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Hnaini M, Downs M, Miller MR, Campbell C, St-Laurent A. Duchenne muscular dystrophy respiratory profiles from real world registry data. Pediatr Pulmonol 2023; 58:2725-2732. [PMID: 37539841 DOI: 10.1002/ppul.26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/16/2023] [Accepted: 06/03/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Understanding real-world profiles from neuromuscular databases is helpful for optimizing clinical care and planning research studies. The Canadian Neuromuscular Disease Registry (CNDR) has respiratory data from a population of boys with Duchenne Muscular Dystrophy (DMD). OBJECTIVES To describe cross-sectional respiratory profiles from a national DMD real-world dataset. To explore the relationship between forced vital capacity percent predicted (FVC%) and disease severity parameters: scoliosis, ambulation and ventilation status. METHODS Descriptive statistics summarized the respiratory profiles. The CNDR registry enrolls and collects DMD clinic data from 36 Canadian centers. RESULTS There were 414 participants enrolled. The age ranged from 2 to 36 years old. Pulmonary function test data were available for 323 participants. The use of ventilatory support was seen in a significant proportion (19.5%) of subjects by age 14-16 years and was used by the majority (69.2%) by age 20-22 years. FVC% declined at a rate of 3.19% per year with every 1-year increase in age. FVC% declined annually by 2.47% in nonambulatory participants versus by 0.96% in ambulatory participants. FVC% did not significantly change over age with the presence of scoliosis or use of ventilatory technology. CONCLUSIONS The data from this large cohort are valuable for understanding real-world patterns of clinical care and disease progression. There is a significant association between the loss of ambulation and the rate of FVC% decline. Further longitudinal studies are needed to better understand the impact of disease parameters on pulmonary function decline and the need for ventilatory support.
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Affiliation(s)
- Mona Hnaini
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
| | - Matt Downs
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
| | - Michael R Miller
- Division of Children's Health & Therapeutics, Department of Pediatrics, Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Craig Campbell
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
- Division of Children's Health & Therapeutics, Department of Pediatrics, Children's Health Research Institute, Western University, London, Ontario, Canada
| | - Aaron St-Laurent
- Department of Pediatrics, Schulich School of Medicine & Dentistry Western University, London, Ontario, Canada
- Department of Pediatrics, Children's Hospital London Health Sciences Centre, London, Ontario, Canada
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Menapace B, McCarthy J, Schultz L, Leitsinger N, Jain V, Sturm P. Utilizing two surgeons for neuromuscular scoliosis suggests improved operative efficiency. Spine Deform 2023; 11:985-992. [PMID: 37067777 DOI: 10.1007/s43390-023-00678-x] [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: 08/18/2022] [Accepted: 03/11/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Neuromuscular scoliosis (NMS) patients tend to have significant comorbidities with complex medical and surgical histories. When undergoing posterior spinal fusion (PSF), NMS risks can be much higher than the idiopathic population. This study aimed to identify the impact of two experienced pediatric cosurgeons (CS) compared to a single spine surgeon (SS) on the intra- and postoperative results of NMS PSF. METHODS A database of NMS patients who had undergone PSF 2016-2021 identified 53 patients, of which 32 were CS, while 21 were SS. Patients' sex, age, weight, diagnosis, curve severity, fusion performed, estimated blood loss (EBL), transfusion rates, hemoglobin, anesthesia and surgical times, length of stay, and complications were collected. RESULTS Patient demographics were similar between groups. Curves were more severe in the CS group (p = 0.013). Intraoperatively, CS patients underwent larger corrections (p = 0.089) but in significantly shorter anesthetic (p = 0.0018) and operative (p = 0.0025) times. Blood loss and transfusions were similar. Postoperatively, intensive-care unit (ICU) admission and length of stay (LOS) were similar, but SS had higher rates of both unplanned ICU admissions (p = 0.36) and 30 day readmissions (p = 0.053). Complications overall were similar between the groups both within 30 days (p = 0.40) and in the short-term period (31-90 days, p = 0.76), though the CS cohort had less Grade 2 immediate postoperative pulmonary complications (p = 0.16). CONCLUSION Utilizing CS for NMS PSF has been found to reduce operative times. Downstream, additional potential impacts trended toward fewer unplanned ICU admissions, less-frequent postoperative pulmonary complications, and reduced 30-day readmission rates.
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Affiliation(s)
- Bryan Menapace
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - James McCarthy
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lindsay Schultz
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nichole Leitsinger
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Viral Jain
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter Sturm
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Angeli M, Alpantaki K, Pandis N, Koutserimpas C, Hadjipavlou A. The effect of scoliosis surgery on pulmonary function in spinal muscular atrophy patients: review of the literature and a meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2279-2286. [PMID: 35662367 DOI: 10.1007/s00586-022-07182-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the effect of surgical instrumentation on pulmonary function after surgery. METHODS A literature review was performed to identify articles reporting on the effect of scoliosis surgery on the pulmonary function in patients with spinal muscular atrophy (SMA). Data for each patient were extracted from included studies, and a meta-analysis was performed using the values of forced vital capacity (FVC) before and after surgery. RESULTS A total of 127 articles were reviewed, and ten articles were selected for data extraction according to inclusion criteria. The results of the meta-analysis showed no difference in respiratory function pre-operatively and at last follow-up. Four out of ten studies demonstrated similar results and five studies reported a decrease in pulmonary function after surgery. Only one study showed improvement in lung function. CONCLUSION At the moment, there is insufficient evidence in the literature to support that spinal surgery can improve respiratory function. According to our meta-analysis study, vital capacity remains either unchanged or the rate of deterioration is decreased after surgery. Nevertheless, these are both considered favorable outcomes taking into account the natural course of the disease with progressive deterioration of pulmonary function over time.
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Affiliation(s)
- Maria Angeli
- Department of Paediatrics, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma Surgery, Venizeleio General Hospital of Heraklion, Crete, Greece
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopaedics, University of Bern, Bern, Switzerland
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, "251" Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Alexander Hadjipavlou
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA.
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Yoon JY, Park SH, Won YH. Respiratory failure after scoliosis correction surgery in patients with Prader-Willi syndrome: Two case reports. World J Clin Cases 2021; 9:9960-9969. [PMID: 34877337 PMCID: PMC8610914 DOI: 10.12998/wjcc.v9.i32.9960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/03/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sleep-disordered breathing, including hypoventilation and obstructive sleep apnea, is often observed in Prader-Willi syndrome (PWS). Particularly in adolescence, scoliosis causes a progressive restrictive pulmonary pattern, leading to hypoventilation, so timely corrective surgery is required. However, the effect is controversial. In addition, since mental retardation of PWS, patient effort-based respiratory tests may be less reliable. So far, no studies have accurately reported on the comparison of respiratory function before and after corrective surgery, and appropriate respiratory function measurement method in PWS.
CASE SUMMARY We present two cases of adolescent PWS with typical characteristics, including obesity, mental retardation, and scoliosis. Two boys, aged 12 and 13, diagnosed with PWS, both underwent scoliosis correction surgery. Before and immediately after surgery, arterial blood tests showed no abnormalities and no respiratory symptoms occurred. However, after 6-7 mo, both patients complained of daytime sleepiness, difficulty sleeping at night, dyspnea on exertion, and showed cyanosis. Hypercapnia and hypoxia were confirmed by polysomnography and transcutaneous CO2 monitoring during sleep and were diagnosed with obstructive sleep apnea and alveolar hypoventilation. It was corrected by nighttime noninvasive ventilation application and normal findings of arterial blood gas were maintained after 6-8 mo follow-up.
CONCLUSION Even after scoliosis surgery, “periodic” monitoring of respiratory failure with an “objective” test method is needed for timely respiratory support.
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Affiliation(s)
- Ju-Yul Yoon
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Jeonbuk, South Korea
| | - Sung-Hee Park
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Jeonbuk, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, South Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju 54907, Jeonbuk, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Jeonbuk, South Korea
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Lee JW, Oh HJ, Choi WA, Kim DJ, Kang SW. Relationship between Eating and Digestive Symptoms and Respiratory Function in Advanced Duchenne Muscular Dystrophy Patients. J Neuromuscul Dis 2020; 7:101-107. [PMID: 31903995 PMCID: PMC7175944 DOI: 10.3233/jnd-190435] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Duchenne muscular dystrophy (DMD) patients can have various issues that affect their quality of life, including eating and digestive conditions. Objective: We sought to identify the relationship between respiratory function and various eating and digestion related symptoms in patients with advanced Duchenne muscular dystrophy (DMD). Methods: Eating and digestive symptoms, including loss of appetite, nausea, vomiting, diarrhea, constipation, swallowing difficulty, mastication difficulty, early satiety, and aspiration, were evaluated among patients with advanced DMD who were nonambulatory and required noninvasive mechanical ventilatory support. In addition, various respiratory function parameters were measured, including forced vital capacity (FVC), maximal insufflation capacity (MIC), peak cough flow (PCF), assisted PCF (APCF), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). We then analyzed the relationship between gastrointestinal symptoms and respiratory function parameters. Results: A total of 180 patients (age, 22.3±5.0 years) were included in the analysis. Loss of appetite and early satiety showed no correlation with any of the respiratory function parameters. Constipation was correlated with MEP; swallowing difficulty was correlated with MIC, APCF, MIP and MEP; and mastication difficulty was correlated with FVC, PCF, APCF, MIP, and MEP. Notably, age did not correlate with any gastrointestinal symptoms. Conclusions: Eating and digestive symptoms are more closely correlated with respiratory function than with age in patients with DMD. We think this correlation is mainly caused by the skeletal muscle strength, which is major determinant of both digestive and respiratory function.
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Affiliation(s)
- Jang Woo Lee
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Korea.,Yonsei University Graduate School of Medicine, Seoul, Korea
| | - Hyun Jun Oh
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ah Choi
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Rehabilitation Medicine, SRC Rehabilitation Hospital, Gwangju-si, Gyeonggi-do, Korea
| | - Seong-Woong Kang
- Department of Rehabilitation Medicine and Rehabilitation Institute of Neuromuscular Disease, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Pulmonary Rehabilitation Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.,Yonsei University Graduate School of Medicine, Seoul, Korea
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Impact of growth friendly interventions on spine and pulmonary outcomes of patients with spinal muscular atrophy. 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 2020; 30:768-774. [PMID: 32809150 DOI: 10.1007/s00586-020-06564-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Patients with spinal muscular atrophy (SMA) are often treated with growth friendly devices such as vertical expandable prosthetic titanium rib(VEPTR) and magnetically controlled growing rods(MCGR) to correct spinal deformity and improve pulmonary function. There is limited data on this topic, and the purpose of this study was to assess the effect of these constructs and the addition of chest wall support (CWS) on spinal deformity, thorax morphology and pulmonary outcomes. METHODS This is a retrospective analysis of prospectively collected data. We included patients with chest wall deformity and scoliosis secondary to SMA who were treated with growth friendly interventions and had two-year follow-up. Descriptive statistics and univariate analyses were performed. RESULTS This study included 66 patients (25% MCGR, 73% VEPTR, 2% unknown). Approximately 23% of constructs included CWS. The average Cobb angle improved from 67° (SD: 27°) to 50° (SD: 26°) at 2 years in patients with CWS (p = 0.02), and from 59° (SD: 20°) to 46° (SD: 15°) at 2 years in patients without CWS (p < 0.01). Hemithorax height improved in patients treated with and without CWS (p = 0.01), but hemithorax width only improved in patients with CWS (p = 0.01). One patient with CWS and two patients without CWS required additional respiratory support at 2 years. The rates of postoperative complications were not significantly different in patients treated with and without CWS (p = 0.31). CONCLUSIONS Growth friendly constructs improve spinal deformity and may be effective in altering the progression toward respiratory failure in patients with SMA. Patients treated with CWS have significant improvements in thorax morphology compared to patients without CWS.
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Preliminary Safety and Tolerability of a Novel Subcutaneous Intrathecal Catheter System for Repeated Outpatient Dosing of Nusinersen to Children and Adults With Spinal Muscular Atrophy. J Pediatr Orthop 2018; 38:e610-e617. [PMID: 30134351 PMCID: PMC6211782 DOI: 10.1097/bpo.0000000000001247] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many patients with spinal muscular atrophy (SMA) who might benefit from intrathecal antisense oligonucleotide (nusinersen) therapy have scoliosis or spinal fusion that precludes safe drug delivery. To circumvent spinal pathology, we designed a novel subcutaneous intrathecal catheter (SIC) system by connecting an intrathecal catheter to an implantable infusion port. METHODS Device safety and tolerability were tested in 10 SMA patients (age, 5.4 to 30.5 y; 80% with 3 copies of SMN2); each received 3 sequential doses of nusinersen (n=30 doses). Pretreatment disease burden was evaluated using the Revised Hammersmith Scale, dynamometry, National Institutes of Health pegboard, pulmonary function testing, electromyography, and 2 health-related quality of life tools. RESULTS Device implantation took ≤2 hours and was well tolerated. All outpatient nusinersen doses were successfully administered via SIC within 20 minutes on the first attempt, and required no regional or systemic analgesia, cognitive distraction, ultrasound guidance, respiratory precautions, or sedation. Cerebrospinal fluid withdrawn from the SIC had normal levels of glucose and protein; cerebrospinal fluid white blood cells were slightly elevated in 2 (22%) of 9 specimens (median, 1 cell/µL; range, 0 to 12 cells/µL) and red blood cells were detected in 7 (78%) specimens (median, 4; range, 0 to 2930 cells/µL). DISCUSSION Preliminary observations reveal the SIC to be relatively safe and well tolerated in SMA patients with advanced disease and spinal fusion. The SIC warrants further study and, if proven effective in larger trials of longer duration, could double the number of patients able to receive nusinersen worldwide while reducing administration costs 5- to 10-fold.
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Abstract
Scoliosis affects up to 6 % of the population. The resulting spine deformity, the increasing risk of back pain, cosmetic aspects, pulmonary disorders if the Cobb angle is > 80°, and the progress of the deformity to > 50° after the end of growth indicate non-operative or operative therapy. In daily clinical practice, the classifications of scoliosis allow the therapy to be adapted. Classifications consider deformity, topography of the scoliosis, and the age at diagnosis. This publication gives an overview of the relevant and most common classifications in the treatment of adolescent scoliosis. For evaluation, the deformity measurement on the coronary radiographic projection of the total spine (Cobb angle) is relevant to therapy. The classification of topography, form, and the sagittal profile of the deformity of the spine are useful for preoperative planning of the fusion level. Classifications that take into account the age at the time of the diagnosis of scoliosis differentiate among early onset scoliosis (younger than 10 years of age), adolescent scoliosis (up to the end of growth), and adult scoliosis. Early onset scoliosis is subdivided by age and etiology. Therapy is derived from the classification of clinical and radiological findings. Classifications that take into account clinical and radiological parameters are essential components of modern scoliosis therapy.
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