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Zhang Y, Wang Y, Xie J, Bi N, Zhao Z, Li T, Shi Z, Huang T, Gao B, Gu K, Li W. Factors Associated with Postoperative Respiratory Complications following Posterior Spinal Instrumentation in Children with Early-onset Scoliosis. Orthop Surg 2022; 14:1489-1497. [PMID: 35686538 PMCID: PMC9251275 DOI: 10.1111/os.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the incidence and risk factors of postoperative respiratory complications (PRCs) in children with early‐onset scoliosis (EOS) following posterior spine deformity surgery (PSDS) based on growth‐friendly techniques, so as to help improve the safety of surgery. Methods A retrospective study of children with EOS admitted for PSDS based on growth‐friendly techniques from October 2013 to October 2018 was reviewed at a single center. There were 73 children (30 boys, 43 girls) who fulfilled the criteria in this research. The mean age of the patients was 7 ± 6.2 years. Patients were divided into the groups with and without PRCs. Variables that might affect the PRCs during the perioperative period, including general factors, radiographic factors, laboratory factors and surgical factors, were analyzed using univariate analysis to evaluate the potential risk factors. The variables that were significantly different were further analyzed by binary logistic regression analysis to identify the independent factors of PRCs. Results All the 73 children included 42 idiopathic scoliosis (57.5%), 12 congenital scoliosis (16.4%), 10 syndromic scoliosis (13.7%) and nine neuromuscular scoliosis (12.3%). PRCs were detected in 16 children (21.9%) with nine different PRCs. The total frequency of detected PRCs was 54, including pleural effusion (25.9%), postoperative pneumonia (20.4%), hypoxemia (18.5%), atelectasis (14.8%), prolonged intubation with mechanical positive pressure ventilatory support (PIMPPVS) (7.4%), bronchospasm (3.7%), reintubation (3.7%), delayed extubation (3.7%) and pneumothorax (1.9%). Results of univariate testing demonstrated that the following six variables were statistically different (P < 0.05): nonidiopathic scoliosis, combined with pulmonary comorbidities, pretransferrin < 200 mg/dL, prealbumin < 3.5 g/dL, anesthesia time ≥ 300 min and blood loss to total blood volume ratio (BL/TBV) ≥ 15%. Binary logistic regression analysis confirmed that BL/TBV≥15% (odd ratio OR = 29.188, P = 0.010), combined with pulmonary comorbidities (OR = 19.216, P = 0.012), pretransferrin < 200 mg/dL (OR = 11.503, p = 0.024), and nonidiopathic scoliosis (OR = 7.632, P = 0.046) were positively linear correlated with PRCs in children with EOS following PSDS. Conclusion PRCs has a higher incidence in children with EOS following PSDS. BL/TBV ≥15%, combined with pulmonary comorbidities, pre‐transferrin < 200 mg/dL, and nonidiopathic scoliosis play an important role for the development of PRCs in this population.
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Affiliation(s)
- Ying Zhang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yingsong Wang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jingming Xie
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ni Bi
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhi Zhao
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiyue Shi
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tianyi Huang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bing Gao
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Kaiwen Gu
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wuyao Li
- Department of Orthopaedics, The 2nd Affiliated Hospital of Kunming Medical University, Kunming, China
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Du ZS, Wang YS, Xie JM, Li T, Shi ZY, Lu QA, Zhang Y, Zhao Z, Bi N, Song ZB, Zhu TB. Feasibility of microwave ablation of the vertebral growth plate for spine growth regulation: a preliminary study. Int J Hyperthermia 2021; 38:1233-1241. [PMID: 34396870 DOI: 10.1080/02656736.2021.1964619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To explore the feasibility of microwave ablation (MWA) of the vertebral growth plate as a minimally invasive treatment for early-onset scoliosis. MATERIALS AND METHODS One side of the L1-L3 vertebral growth plates were ablated using different MWA powers. Ablation safety and size were examined. Subsequently, L1-L3 vertebral growth plates were ablated on one side for 40 s at 20 W. At 2, 4, and 6 weeks after the ablation, growth changes of the spine were observed. RESULTS No piglets died during and after ablation, and all had modified Tarlov Grade 5. The safe MWA time (time for safely ablating the vertebral growth plate) was 17.0 ± 1.5 s at 50 W, 23.0 ± 2.3 s at 40 W, 31.0 ± 3.1 s at 30 W, 47.0 ± 3.7 s at 20 W, 70.0 ± 4.2 s at 15 W, and 158.0 ± 5.0 s at 10 W. With power <15 W, the vertebral growth plate could not be effectively ablated within the safe ablation time. Within the safe ablation times, the MWA size on hematoxylin and eosin slices on a transverse diameter was between 7 and 10 mm; and that on longitudinal diameter was mainly determined by the ablation needle length. Moreover, the growth plate and annulus fibrosus on the ablated side grew poorly over time, the vertebral body showed significant wedge-shaped changes, and the spine showed significant unbalanced growth. CONCLUSION MWA of the vertebral growth plate can be performed safely when accompanied with appropriate thermometry, and could be a new minimally invasive strategy in regulating spine growth.
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Affiliation(s)
- Zhi-Shan Du
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying-Song Wang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jing-Ming Xie
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Tao Li
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Yue Shi
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Qiu-An Lu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ying Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi Zhao
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ni Bi
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Bo Song
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ting-Biao Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Li Q, Zeng F, Chen T, Pu C, Liang Y, Zheng C. Anesthetic Management of Patients After Scoliosis Surgery: A Single-Center Retrospective Study. Orthop Surg 2020; 12:1753-1759. [PMID: 33043614 PMCID: PMC7767771 DOI: 10.1111/os.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the effect of anesthetic management on scoliosis surgery and review the incidence rate of perioperative adverse events. METHODS This was a retrospective study and approved by the ethics committee. Patients who underwent scoliosis surgery from April 2011 to March 2018 in the Third Hospital of ChengDu were enrolled in this study. Characteristics of patients were obtained from the hospital's electronic records. The following information on patients was collected: preoperative assessment details, premedication, type of anesthesia and operation, the main postoperative outcome, and complications. Data were presented as the mean ± standard deviations (SD) for normally distributed continuous variables and numbers for categorical variables. Statistical analyses were performed using SPSS version 22.0. RESULTS In total, 513 patients were enrolled in the present study. The main preoperative complication was cardiopulmonary dysfunction (386 cases, 75.24%). Anesthesia induction was performed with conscious tracheal intubation after oral surface anesthesia. In total, the common postoperative complications involved anesthesia (24 cases, 4.68%), surgery (23 cases, 4.48%), the respiratory system (138 cases, 26.90%), and the gastrointestinal tract (nine cases, 1.75%). The majority of postoperative complications were postoperative hypoxemia and hypercapnia, caused by poor cardiopulmonary function. Rare and serious complications still occurred. Three patients died in hospital. CONCLUSION Our study demonstrated a high incidence of complications in scoliosis surgery, especially postoperative complications. Extreme postoperative vigilance is required and high-level monitoring of conditions is highly recommended.
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Affiliation(s)
- Qiang Li
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Fei Zeng
- Center of Cardiac Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's HospitalChengduChina
| | - Tao Chen
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Chun Pu
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Yi‐jian Liang
- Department of Orthopaedics, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Chuan‐dong Zheng
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
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Otremski H, Widmann RF, Di Maio MF, Ovadia D. The correlation between spinal and chest wall deformities and pulmonary function in Marfan syndrome. J Child Orthop 2020; 14:343-348. [PMID: 32874369 PMCID: PMC7453168 DOI: 10.1302/1863-2548.14.200076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Scoliosis, chest wall deformities and pulmonary involvement are common features of Marfan syndrome (MFS). We aimed to assess the impact of spinal and chest wall deformities on pulmonary function in paediatric MFS patients with a surgically managed spinal deformity. METHODS In this multicentre retrospective study, spirometry, lung volumes and radiographic imaging were performed on 26 MFS patients between the ages of seven and 18 years who were undergoing planned spinal fusion surgery for spinal deformity. A correlation analysis assessed the relationship between radiographic measurements of spinal and chest wall deformities and predicted total lung capacity (TLC), forced vital capacity (FVC) and the ratio between forced expiratory volume in one second and FVC (FEV1/FVC). RESULTS In total, 18 patients (70%) had impaired pulmonary function. Thoracic kyphosis (mean 19.3°; -32° to 54°) had a strong positive correlation with FEV1/FVC (r = 0.65; p < 0.001). Significant decrease in FEV1/FVC below 80% occurred at kyphosis under 15° (p = 0.004). Kyphosis had a moderate negative correlation with FVC (r = -0.43; p = 0.03). Chest wall deformity had a strong negative correlation with FEV1/FVC (r = -0.61; p = 0.001). The magnitude of the thoracic curve (mean 55.2°; 28° to 92°) had a significant moderate negative correlation with TLC (r = -0.45; p = 0.04). CONCLUSION In MFS, three factors correlate with decreased pulmonary function measures: hypokyphosis, increasing chest wall deformity and increasing coronal curve magnitude. Hypokyphosis and increased chest wall deformity correlated with diminished FEV1/FVC; increasing thoracic spinal curvature with diminished TLC. Further analysis with a larger cohort will help better define the relationship between these deformities and pulmonary function in this unique population. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hila Otremski
- Pediatric Orthopaedic Department, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Correspondence should be sent to Hila Otremski, Pediatric Orthopaedic Department, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, 6 Weisman Street, Tel-Aviv 6423906, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. E-mail:
| | - Roger F. Widmann
- Pediatric Orthopaedic Department, Hospital for Special Surgery, New York, New York, USA
| | - Mary F. Di Maio
- Department of Pediatric Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Dror Ovadia
- Pediatric Orthopaedic Department, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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