassing 2294 participants. The pooled prevalence of spinal deformities (scoliosis and kyphosis) after open heart surgery performed on skeletally immature patients was 23.1% (95% confidence interval [CI] = 23.1-35.3; I2 = 97.5%).

CONCLUSION

This review suggests that the prevalence of spinal deformities was high among patients who underwent sternotomy or thoracotomy.

The Impact of Prematurity at Birth on Short-Term Postoperative Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012-2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (<28 weeks), very (28-31 weeks), and moderate-to-late (32-36 weeks) premature. Univariate analysis with post hoc Bonferroni compared demographics, hospital parameters, and 30-day outcomes. Multivariate logistic regression identified independent predictors of adverse 30-day outcomes. 5531 patients (term = 5099; moderate-to-late premature = 250; very premature = 101; extremely premature = 81) were included. Premature patients had higher baseline rates of multiple individual comorbidities, longer mean length of stay, and higher 30-day readmissions and infections than the term cohort. Thirty-day readmissions increased with increasing prematurity. Very premature birth predicted UTIs, superficial SSI/wound dehiscence, and any infection, and moderate-to-late premature birth predicted renal insufficiency, deep space infections, and any infection. Prematurity of AIS patients differentially impacted rates of 30-day adverse outcomes following ≥7-level PSF. These results can guide preoperative optimization and postoperative expectations.

Progression of infantile scoliosis after thoracotomy and sternotomy for the treatment of congenital cardiac abnormalities

PURPOSE

To determine whether the rate of progression of scoliosis is higher following thoracotomies and sternotomies in children.

METHODS

We undertook a retrospective review of 1744 patients from a tertiary paediatric referral unit who had sternotomies or thoracotomies from 2005 to 2010 to identify those with scoliosis and to determine where possible, the pre- and post-operative rate of scoliosis progression. A secondary objective was to assess the risk factors for progression after surgery through Chi-square analysis.

RESULTS

1419/1744 (81.4%) patients (55% M, 45% F) had post-op chest X-rays. 25% had a thoracotomy, and 75% had a sternotomy. 5.8% had scoliosis at their most recent chest X-ray (mean Cobb angle 20° (range 11-63°)). There was no significant difference for rates of scoliosis for those who had sternotomies vs thoracotomies (6.3% vs. 4.6% P = 0.258) but a significant difference for those who had primary vs revision sternotomies (5.1% vs. 9.9% P = 0.008). Pre- and post-op progression calculations were possible in 30 patients. The mean time from surgery to the start of the progression was 12 months (range 0-93 months). There was no significant difference between the rates of progression pre-op vs post-op: 1.0 vs. 0.5 deg/month, P = 0.228. There was no significant difference between the rates of post-op progression for those who had a sternotomy versus a thoracotomy (0.5 vs. 0.5 deg/month P = 0.503).

CONCLUSION

Thoracotomies and sternotomies do not appear to increase the rate of progression of scoliosis in these patients.

LEVEL OF EVIDENCE

III. Radiographs illustrating scoliosis progression.

Curve Characteristics and Surgical Outcomes in Scoliosis Associated With Childhood Sternotomy or Thoracotomy

BACKGROUND

The purpose of this study is to describe curve characteristics and postoperative outcomes in patients undergoing spinal fusion (SF) to treat thoracogenic scoliosis related to sternotomy and/or thoracotomy as a growing child.

METHODS

A retrospective review of electronic medical records of all patients with Post-Chest Incision scoliosis treated with SF was performed at 2 tertiary care pediatric institutions over a 19-year period. Curve characteristics, inpatient, and outpatient postoperative outcomes are reported.

RESULTS

Thirty-nine patients (62% female) were identified. Eighteen had sternotomy alone, 14 had thoracotomy alone, and 7 had both. Mean age at the time of first chest wall surgery was 2.5 years (range: 1.0 d to 14.2 y). Eighty-five percent of patients had a main thoracic curve (mean major curve angle 72 degrees, range: 40 to 116 degrees) and 15% had a main lumbar curve (mean major curve angle 76 degrees, range: 59 to 83 degrees). Mean thoracic kyphosis was 40 degrees (range: 4 to 84 degrees). Mean age at the time of SF was 14 years (range: 8.2 to 19.9 y). Thirty-six patients had posterior fusions and 3 had combined anterior/posterior. Mean coronal curve correction measured at the first postoperative encounter was 53% (range: 9% to 78%). There were 5 (13%) neuromonitoring alerts and 2 (5%) patients with transient neurological deficits. Mean length of hospital stay was 9±13 days. At an average follow-up time of 3.1±2.4 years, 17 complications (10 medical and 7 surgical) were noted in 9 patients for an overall complication rate of 23%. There was 1 spinal reoperation in the cohort. 2/17 (12%) complications were Clavien-Dindo-Sink class III and 5/17 (29%) were class IV.

CONCLUSION

Kyphotic thoracic curves predominate in patients with Post-Chest Incision scoliosis undergoing SF. Although good coronal and sagittal plane deformity can be expected after a fusion procedure, postoperative complications are not uncommon in medically complex patients, often necessitating longer postoperative stays.

LEVEL OF EVIDENCE

Level III.