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Badin D, Shah SA, Narayanan UG, Cahill PJ, Marrache M, Samdani AF, Yaszay B, Hunsberger JB, Marks MC, Sponseller PD. Fifteen Years of Spinal Fusion Outcomes in Children With Cerebral Palsy: Are We Getting Better? Spine (Phila Pa 1976) 2024; 49:247-254. [PMID: 37991210 DOI: 10.1097/brs.0000000000004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/21/2023] [Indexed: 11/23/2023]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVE We reviewed 15-year trends in operative factors, radiographic and quality of life outcomes, and complication rates in children with cerebral palsy (CP)-related scoliosis who underwent spinal fusion. SUMMARY OF BACKGROUND DATA Over the past two decades, significant efforts have been made to decrease complications and improve outcomes of this population. MATERIALS AND METHODS We retrospectively reviewed a multicenter registry of pediatric CP patients who underwent spinal fusion from 2008 to 2020. We evaluated baseline and operative, hospitalization, and complication data as well as radiographic and quality of life outcomes at a minimum 2-year follow-up. RESULTS Mean estimated blood loss and transfusion volume declined from 2.7±2.0 L in 2008 to 0.71±0.34 L in 2020 and 1.0±0.5 L in 2008 to 0.5±0.2 L in 2020, respectively, with a concomitant increase in antifibrinolytic use from 58% to 97% (all, P <0.01). Unit rod and pelvic fusion use declined from 33% in 2008 to 0% in 2020 and 96% in 2008 to 79% in 2020, respectively (both, P <0.05). Mean postoperative intubation time declined from 2.5±2.6 to 0.42±0.63 days ( P< 0.01). No changes were observed in preoperative and postoperative coronal angle and pelvic obliquity, operative time, frequency of anterior/anterior-posterior approach, and durations of hospital and intensive care unit stays. Improvements in the Caregiver Priorities and Child Health Index of Life with Disabilities postoperatively did not change significantly over the study period. Complication rates, including reoperation, superficial and deep surgical site infection, and gastrointestinal and medical complications remained stable over the study period. CONCLUSIONS Over the past 15 years of CP scoliosis surgery, surgical blood loss, transfusion volumes, duration of postoperative intubation, and pelvic fusion rates have decreased. However, the degree of radiographic correction, the rates of surgical and medical complications (including infection), and health-related quality of life measures have broadly remained constant.
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Affiliation(s)
- Daniel Badin
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Suken A Shah
- Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE
| | - Unni G Narayanan
- Department of Orthopaedic Surgery, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Majd Marrache
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA
| | - Burt Yaszay
- Department of Orthopedics and Sports Medicine, Seattle Children's Hospital and University of Washington, Seattle, WA
| | - Joann B Hunsberger
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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Brandenburg JE, Rabatin AE, Driscoll SW. Spasticity Interventions: Decision-Making and Management. Pediatr Clin North Am 2023; 70:483-500. [PMID: 37121638 DOI: 10.1016/j.pcl.2023.01.005] [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] [Indexed: 05/02/2023]
Abstract
Spasticity results from an abnormality of the central nervous system and is characterized by a velocity-dependent increase in muscle tone or stiffness. In children, it can cause functional impairments, delays in achieving developmental or motor milestones, participation restrictions, discomfort, and musculoskeletal differences. Unique to children is the ongoing process of a maturing central nervous system and body, which can create the appearance of worsening or changing spasticity. Treatment options include physical interventions such as stretching, serial casting, and bracing; oral and injectable medications; and neurosurgical procedures such as selective dorsal rhizotomy and intrathecal baclofen pump.
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Affiliation(s)
- Joline E Brandenburg
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | - Amy E Rabatin
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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Li MMJ, Ocay DD, Larche CL, Vickers K, Saran N, Ouellet JA, Gélinas C, Ferland CE. Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery. Can J Pain 2023; 7:2156332. [PMID: 36874228 PMCID: PMC9980602 DOI: 10.1080/24740527.2022.2156332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults. Aims The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery. Methods Twenty-four patients (10-18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients' self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients' behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores. Results Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients' self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters. Conclusions These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.
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Affiliation(s)
- Mandy M J Li
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Don Daniel Ocay
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada
| | - Cynthia L Larche
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Kelsey Vickers
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada
| | - Neil Saran
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - Jean A Ouellet
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
| | - Catherine E Ferland
- Department of Clinical Research, Shriners Hospitals for Children-Canada, Montreal, Quebec, Canada.,Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Child Health and Human Development Research Axis, Research Institute-McGill University Health Centre, Montreal, Quebec, Canada
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Mun F, Vankara A, Suresh KV, Margalit A, Sponseller PD. Sacral-Alar-Iliac (SAI) Fixation in Patients With Previous Pelvic Osteotomy. Clin Spine Surg 2022; 35:E702-E705. [PMID: 35501910 DOI: 10.1097/bsd.0000000000001339] [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] [Received: 11/29/2021] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The purpose of this study was to investigate the technical challenges and outcomes of sacral-alar-iliac (SAI) fixation for scoliosis in patients who had previously undergone a pelvic osteotomy for hip dysplasia. SUMMARY OF BACKGROUND DATA Patients with neuromuscular disease are at high risk for developing hip dislocation and scoliosis. Surgical correction of one may affect the other. METHODS We reviewed the records of patients aged 18 years and below who underwent spinal fusion using SAI screws after having undergone a pelvic osteotomy, with ≥2-year follow-up. We recorded the SAI screw dimensions, time from osteotomy to SAI fixation, type of osteotomy, and any complications performing SAI fixation due to the pelvic osteotomy. Bivariate statistics were used to analyze the data with statistical significance defined as P -value <0.05. RESULTS Thirty-two patients were included. The average age was 10.3±3.2 years at pelvic osteotomy and 13.5±3.4 years at SAI fixation. Most patients had cerebral palsy (87.5%) and a unilateral Dega osteotomy (78.1%). Average screw dimensions were significantly shorter on the side of the osteotomy (66 vs. 72 mm, P <0.05). SAI screw placement was technically challenging in 8 patients (25%), due to pelvic distortion from the pelvic osteotomy. The use of a curved awl helped to find the intracortical channel. No patients had complications due to the SAI screw, and there were no significant differences in pelvic obliquity and major coronal curve correction. Two patients (6.3%) had screw lucency >2 mm around the SAI screw on the side of the pelvic osteotomy but no clinical symptoms. CONCLUSIONS SAI fixation in patients with previous pelvic osteotomy is technically challenging due to pelvic morphology and prior implants. Often, a shorter SAI screw is required on the side of the osteotomy. However, outcomes in this patient population are satisfactory, with no significant complications at a 2-year follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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Mun F, Vankara A, Suresh KV, Margalit A, Crasta N, Sponseller PD. Pelvic Osteotomy in Patients With Previous Sacral-Alar-Iliac (SAI) Fixation. J Pediatr Orthop 2022; 42:376-381. [PMID: 35522850 DOI: 10.1097/bpo.0000000000002166] [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: 02/07/2023]
Abstract
INTRODUCTION Patients with neuromuscular disease are at high risk for developing hip dysplasia and scoliosis. The purpose of this study was to investigate the technical challenges and outcomes of pelvic osteotomy in patients with prior sacral-alar-iliac (SAI) fixation. METHODS We reviewed clinical and radiographic records of patients aged 18 years and below who underwent pelvic osteotomy after SAI fixation. We recorded technical challenges during the osteotomy, time from SAI fixation to osteotomy, type of osteotomy, migration index, and distance from the SAI screw to the acetabulum. A 2-sample Wilcoxon rank-sum test was used to assess the data. RESULTS Nineteen patients were included. Technical challenges were defined as having greater intraoperative fluoroscopy times and noted difficult osteotomy in the operative report. The mean time from SAI fixation to pelvic osteotomy was 2.2±1.5 years. For all 12 Chiari osteotomies, the ilium could not be laterally displaced; however, medial displacement of the distal segment of the osteotomy allowed adequate coverage. All 7 Dega osteotomies were performed by cutting the cortex at the tip of the SAI screw. The screw improved proximal leverage and provided a strong buttress for bone graft. The mean migration index before pelvic osteotomy was 59±19%, and at most recent follow-up was 13±4%. Twelve patients, who had a noted complicated osteotomy, had SAI screws that were ≤1.87 cm ( P <0.01) from the acetabulum and significantly increased intraoperative fluoroscopy time (1.76 vs. 1.18 min, P <0.01). CONCLUSIONS The presence of SAI screws may cause iliac osteotomies to be technically challenging if the tip of the SAI screw is ≤1.87 cm to the acetabulum. When initially implanting SAI screws in neuromuscular patients, surgeons should attempt to place screw tips ∼2 cm from the acetabulum in the event these patients require subsequent pelvic osteotomy. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Frederick Mun
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
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Gascón-Navarro JA, De La Torre-Aguilar MJ, Fernández-Ramos JA, Torres-Borrego J, Pérez-Navero JL. Experience in neuromuscular diseases in children and adolescents and their comorbidities in a tertiary hospital. Ital J Pediatr 2021; 47:228. [PMID: 34784950 PMCID: PMC8597309 DOI: 10.1186/s13052-021-01176-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 10/23/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Neuromuscular diseases include a large group of heterogeneous and rare pathologies that affect different components of the motor unit. It is essential to optimize resources to know the prevalence of comorbidities in the most frequent groups to establish an early multidisciplinary approach in a specialized setting. Patients and methods Retrospective descriptive study of pediatric and adolescent patients with neuromuscular diseases (NMDs). The Inclusion criteria were NMDs patients with motor neuron involvement divided into three groups, depending on the affected component of the motor unit. Group I: involvement of the motor neuron; Group II: peripheral neuropathies; Group III: myopathies. Demographic variables, association with comorbidities, need for respiratory support, and rehabilitative treatment were collected in each group. Results Ninety-six patients who met the inclusion criteria were studied. In group I, when compared to the other two groups, a higher incidence of scoliosis (68.3%, p = 0.011), deformity of the rib cage (31.3%, p = 0.0001), chronic respiratory insufficiency (62.5%, p = 0.001) and bronchial aspiration (12.5%, p = 0.03) was detected. In this group, 50%of the patients required non-invasive mechanical ventilation (p = 0.0001). The in-hospital requirement for respiratory physiotherapy was higher in group I (75%, p = 0.001). We observed a higher incidence of scoliosis in Group III compared to Group II. Conclusions Neuromuscular diseases with motor neuron involvement present more comorbidities and require an early approach after diagnosis to improve prognosis.
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Affiliation(s)
- J A Gascón-Navarro
- Department of Pediatrics. Reina Sofia University Hospital, Córdoba University, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Avd. Menéndez Pidal s/n. PC, 14004, Córdoba, Spain
| | - M J De La Torre-Aguilar
- Department of Pediatrics. Reina Sofia University Hospital, Córdoba University, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Avd. Menéndez Pidal s/n. PC, 14004, Córdoba, Spain.
| | - J A Fernández-Ramos
- Neuropediatrics Unit. Department of Pediatrics. Reina Sofia University Hospital, Córdoba University, Córdoba, Spain.,Center for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - J Torres-Borrego
- Pediatric Pneumology Unit, Department of Pediatrics. Reina Sofía University Hospital, Córdoba University, Córdoba, Spain
| | - J L Pérez-Navero
- Department of Pediatrics. Reina Sofia University Hospital, Córdoba University, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Avd. Menéndez Pidal s/n. PC, 14004, Córdoba, Spain.,Center for Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
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Noninvasive spinal stimulation safely enables upright posture in children with spinal cord injury. Nat Commun 2021; 12:5850. [PMID: 34615867 PMCID: PMC8494794 DOI: 10.1038/s41467-021-26026-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/06/2021] [Indexed: 12/23/2022] Open
Abstract
In children with spinal cord injury (SCI), scoliosis due to trunk muscle paralysis frequently requires surgical treatment. Transcutaneous spinal stimulation enables trunk stability in adults with SCI and may pose a non-invasive preventative therapeutic alternative. This non-randomized, non-blinded pilot clinical trial (NCT03975634) determined the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 8 children with trunk control impairment due to acquired SCI using within-subject repeated measures study design. Primary safety and efficacy outcomes (pain, hemodynamics stability, skin irritation, trunk kinematics) and secondary outcomes (center of pressure displacement, compliance rate) were assessed within the pre-specified endpoints. One participant did not complete the study due to pain with stimulation on the first day. One episode of autonomic dysreflexia during stimulation was recorded. Following hemodynamic normalization, the participant completed the study. Overall, spinal stimulation was well-tolerated and enabled upright sitting posture in 7 out of the 8 participants. Scoliosis due to trunk muscle paralysis frequently requires surgical treatment in children with spinal cord injury. The authors demonstrate the safety and efficacy of transcutaneous spinal stimulation to enable upright sitting posture in 7/8 children with trunk control impairment in a within-subjects, repeated measures pilot clinical trial.
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[Etiology, epidemiology, prognosis and biomechanical principles of neuromuscular scoliosis]. DER ORTHOPADE 2021; 50:608-613. [PMID: 34228159 DOI: 10.1007/s00132-021-04126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Deformity due to neuromuscular disease is often progressive and associated with reduced vital capacity. In general, all treatment should be performed in specialized centers, since invasive measures are associated with an increased morbidity compared to adolescent scoliosis. Derived from the etiology and the resulting biomechanical basis (characteristics), important aspects and considerations arise for all healthcare institutions from the examination interval to the duration of conservative therapy and initiation of surgical therapy. Proper monitoring and assessment are key components to identify curve progression and to achieve preservation or improvement of basic functions.
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Prolonged Postoperative Intubation After Spinal Fusion in Cerebral Palsy: Are There Modifiable Risk Factors and Associated Consequences? J Pediatr Orthop 2020; 40:431-437. [PMID: 32301849 DOI: 10.1097/bpo.0000000000001566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Instrumented spinal fusion is performed to correct severe spinal deformity that commonly complicates cerebral palsy (CP). Prolonged intubation (PI) is a common perioperative complication, though little is known about the risk factors and consequences of this phenomenon. QUESTIONS/PURPOSES The purpose of this study was to determine (1) the preoperative and intraoperative risk factors associated with PI after spine surgery for CP; (2) the perioperative and postoperative complications associated with PI; and (3) any long-term impacts of PI with respect to health-related quality of life. PATIENTS AND METHODS A retrospective case-control analysis of prospectively collected, multicenter data was performed on patients with Gross Motor Function Classification System (GMFCS) 4 or 5 CP who underwent instrumented spinal fusion. Patients extubated on postoperative day (POD) 0 were in the early extubation (EE) cohort and those extubated on POD 3 or later were in the PI cohort. Comparisons were made between PI and EE groups with respect to several preoperative and intraoperative variables to identify risk factors for PI. Multivariate logistic regression was performed to identify independent predictors of this outcome. The postoperative hospital course, rate of complications, and health-related quality of life at 2 years were also compared. RESULTS This study included 217 patients (52% male individuals; mean age, 14.0±2.8 y) who underwent spinal fusion for CP. In this cohort, 52 patients (24%) had EE and 58 patients (27%) had PI. There were several independent predictors of PI including history of pneumonia [odds ratio (OR), 6.2; 95% confidence interval (CI), 1.6-24.3; P=0.01], estimated blood loss of >3000 mL (OR, 16.5; 95% CI, 2.0-134; P=0.01), weight of <37 kg (OR, 6.4; 95% CI, 1.5-27.1), and Child Health Index of Life with Disabilities (CPCHILD) Communication and Social Interaction score of <15 (OR, 10.8; 95% CI, 1.1-107.3; P=0.04). In addition, PI was associated with a higher rate of perioperative and postoperative respiratory (P<0.001), cardiovascular (P=0.014), gastrointestinal (P<0.001), and surgical site (0.027) complications, in addition to prolonged hospitalization (P<0.001) and intensive care unit stay (P<0.001). CONCLUSIONS Surgeons should seek to optimize nutritional status and pulmonary function, and minimize blood loss in patients with CP to decrease the risk of PI after spinal fusion. Efforts should be made to extubate patients on POD 0 to decrease the risk of complications associated with PI.
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Redding GJ. Clinical Issues for Pediatric Pulmonologists Managing Children With Thoracic Insufficiency Syndrome. Front Pediatr 2020; 8:392. [PMID: 32793525 PMCID: PMC7390874 DOI: 10.3389/fped.2020.00392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/09/2020] [Indexed: 11/13/2022] Open
Abstract
Thoracic insufficiency Syndrome (TIS) is a recently coined phrase to describe children with spine and chest wall deformities, inherited and acquired, who have respiratory impairment, and are skeletally immature. This population has both restrictive and less often obstructive lung disease due to changes in spine and rib configuration which reduce lung volume, stiffen the chest wall, and reduce respiratory muscle strength. Although the population is heterogeneous with regard to age of onset, etiology, severity of deformity, and rate of progression of the deformity, there are common issues that arise which can be addressed by pediatric pulmonologists. These are illustrated in this review by using Early Onset Scoliosis as a common form of TIS. The pulmonary issues pertaining to TIS require collaboration with multi-disciplinary teams, particularly spine surgeons, in order to make decisions about non-surgical and surgical strategies, timing of surgery and medical supportive care over time. Pulmonary input about respiratory function should be used in conjunction with structural features of each deformity in order to determine the impact of the deformity and the response to various treatment options. In those patients with residual lung function impairment as young adults, pediatric pulmonologists must also ensure successful transition to adult care.
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Affiliation(s)
- Gregory J. Redding
- Pulmonary and Sleep Medicine Division, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, United States
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Scoliosis in paediatric onset spinal cord injuries. Spinal Cord 2020; 58:711-715. [PMID: 31959874 DOI: 10.1038/s41393-020-0418-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 01/05/2020] [Accepted: 01/06/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN This is a retrospective longitudinal review. OBJECTIVE The purpose of this review was to identify predictors of developing clinical scoliosis and compare between traumatic and neurological aetiologies of SCI. SETTING This study was conducted at the Midland Centre of SCI. METHOD Case notes of all patients injured at an age up to 18 years and admitted between 1971 and 2013 were reviewed. RESULTS Sixty-nine individuals were identified, of which seven were excluded: three with pre-existing scoliosis and four with spina bifida. The remaining 62 (44 males, 18 females) had a median age at injury of 17 years (inter quartile range 13-17). Of these, 51 (82%) had traumatic and 11 (18%) had neurological injury. Most (42/51; 82%) of the children who had a traumatic injury were older than 13 years. The risk of developing scoliosis was lower for older patients (RR 0.68 per year, 95% CI 0.52-0.83) or following a traumatic injury (RR 0.36, 95% CI 0.20-0.66). A multivariable analysis based on age and trauma showed that only older age decreased the risk. A robust Receiver Operator Curve analysis suggested 14.6 years as the optimal threshold to predict development of scoliosis within 10 years (Area Under the Curve; AUC 0.83 (95% CI 0.73-0.93), sensitivity 70% (95% CI 50-89%), specificity 89% (95% CI 74-100%). CONCLUSION Our results suggest that age below 14.6 years was a predictor for scoliosis. Once adjustment is made for age, the incidence of scoliosis does not differ between traumatic and neurological aetiologies of paediatric SCI injury.
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Otjen JP, Sousa TC, Bauer JM, Thapa M. Cerebral palsy - beyond hip deformities. Pediatr Radiol 2019; 49:1587-1594. [PMID: 31686165 DOI: 10.1007/s00247-019-04519-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] [Received: 07/04/2019] [Revised: 07/29/2019] [Accepted: 08/28/2019] [Indexed: 11/25/2022]
Abstract
Cerebral palsy is a neurologic condition with myriad musculoskeletal and articular manifestations. While every patient is unique with innumerable variations in presentation, symptoms and treatments, there are broad themes and recognizable patterns of development. Many of these findings spill over to other neurodevelopmental disorders, and lessons learned from children with cerebral palsy translate well to multiple neurologic conditions. This review focuses on the more common manifestations involving the spine, knee, foot and ankle, with an emphasis on collecting and describing imaging features, along with clinical and radiologic pearls and pitfalls.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington, Mail Stop MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Ted C Sousa
- Department of Orthopedic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Jennifer M Bauer
- Department of Orthopedic Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Mahesh Thapa
- Department of Radiology, Seattle Children's Hospital, University of Washington, Mail Stop MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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The Impact of Body Mass Index (BMI) on 30-day Outcomes Following Posterior Spinal Fusion in Neuromuscular Scoliosis. Spine (Phila Pa 1976) 2019; 44:1348-1355. [PMID: 31261270 DOI: 10.1097/brs.0000000000003084] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective. OBJECTIVE Assess the impact of varying severity of BMI on 30-day outcomes following posterior spinal fusions in neuromuscular scoliosis. SUMMARY OF BACKGROUND DATA Obesity in the pediatric population is shown to be associated with adverse outcomes across varying specialties. The weight-outcome relationship in neuromuscular scoliosis has not been thoroughly investigated. METHODS The 2012-2016 American College of Surgeons - National Surgical Quality Improvement (ACS-NSQIP) database was queried using Current Procedural Terminology codes 22800, 22802, and 22804 to identify patients undergoing posterior spinal fusion for neuromuscular scoliosis only. BMI was classified into four groups based on the Center for Disease Control (CDC) BMI-for-age percentile chart - Normal weight (BMI ≥5th to <85th percentile), Underweight (<5th percentile), Overweight (≥85th to <95th percentile) and Obese (≥95th percentile). Multivariate regression models were built to understand the impact of varying BMI severity classes on 30-day outcomes. RESULTS A total of 1291 patients underwent posterior spinal fusion for neuromuscular scoliosis. A total of 695 (53.8%) were normal weight, 286 (22.2%) were underweight, 145 (11.2%) were overweight, and 165 (12.8%) were obese. Obese patients versus normal weight patients were at a significantly higher risk of surgical site infections (OR 2.15; P = 0.035), wound dehiscence (OR 1.58; P = 0.037), urinary tract infections (OR 3.41; P = 0.010), and 30-day readmissions (OR 1.94; P = 0.029). Of note, overweight versus normal weight individuals had higher odds of cardiopulmonary complications (OR 8.82; P = 0.024). No significant associations were seen for varying BMI and other 30-day outcomes. CONCLUSIONS Obese neuromuscular patients undergoing PSF have higher odds of experiencing adverse outcomes, particularly surgical site infections, urinary tract infections, and readmissions. Providers should promote prevention strategies, such as dietary modification and/or early physical activity in these high-risk patients to minimize the risks of experiencing complications in the acute postoperative period. LEVEL OF EVIDENCE 3.
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Cuddihy LA, Antonacci MD, Hussain AK, Vig KS, Mulcahey MJ, Betz RR. Progressive Neuromuscular Scoliosis Secondary to Spinal Cord Injury in a Young Patient Treated With Nonfusion Anterior Scoliosis Correction. Top Spinal Cord Inj Rehabil 2019; 25:150-156. [PMID: 31068746 DOI: 10.1310/sci2502-150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ninety-eight percent of skeletally immature patients with spinal cord injury (SCI) suffer from progressive neuromuscular scoliosis (NMS). Operative treatment has typically been limited to posterior spinal fusion (PSF), but a newer technique as described may be less invasive and preserve more function. A PSF of the entire spine to the pelvis is standard of care. However, maintenance of spinal flexibility, motion, and potential growth is desirable. We present a case for proof-of-concept of utilizing a surgical motion-preserving technique to treat progressive NMS in an 11year-old girl with T10 level (AIS B) paraplegia with a progressive 60° NMS of the lumbar spine. She had anterior scoliosis correction (ASC) from T11-L5 without fusion. Over 24 months, the curve growth-modulated to a residual of 12° with continued modulation to 7° at 3-year follow-up (skeletal maturity).
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Affiliation(s)
- Laury A Cuddihy
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
| | | | - Awais K Hussain
- Department of Orthopaedic Surgery, University of Illinois College of Medicine, Chicago, Illinois
| | - Khushdeep S Vig
- Department of Orthopedic Surgery, Albany Medical Center, Albany, New York
| | - Mary Jane Mulcahey
- Jefferson College of Rehabilitation Sciences (Philadelphia University & Thomas Jefferson University), Philadelphia, Pennsylvania
| | - Randal R Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
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Brandenburg JE, Fogarty MJ, Sieck GC. A Critical Evaluation of Current Concepts in Cerebral Palsy. Physiology (Bethesda) 2019; 34:216-229. [PMID: 30968751 PMCID: PMC7938766 DOI: 10.1152/physiol.00054.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/11/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022] Open
Abstract
Spastic cerebral palsy (CP), despite the name, is not consistently identifiable by specific brain lesions. CP animal models focus on risk factors for development of CP, yet few reproduce the diagnostic symptoms. Animal models of CP must advance beyond risk factors to etiologies, including both the brain and spinal cord.
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Affiliation(s)
- Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine , Rochester, Minnesota
- Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine , Rochester, Minnesota
| | - Matthew J Fogarty
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine , Rochester, Minnesota
| | - Gary C Sieck
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine , Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine , Rochester, Minnesota
- Department of Anesthesiology, Mayo Clinic College of Medicine , Rochester, Minnesota
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Brooks JT, Yaszay B, Bartley CE, Bastrom TP, Sponseller PD, Shah SA, Samdani A, Cahill PJ, Miyanji F, Newton PO. Do All Patients With Cerebral Palsy Require Postoperative Intensive Care Admission After Spinal Fusion? Spine Deform 2019; 7:112-117. [PMID: 30587303 DOI: 10.1016/j.jspd.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN Retrospective review of a prospective cohort. OBJECTIVE To identify patient and surgical factors that alter the length of postoperative intensive care unit (ICU) stays after spinal fusion/instrumentation in patients with neuromuscular scoliosis secondary to cerebral palsy (CP). SUMMARY OF BACKGROUND DATA High perioperative complication rates in patients with CP contribute to the practice of utilizing the ICU postoperatively for monitoring. However, this is costly and little is known regarding which patients truly need this increased acuity of care. METHODS A prospective, multicenter database was queried for patients with CP who underwent spinal fusion and instrumentation. Patients with an ICU length of stay (LOS) ≤1 day were assumed to not have required postoperative ICU admission. Demographic and surgical characteristics were compared between those with ICU LOS of ≤1 day versus >1 day. A classification and regression tree (CART) analysis was utilized to create a decision algorithm for postoperative ICU admission. RESULTS Three hundred twenty-four patients were identified with a mean ICU LOS of 4.7 days (range 0-47). Sixty-eight patients (21%) had an ICU LOS ≤1 day and 256 patients (79%) had an ICU LOS >1 day. CART analysis demonstrated that the institution where the surgery was performed was the primary predictor with two groups: sites that almost routinely had ICU stay >1 day (92%) and those that were split (50.5% >1 day). In the latter group, an operative time greater than 4 hours was a risk factor for a longer ICU stay. CONCLUSION Because of their heterogeneous makeup, CP patients should be evaluated individually and their postoperative disposition should not be based on institutional tradition but instead on objective surgical factors. For those patients with surgical times less than 4 hours, discussions should be held regarding the safety of a postoperative disposition to a regular floor. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jaysson T Brooks
- Children's of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA
| | - Burt Yaszay
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA.
| | - Carrie E Bartley
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Tracey P Bastrom
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Paul D Sponseller
- The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Suken A Shah
- Nemours Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Amer Samdani
- Shriners Hospitals for Children, 3551 N. Broad St., Philadelphia, PA 19140, USA
| | - Patrick J Cahill
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, PA 19104, USA
| | - Firoz Miyanji
- British Columbia Children's Hospital, 4480 Oak St, Vancouver, Vancouver, BC, Canada
| | - Peter O Newton
- Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
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Minimally invasive Dega acetabuloplasty for the treatment of neuromuscular hip dysplasia. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ALÍ-MORELL OSAMAJ, ZURITA-ORTEGA FÉLIX, FERNÁNDEZ-ESTÉVEZ BERENICE, PADILLA-OBISPO BEATRIZ, MARTÍNEZ-PORCEL ROBERTO. ERECTOR SPINAE AND SCOLIOSIS IN A POPULATION WITH CEREBRAL PALSY: A PRELIMINARY STUDY. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181701155345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To verify the relation of muscular response to the vestibular stimulation of the erector spinae, specifically longissimus thoracis and iliocostalis lumborum, with the origin of scoliosis in a population of individuals with level V cerebral palsy of the Gross Motor Function Classification System (GMFCS). Methods: Cross-sectional study of 12 individuals aged between four and 14 years. The muscular activity of the longissimus thoracis and iliocostalis lumborum was recorded by electromyography in the presence of anteroposterior and lateral imbalances, comparing it with that obtained in sitting position without imbalances. Scoliosis was assessed by radiological study following Cobb method. Results: Statistically significant differences were found between correct responses of both muscles to anteroposterior imbalances and absence of right thoracolumbar scoliosis (p=0.005; p=0.028), left thoracic scoliosis (p=0.005; p=0.046) and right lumbar scoliosis (p=0.005; p=0.046). Conclusions: The symmetry of muscular responses to anteroposterior imbalances, both of longissimus thoracis and iliocostalis lumborum, seems to be one of the factors that prevent the development of spine deviations in this population. Level of evidence: IV. Type of Study: Case series
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Matthews M, Blandford S, Marsden J, Freeman J. The use of dynamic elastomeric fabric orthosis suits as an orthotic intervention in the management of children with neuropathic onset scoliosis: A retrospective audit of routine clinical case notes. SCOLIOSIS AND SPINAL DISORDERS 2016; 11:14. [PMID: 27299163 PMCID: PMC4900238 DOI: 10.1186/s13013-016-0073-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
Background To date the main treatment approach for neuropathic onset scoliosis has utilised thoracic lumbar sacral orthoses (TLSO) to stabilize the spine and enable stable sitting. Dynamic elastomeric fabric orthoses (DEFOs) may achieve both of these aims if used as an early intervention. Due to a lack of evidence in this area, a retrospective audit of case notes was undertaken to understand current orthotic practice investigating the usage, outcomes and clinical characteristics of treated children with neuropathic onset scoliosis. Clinical notes of 180 children at risk for, or identified with, scoliosis were audited using a search matrix to identify diagnostic group, spinal muscle tone, Gross Motor Functional Classification Scale (GMFCS) level, orthotic treatment modalities, scoliosis specific data, surgical interventions, adaptive technologies used, and outcome measurements reported. Results Of the 180 notes examined, 85 were male; mean age nine years one month [SD four years seven months]. Spinal muscle tone was reported in 137 cases: 122/137 presented as low tone, 4/137 high tone, 6/137 fluctuating tone and 5/137 typical tone. Scoliosis was confirmed in (77/180) of whom (39/77) used a DEFO. Another (43/180) had a spinal curve developing, of whom (22/43) used a DEFO. The remaining (60/180) had no report of spinal curvature, but used a DEFO as a preventative measure. GMFCS scores were reported for 49 children of whom 14/49 were graded as level 4 and 17/49 level 5. Of the children with scoliosis who had spinal curve shapes reported, 48/60 had a C-shape presentation and 12/60 had an S-shape. Conclusions The findings confirm previously reported papers in children with neuropathic onset scoliosis in relation to curve shape and GMFCS levels. It provides some evidence of the role DEFOs may have in the management of these children, and highlights the need for further research in this area due to the lack of peer-reviewed publications.
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Affiliation(s)
- Martin Matthews
- DM Orthotics Ltd, Cardrew Way, Cardrew Industrial Estate, Redruth, Cornwall TR15 1SS UK
| | - Suzanne Blandford
- Faculty of Health and Human Sciences, Peninsula Allied Health Centre, Plymouth University, Derriford Road, Plymouth, PL6 8BH UK
| | - Jonathan Marsden
- Faculty of Health and Human Sciences, Peninsula Allied Health Centre, Plymouth University, Derriford Road, Plymouth, PL6 8BH UK
| | - Jennifer Freeman
- Faculty of Health and Human Sciences, Peninsula Allied Health Centre, Plymouth University, Derriford Road, Plymouth, PL6 8BH UK
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Abi Chahine NH, Wehbe TW, Hilal RA, Zoghbi VV, Melki AE, Bou Habib EB. Treatment of Cerebral Palsy with Stem Cells: A Report of 17 Cases. Int J Stem Cells 2016; 9:90-5. [PMID: 27426090 PMCID: PMC4961108 DOI: 10.15283/ijsc.2016.9.1.90] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/27/2022] Open
Abstract
Cerebral Palsy (CP) is a disabling condition that affects a child's life and his/her family irreversibly. It is usually a non-progressive condition but improvement over time is rarely seen. The condition can be due to prenatal hypoxia, metabolic, genetic, infectious, traumatic or other causes. It is therefore a heterogeneous group that results in functional motor disability associated with different degrees of cognitive abnormalities. There are no treatments that can cure or even improve CP and the best available approach aims at functional, social and nutritional supportive care and counseling. In this paper, we report 17 sequential patients with CP treated with intrathecal administration of Bone Marrow Mononuclear Cells (BMMC). All patients had an uneventful post-injection course with 73% of the evaluable patients treated having a good response using the Gross Motor Function Classification System (GMFCS). The average improvement was 1.3 levels on the GMFCS with cognitive improvements as well.
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Affiliation(s)
| | - Tarek W. Wehbe
- Head of the Department of Hematology, Notre Dame Du Liban University Hospital and The Lebanese-Canadian Hospital, Beirut,
Lebanon
| | - Ramzi A. Hilal
- Neurology, Head of the Department, The Lebanese-Canadian Hospital, Beirut,
Lebanon
| | | | - Alia E. Melki
- Doctorate of Acupuncture and TCM, The Five Elements Wellness Center, Koura,
Lebanon
| | - Emil B. Bou Habib
- Neurosurgery, Head of Department, The Lebanese-Canadian Hospital, Beirut,
Lebanon
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Yuan N, Sterni LM. Outpatient Care of the Ventilator Dependent Child. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Garcez CA, Neves ELA, Melo SMD, Nunes PS, Barreto LCL, Costa IMP, Souza CC, Rezende RL, Araújo AADS. Evaluation of Respiratory Muscle Strength and Pulmonary Function in Patients with Charcot-Marie-Tooth Disease Type 2. Eur Neurol 2015; 74:310-4. [PMID: 26674657 DOI: 10.1159/000442282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/08/2015] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate the pulmonary condition in a large family with Charcot-Marie-Tooth disease type 2 (CMT2). Eighteen participants diagnosed with CMT2 and 20 healthy individuals were evaluated by spirometry and maximal expiratory and maximal inspiratory pressures (MEP and MIP, respectively). Clinical disability was measured with CMT neuropathy score (CMTNS; range 0-36). One control group (CG) comprising 20 individuals, matched for age, sex and body mass index, were used for comparison. Eight patients were female (44.5%) and 10 patients were male (55.5%); mean age was 31.8 years (range 11-79) and CMTNS range was 6-26. Differences between CMT2 and CG in the spirometry and respiratory muscle strength were statistically significant for all dimensions. There were significant correlations between CMTNS and MIP (Pearson = -0.581) and MEP (Pearson = -0.5090). The results of this study show that patients with CMT, in spite of not showing clinical signs of advanced respiratory impairment, may present subclinical respiratory changes. The respiratory comprise in the CMT disease can be silent and insidious without presenting characteristic clinical signals.
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Affiliation(s)
- Catarina Andrade Garcez
- Nx00FA;cleo de Px00F3;s-Graduax00E7;x00E3;o em Medicina da Universidade Federal de Sergipe-UFS, Sx00E3;o Cristx00F3;vx00E3;o, Sergipe, Brazil
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Hasegawa T, Oshima Y, Hisamatsu C, Matsuhisa H, Maruo A, Yokoi A, Bitoh Y, Nishijima E, Okita Y. Innominate artery compression of the trachea in patients with neurological or neuromuscular disorders. Eur J Cardiothorac Surg 2013; 45:305-11. [DOI: 10.1093/ejcts/ezt346] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Sint Jan S, Wermenbol V, Van Bogaert P, Desloovere K, Degelaen M, Dan B, Salvia P, Ortibus E, Bonnechère B, Le Borgne YA, Bontempi G, Vansummeren S, Sholukha V, Moiseev F, Rooze M. Une plate-forme technologique liée à la paralysie cérébrale. Med Sci (Paris) 2013; 29:529-36. [DOI: 10.1051/medsci/2013295017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mulcahey MJ, Gaughan JP, Betz RR, Samdani AF, Barakat N, Hunter LN. Neuromuscular scoliosis in children with spinal cord injury. Top Spinal Cord Inj Rehabil 2013; 19:96-103. [PMID: 23671379 DOI: 10.1310/sci1902-96] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of neuromuscular scoliosis in children with spinal cord injury (SCI) is high. Published reports suggest that age at time of injury is the most important determinant. No studies have evaluated neurological characteristics using standardized methods to determine if they are strong predictors of scoliosis. OBJECTIVE To test the hypothesis that neurological level, motor score, and injury severity are strong predictors of neuromuscular scoliosis. METHODS Two hundred seventeen children were evaluated using the testing guidelines of the International Standards for Neurological Classification of Spinal Cord Injury. Cobb angles were calculated from plain radiographs as a measure of scoliosis. Multivariate analysis with statistical selection was used to determine predictors of worst Cobb angle and spinal fusion. The odds of having a spine fusion for subjects with at least 2-year follow-up and injured prior to (n=16) and after (n=91) 12 years of age were calculated. RESULTS The hypothesis was not supported. Although there was a very high prevalence (100%) of scoliosis in the study sample, age at time of injury was the only predictor of worst curve (P < .0001) and spine fusion (P < .007). The calculated odds ratio demonstrated that children injured <12 years were 3.7 times more likely to have a spine fusion (95% CI, 0.31-44.64). CONCLUSION There is a very high prevalence of neuromuscular scoliosis in pediatric SCI. Neurological level, motor level, and severity of injury are not strong predictors. Age is the only predictor of worst curve and spine fusion.
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Affiliation(s)
- M J Mulcahey
- Jefferson School of Health Professions, Thomas Jefferson University , Philadelphia, Pennsylvania ; Shriners Hospitals for Children , Philadelphia, Pennsylvania
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Mohanty RK, Tripathi A, Lenka P, Equebal A, Kumar R. The effect of a spinal orthosis on posture and cardio-respiratory functions in progressive myopathic scoliosis. Prosthet Orthot Int 2012; 36:450-5. [PMID: 22549821 DOI: 10.1177/0309364612442678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Historically, the orthotic treatment in progressive myopathic scoliosis has not been as effective as expected. The purpose of this study was to investigate the effect of a spinal orthosis on scoliotic curve correction, alignment of altered posture and cardio-respiratory functions. CASE DESCRIPTION AND METHODS An 11 year-old girl diagnosed with myopathy was fitted with a custom molded thoraco-lumbo-sacral orthosis to enhance the sitting ability. The cardio-respiratory tests were performed by a COSMED K4 b(2); metabolic analyzer. The anterior posterior radiographs were analyzed for measuring Cobb angle and Ferguson angle. A plumb line test was used to assess the postural improvements. FINDINGS AND OUTCOMES No significant difference was observed for variables such as O(2) consumption level, PaO(2), tidal volume, heart rate and energy expenditure/min. The improved posture was evident by shifting of the plumb line 18 mm towards the mid line with the use of orthosis. Very minor improvements in both angles were observed with the use of the brace. CONCLUSION The brace treatment cannot be expected to have a lasting corrective effect although it can be used as a sitting support and for maintaining posture Clinical relevance This case study provides an objective prescription of thoraco-lumbo-sacral orthosis as a sitting support and for improving posture in progressive myopathic scoliosis if suitably designed and properly fitted.
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Affiliation(s)
- Rajesh K Mohanty
- MPO Training Section, National Institute for the Orthopaedically Handicapped, Kolkata, India.
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Hadianfard MJ, Ashraf A. Hip dysplasia associated with a hereditary sensorimotor polyneuropathy mimics a myopathic process. Ann Indian Acad Neurol 2012; 15:211-3. [PMID: 22919197 PMCID: PMC3424802 DOI: 10.4103/0972-2327.99722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 05/16/2011] [Accepted: 06/28/2011] [Indexed: 11/04/2022] Open
Abstract
Some orthopedic complications have been reported in the hereditary neuropathies. However, the association of the hip dysplasia with this category of neuropathy is rarely recognized. We present a 13-year-old boy with the progressive weakness of the lower extremities, difficulty in walking, climbing stairs, and rising from floor; a wide-based, hyper-extended and waddling gait similar to a myopathic process. Hip radiography showed dysplastic acetabulae with hip subluxation, broken Shenton's lines, and valgus femoral necks. In electrodiagnosis, there was a significant neuropathic process (absent all evoked sensory potentials, abnormal evoked motor responses, and neurogenic electeromyography) which eventually was found to be a hereditary mixed axonal and demyelinating sensorimotor polyneuropathy with concomitant hip dysplasia confirmed with thorough physical examination and the electrodiagnostic study. In patients with gait difficulties such as waddling gait mimicking a myopathic process, hereditary polyneuropathy complicated with hip dysplasia should be considered as well.
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Affiliation(s)
- Mohammad Javad Hadianfard
- Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
PURPOSE OF REVIEW The heterogeneous nature of neuromuscular disorders (NMDs) continues to promote slow but steady advances in diagnosis, classification, and treatment. This review focuses on the updates in the general management and treatment of NMDs, with emphasis on key updates in muscular dystrophy, myotonic dystrophy, mitochondrial myopathy, spinal muscular atrophy, and hereditary neuropathies. RECENT FINDINGS Current research shows that improvements in morbidity and mortality in various NMDs may be possible. Key components include advances in identification and classification of individual NMDs; attention to anesthetic and surgical risks; aggressive pulmonary care; and implementations of a proactive, multidisciplinary, standard-of-care approach. Innovative molecular and pharmaceutical therapeutic options are being investigated in many of these disorders, but unfortunately no new intervention has borne out. SUMMARY Important advances were made in the last year in the field of neuromuscular disease. However, because of their heterogeneous nature and rarity, diagnosis and treatment of these disorders either as a single disorder or as a group continue to be both a clinical and a research challenge. It is of utmost importance that clinicians and researchers be aware of these disorders to aid in identification and treatment.
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Pontes JF, Ferreira GMH, Fregonezi G, Sena-Evangelista KCMD, Dourado Junior ME. Força muscular respiratória e perfil postural e nutricional em crianças com doenças neuromusculares. FISIOTERAPIA EM MOVIMENTO 2012. [DOI: 10.1590/s0103-51502012000200002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: As doenças neuromusculares infantis são crônicas, degenerativas e determinam alterações funcionais, musculares e nutricionais. OBJETIVOS: Avaliar sistematicamente a força muscular respiratória e o perfil postural e nutricional de crianças com doenças neuromusculares em seguimento multidisciplinar institucional. MATERIAIS E MÉTODOS: Foram estudados pacientes com diferentes doenças neuromusculares por meio da verificação da força muscular respiratória, da avaliação nutricional de massa muscular, do índice de massa corpórea e da porcentagem (%) de gordura corporal, além de avaliação postural e dos padrões de movimento. RESULTADOS: Foram avaliados 41 sujeitos. As crianças do sexo masculino predominaram na população em estudo, sendo 82,9% dela (n = 34), e os outros 17,1% (n = 7) eram do sexo feminino. A média de idade encontrada foi de 9,65 ± 3,11 anos. O principal diagnóstico encontrado foi Distrofia Muscular de Duchenne, 43,9% (n = 18), seguido de Atrofia Muscular Espinhal, 9,75% (n = 4), Distrofia Congênita, 7,31% (n = 3), Distrofia Muscular de Cinturas, Polineuropatia e Miopatia Congênita, todos com 4,9% (n = 2), além de Distrofia Muscular Progressiva, Miastenia Grávis, Charcoot Marie Toot, Emery Dreifuss, encontrados em 2,43% (n = 1). Foi verificada uma diminuição da força muscular respiratória (PImáx = 81 ± 24,3 cmH2O, 91% predito e PEmáx = 70 ± 29,6 cmH2O, 72% predito), mais evidente nos músculos expiratórios. A Hiperlordose lombar foi encontrada em 26 pacientes (64%) e 9 pacientes (22%) já haviam perdido a capacidade de deambular. Em relação ao perfil nutricional, 90% dos pacientes (n = 30) mostraram uma alta incidência de perda de reserva muscular e 52% deles (n = 13) apresentaram a porcentagem de gordura corporal abaixo do aceitável. CONCLUSÃO: A avaliação multidisciplinar das doenças neuromusculares pediátricas podem auxiliar no estabelecimento de tratamento precoce da Fisioterapia para melhorar a qualidade de vida dos pacientes e cuidadores.
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Cancel D, Capoor J. Patient safety in the rehabilitation of children with spinal cord injuries, spina bifida, neuromuscular disorders, and amputations. Phys Med Rehabil Clin N Am 2012; 23:401-22. [PMID: 22537702 DOI: 10.1016/j.pmr.2012.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pediatric patient safety continues to challenge both pediatricians and pediatric physiatrists. While there is a trend toward developing general patient safety initiatives, there is little research on pediatric patient safety. This article identifies major areas of general safety risk, with a focus on timely diagnosis and care coordination to prevent secondary complications that compromise health, function, and quality of life in pediatric neuromuscular disease, spinal cord disorders, and amputation.
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Affiliation(s)
- David Cancel
- Department of Rehabilitation Medicine, Kingsbrook Rehabilitation Institute, 585 Schenectady Avenue, Brooklyn, NY 11203, USA
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Wang CH, Bonnemann CG, Rutkowski A, Sejersen T, Bellini J, Battista V, Florence JM, Schara U, Schuler PM, Wahbi K, Aloysius A, Bash RO, Béroud C, Bertini E, Bushby K, Cohn RD, Connolly AM, Deconinck N, Desguerre I, Eagle M, Estournet-Mathiaud B, Ferreiro A, Fujak A, Goemans N, Iannaccone ST, Jouinot P, Main M, Melacini P, Mueller-Felber W, Muntoni F, Nelson LL, Rahbek J, Quijano-Roy S, Sewry C, Storhaug K, Simonds A, Tseng B, Vajsar J, Vianello A, Zeller R. Consensus statement on standard of care for congenital muscular dystrophies. J Child Neurol 2010; 25:1559-81. [PMID: 21078917 PMCID: PMC5207780 DOI: 10.1177/0883073810381924] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Congenital muscular dystrophies are a group of rare neuromuscular disorders with a wide spectrum of clinical phenotypes. Recent advances in understanding the molecular pathogenesis of congenital muscular dystrophy have enabled better diagnosis. However, medical care for patients with congenital muscular dystrophy remains very diverse. Advances in many areas of medical technology have not been adopted in clinical practice. The International Standard of Care Committee for Congenital Muscular Dystrophy was established to identify current care issues, review literature for evidence-based practice, and achieve consensus on care recommendations in 7 areas: diagnosis, neurology, pulmonology, orthopedics/rehabilitation, gastroenterology/ nutrition/speech/oral care, cardiology, and palliative care. To achieve consensus on the care recommendations, 2 separate online surveys were conducted to poll opinions from experts in the field and from congenital muscular dystrophy families. The final consensus was achieved in a 3-day workshop conducted in Brussels, Belgium, in November 2009. This consensus statement describes the care recommendations from this committee.
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Affiliation(s)
- Ching H. Wang
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | | | | | - Robert O. Bash
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Christophe Béroud
- INSERM U827, Laboratoire de Génétique Moleculaire, Montpellier, France
| | | | - Kate Bushby
- Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ronald D. Cohn
- John Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Michelle Eagle
- Institute of Human Genetics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Ana Ferreiro
- UMR 787 Groupe Myologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Albert Fujak
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | | | | | | | | | | | | | - Jes Rahbek
- Rehabiliterings Center for Muskelsvind, Aarhus, Denmark
| | | | | | - Kari Storhaug
- National Resource Centre for Oral Health in Rare Medical Conditions, Oslo, Norway
| | | | - Brian Tseng
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jiri Vajsar
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Reinhard Zeller
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
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Current world literature. Curr Opin Pediatr 2010; 22:117-26. [PMID: 20068414 DOI: 10.1097/mop.0b013e32833539b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Horan MP, Milbrandt TA. Scoliosis in pediatric patients: comorbid disorders and screening. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/phe.09.48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Scoliosis is one of the most commonly encountered pediatric spinal deformities. Knowledge of comorbid disorders associated with scoliosis is required in order to rule out other serious conditions. A thorough knowledge of the clinical scenarios associated with each of these disorders will help guide the pediatric practitioner in their work-up of associated conditions and possible further referrals. The aim of this review is to discuss the comorbidities associated with scoliosis and review appropriate screening tools aiding diagnosis.
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Affiliation(s)
- Michael P Horan
- Chief Resident, Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 740 South Limestone, Suite k-408, Lexington, KY 40536–0248, USA
| | - Todd A Milbrandt
- Assistant Professor, Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 740 South Limestone, Suite k-408, Lexington, KY 40536–0248, USA and Shriners Hospital for Children, 1900 Richmond Road, Lexington, KY 40502, USA
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