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Gouzoulis MJ, Joo PY, Jeong S, Jabbouri SS, Moran J, Zhu JR, Grauer JN. A 10-year perspective on the question of whether surgeries for adolescent idiopathic scoliosis are "one and done"? Spine Deform 2024; 12:903-908. [PMID: 38555557 DOI: 10.1007/s43390-024-00858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE Posterior scoliosis fusion (PSF) for adolescent idiopathic scoliosis (AIS) is considered a highly successful surgery with excellent outcomes. However, especially as many patients "graduate" from their pediatric surgeons, there is the need to quantify the long-term outcomes of such surgeries. METHODS The 2010-2022 Pearldiver M161 dataset was queried for those who were 10 to 18 years old with AIS undergoing PSF with at least 10 years follow-up. Patient characteristics were abstracted. Reoperations were identified based on coding for any subsequent thoracic/lumbar surgery/revision. The 10-year reoperation rate and reasons for reoperation were determined, and multivariate regression was performed to determine risk factors. RESULTS In total, 3,373 AIS PSF patients were identified. Of the study cohort, 324 (9.6%) underwent reoperation within 10-years with an interquartile range for timing of surgery of 81-658 days, of which 29.6% were done for infection. Reoperations were done within the first three months for 152 (46.9% of reoperations), three months to 2 years for 97 (29.9%), and 2 years to 10 years for 74 (22.8%). Based on multivariate regression, need for reoperation was associated with male sex (OR: 1.70), asthma (OR: 1.36) and greater than thirteen segments of instrumentation (OR: 1.48) (p < 0.05 for each) but not age, other comorbidities, or insurance. CONCLUSIONS The current study of a large national AIS PSF population found 9.6% to undergo reoperation in the 10 years following their index operation. Although specifics about the curve pattern could not be determined, the reoperation incidence and correlation with specific risk factors are notable and important for patient counselling.
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Affiliation(s)
- Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Peter Y Joo
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Seongho Jeong
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Sahir S Jabbouri
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, 208071, New Haven, CT, 06510, USA.
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Theologis AA, Wu HH, Oeding JF, Diab M. Costs of revision operations for distal junctional kyphosis following thoracic posterior spinal fusion for adolescent idiopathic scoliosis. 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 2024; 33:2504-2511. [PMID: 38376560 DOI: 10.1007/s00586-024-08160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/09/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE To assess direct costs and risks associated with revision operations for distal junctional kyphosis/failure (DJK) following thoracic posterior spinal instrumented fusions (TPSF) for adolescent idiopathic scoliosis (AIS). METHODS Children who underwent TPSF for AIS by a single surgeon (2014-2020) were reviewed. Inclusion criteria were minimum follow-up of 2 years, thoracolumbar posterior instrumented fusion with a lower instrumented vertebra (LIV) cranial to L2. Patients who developed DJK requiring revision operations were identified and compared with those who did not develop DJK. RESULTS Seventy-nine children were included for analysis. Of these, 6.3% developed DJK. Average time to revision was 20.8 ± 16.2 months. Comparing index operations, children who developed DJK had significantly greater BMIs, significantly lower thoracic kyphosis postoperatively, greater post-operative lumbar Cobb angles, and significantly more LIVs cranial to the sagittal stable vertebrae (SSV), despite having statistically similar pre-operative coronal and sagittal alignment parameters and operative details compared with non-DJK patients. Revision operations for DJK, when compared with index operations, involved significantly fewer levels, longer operative times, greater blood loss, and longer hospital lengths of stay. These factors resulted in significantly greater direct costs for revision operations for DJK ($76,883 v. $46,595; p < 0.01). CONCLUSIONS In this single-center experience, risk factors for development of DJK were greater BMI, lower post-operative thoracic kyphosis, and LIV cranial to SSV. As revision operations for DJK were significantly more costly than index operations, all efforts should be aimed at strategies to prevent DJK in the AIS population.
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Affiliation(s)
- Alekos A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), Floor 05, Room 5430, Box 3212, San Francisco, CA, 94143, USA
| | - Hao-Hua Wu
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), Floor 05, Room 5430, Box 3212, San Francisco, CA, 94143, USA
| | - Jacob F Oeding
- School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), Floor 05, Room 5430, Box 3212, San Francisco, CA, 94143, USA.
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Lenke LG, Lee V, Hassan FM. Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples. J Clin Med 2024; 13:2233. [PMID: 38673506 PMCID: PMC11051103 DOI: 10.3390/jcm13082233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Adolescent idiopathic scoliosis (AIS) is a curvature of the spine that develops in children ages 10-18 and can be attributed to unknown causes. The Lenke AIS classification system provides a template to classify these deformities by curve type paired with recommended operative treatments. Treatment of this patient population has been associated with low complication rates and overall surgical success. Nonetheless, a fraction of patients remain susceptible to revision surgery. This manuscript will focus on the aspects of AIS surgery, highlighting case examples, the different treatment approaches, complication rates, and primary reasons for revision surgery and associated outcomes.
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Affiliation(s)
- Lawrence G. Lenke
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA;
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Irving Medical Center, New York, NY 10034, USA
| | - Veronica Lee
- Roy and Diana Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA;
| | - Fthimnir M. Hassan
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA;
- The Daniel and Jane Och Spine Hospital, New York Presbyterian, Columbia University Irving Medical Center, New York, NY 10034, USA
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Dong Y, Wang S, Tang N, Zhao H, Yu B, Zhang J. Revision Surgery After Spinal Fusion in Adolescent Idiopathic Scoliosis. Global Spine J 2024; 14:603-609. [PMID: 35862230 PMCID: PMC10802548 DOI: 10.1177/21925682221117130] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Aanalysis of a Large Cohort of Cases. OBJECTIVES To explore the rate and cause of revision surgery after spinal fusion in adolescent idiopathic scoliosis(AIS). METHODS The patients diagnosed with AIS who underwent spinal fusion surgery in a single center from 2002 to 2018 were retrospectively analyzed. All the patients were followed up at least 2 years. The causes of revision surgery were analyzed and the incidence of revision surgery was counted. RESULTS A total of 1816 AIS patients were included in the study. After an average of 8.5 years (range 3-18 years) follow-up, a total of 51 patients underwent 54 revision operations. The overall revision rate is 2.8%. The revision rate of combined approach (anterior and posterior) and anterior approach was 6.6% (8/122), and the revision rate of posterior approach was 2.5% (43/1694). The most common causes of revision were malposition of implants/implants failure (37%), followed by poor wound healing/ infection (23%). Spinal decompensation, adding on and proximal junctional kyphosis (PJK) accounted for 20%. The compensatory curve continued to worsen after selective fusion accounted for 14% and finally the discomfort with the implants accounted for 6%. CONCLUSIONS The overall revision rate of spinal fusion for AIS is 2.8%. The implants and incision problems were the most common causes of revision surgeries.
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Affiliation(s)
- Yulei Dong
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ning Tang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Hong Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bin Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
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Jamnik AA, Datcu AM, Lachmann E, Patibandla SD, Thornberg D, Jo CH, Morris WZ, Ramo B, Johnson M. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: a 30-year update. Spine Deform 2024; 12:99-107. [PMID: 37572225 DOI: 10.1007/s43390-023-00742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/22/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Although spinal fusion (SF) is considered "definitive" treatment in juvenile/adolescent idiopathic scoliosis (JIS/AIS), complications requiring reoperation continue to occur. The purpose of this study was to characterize the evolving rates of reoperation following SF in JIS/AIS. METHODS Single-center retrospective review of patients who underwent SF for JIS/AIS as their index surgical treatment between 2013 and 2019. Patient data were collected to identify complications requiring reoperation and factors associated with reoperation. Complication rates from 2013 to 2019 were compared to patients from 1988 to 2012 at the same institution. RESULTS This study analyzed 934 patients (81.7% female, mean age at surgery 14.5 ± 2.1). Thirty-eight patients (4.1%) required a total of 47 reoperations, a > 50% decrease in overall complication rate from the 2008-2012 population (4.1% vs 9.6%, respectively, p < 0.001). The decrease stemmed mainly from decreases in rates of infection (1.1% vs 4.1%, p < 0.001) and symptomatic implants (0.4% vs 2.1%, p = 0.004). There were, however, non-significant increases in implant failures (0.6% vs 0.2%, p = 0.4367) and pseudoarthrosis (1.0% vs 0.4%, p = 0.5202). Both of these complications were associated with patients with a higher mean weight (implant failure: 70.4 kg ± 21.1 vs 56.1 kg ± 14.9, p = 0.002; pseudoarthrosis: 85.8 kg ± 27.9 vs 55.9 ± 14.5, p = 0.001). CONCLUSIONS Reoperation following SF for JIS/AIS has decreased over the past 7 years when compared to 25 years of historical controls. The changing landscape of reoperation demands further research into the risk factors for those reoperations that have become more common.
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Jia R, Long Y. Risk factors for distal junctional kyphosis after posterior spinal surgery in adolescent idiopathic scoliosis: a meta-analysis. Front Surg 2023; 10:1263655. [PMID: 37920534 PMCID: PMC10619151 DOI: 10.3389/fsurg.2023.1263655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction Distal junctional kyphosis (DJK) is a serious complication after posterior spinal surgery in managing adolescent idiopathic scoliosis (AIS). Our study aims to investigate the predictors of DJK in AIS patients. Methods We searched the English databases of PubMed, Embase, and the Cochrane Library for clinical research studies on AIS. To identify the risk factors for DJK, we collected demographic data, such as age, gender, and body mass index (BMI), and sagittal parameters, including preoperative pelvic tilt (PT), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), distal junctional angle (DJA), lowest instrumented vertebrae (LIV) relative to sagittal stable vertebrae (SSV), and postoperative DJA. Data were analyzed by RevMan (5.3 version) and STATA (12.0 version). Results Finally, six included articles (1,240 patients) showed 9% (98 of 1,240 patients) of patients suffering from DJK. Our findings indicated that preoperative TK [p = 0.007, OR = 0.35, 95% CI (0.10, 0.61)], TLK [p < 0.0001, OR = 5.99, 95% CI (3.33, 8.65)], and postoperative DJA [p = 0.002, OR = 0.56, 95% CI (0.21, 0.91)] in the DJK group were markedly higher than those in the non-DJK group. Moreover, patients with LIV above SSV [p < 0.0001, OR = 7.95, 95% CI (4.16, 15.22)] were more likely to develop DJK. No discernible difference was found in age, sex, BMI, preoperative PT, SVA, LL, or DJA between the two groups. Conclusions Regarding the AIS patients, factors such as higher preoperative TK and TLK, higher postoperative DJA, and LIV above the SSV were related to an increased rate of DJK.
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Affiliation(s)
- Ruili Jia
- Department of Nephrology, The First Central Hospital of Baoding, Baoding, China
| | - Yubin Long
- Department of Orthopedics, The First Central Hospital of Baoding, Baoding, China
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Mikhaylovskiy MV, Sorokin AN, Sergunin AY, Gubina EV. Efficiency of repeated corrective surgery in patients with spinal deformities: analysis of the immediate results of a monocenter cohort and a brief review of the literature. HIRURGIÂ POZVONOČNIKA (SPINE SURGERY) 2023. [DOI: 10.14531/ss2023.1.6-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Objective. To analyze the results of repeated corrective surgery in patients with spinal deformities of various etiologies.Material and Methods. The study group included 87 patients (mean age is 22.8 years, m : f = 10 : 77) who underwent repeated deformity correction using third-generation instrumentation (CDI and its analogues), and were selected from 144 patients previously operated on for spinal deformities of various etiologies using different types of spinal instrumentation. The magnitude of scoliotic deformity, thoracic kyphosis, lumbar lordosis, rotation of the apical vertebra, the volume of intraoperative blood loss, and the duration of the operation were assessed. All patients answered the questions of the SRS-24 questionnaire at the stages of treatment and postoperative follow-up, and were also examined by computer optical topography method.Results. Out of 87 reoperated patients, 74 had idiopathic scoliosis. In 31 patients, the results were evaluated within a period of at least 2 years (average 61.8 months). As a result of the intervention, the primary curve was corrected by 29.1° (36.5 %). Loss of correction was 4.6° (p < 0.001), derotation of the apical vertebra – from 34.9° to 22.1° (p < 0.001) and loss of correction – 0.8°. The average blood loss varied from 810 to 1138 ml, and the operation time – from 187 to 289 min. Computer optical topography data convincingly confirmed the corrective effect achieved during the repeated intervention. According to the questionnaire (SRS-24), satisfaction with the results of the operation was quite high.Conclusion. Repeated corrective interventions in patients with spinal deformities of various etiologies, even in long-term periods, can partially restore the lost primary correction and improve the quality of life of patients, which is confirmed by clinical and radiographic data, the results of computer optical topography and the SRS-24 questionnaire.
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Affiliation(s)
- M. V. Mikhaylovskiy
- Novosibirsk Research Institute of Traumatology and Orthopaeducs n.a. Ya.L. Tsivyan
17 Frunze str., Novosibirsk, 630091, Russia
| | - A. N. Sorokin
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
Frunze str., 17, 630091, Novosibirsk, Russia
| | - A. Yu. Sergunin
- Novisibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
17 Frunze str., Novosibirsk, 630091, Russia
| | - E. V. Gubina
- Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya.L. Tsivyan
17 Frunze str., Novosibirsk, 630091, Russia
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Prost M, Windolf J, Konieczny MR. Bovine-derived xenograft is a viable bone graft substitute in multilevel, instrumented, spinal fusion. Orthop Rev (Pavia) 2022; 14:37576. [DOI: 10.52965/001c.37576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate radiological outcomes following the use of xenogeneic bone graft substitute (BGS) in patients undergoing multisegmental spinal fusion. Summery of Background Data Data exists for single level and short segment fusions, there presently is a paucity of data on fusion rate after bone augmentation with BGS in multisegmental posterior spinal fusion (PSF). The leading concern is pseudarthrosis, which often leads to a loss of correction after PSF. Therefore, the bone graft is an essential aspect of PSF. Methods We retrospectively analysed the radiological data of a consecutive cohort of patients who had been treated for adolescent idiopathic scoliosis (AIS) via multisegmental spinal fusion, in whom a bovine derived BGS had been used and had a complete dataset of 24 months follow-up. The Cobb angle of the main curve was measured pre-operatively and then at 6, 12 and 24 months post-operatively. Loosening of the screws was recorded at the same post-operative time points. Results After applying inclusion and exclusion criteria, 28 patients were included. We found no significant change of the cobb angle from the main curve as well as the cobb angle from the thoracic kyphosis during the 24 months of follow up. No patient showed a lack of bony fusion. There was 1 revision surgery, which was due to trauma. Conclusion In this cohort, all patients showed successful bone fusion during a 24-month follow-up. Additionally, there was no change in the Cobb angle during the 2-year post-operative period. Our data indicates that the use of bovine-derived BGS supports bone fusion after multisegmental posterior instrumented fusion of the spine.
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Affiliation(s)
- Max Prost
- Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Jochaim Windolf
- Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
| | - Markus Rafael Konieczny
- Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany
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Bassett W, Caruso C, Adolfsen S, McPartland T, Bowe JA, Tuason D. A Two-Surgeon Approach Improves Performance for Young Surgeons in Adolescent Idiopathic Scoliosis. Orthopedics 2021; 44:e347-e352. [PMID: 34039196 DOI: 10.3928/01477447-20210414-05] [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] [Indexed: 02/03/2023]
Abstract
Adolescent idiopathic scoliosis (AIS) is a complex 3-dimensional deformity. Previous studies have suggested a learning curve in the successful execution of this technically demanding procedure. A 2-surgeon model may be helpful for less experienced surgeons by facilitating greater consistency in surgical metrics. The objective of this study was to show no significant difference in the parameters examined for surgeries done by inexperienced primary surgeons with a 2-surgeon model compared with those done by their more experienced cohorts. All surgeries with a primary diagnosis of AIS that were performed from January 2012 to December 2015 and had a minimum of 2-year follow-up were included for analysis. Three groups were created based on surgeon experience: inexperienced surgeons (IS) group, experienced surgeons (ES) group, and a third group where the primary surgeon was in the experienced group and the assistant surgeon was in the inexperienced group (EIS). Variables included for analysis were age, Lenke classification, number of levels fused, length of surgery, length of stay, percent curve correction, ratio of estimated blood loss to levels fused, surgical blood loss, and complications. There were no significant differences between the groups in terms of operative time, blood loss, number of levels fused, lower estimated blood loss ratio to the number of levels fused, or percent curve correction (P>.05). The IS group was found to have a significant shorter length of stay (P=.004). The 2-surgeon model is an effective tool for inexperienced surgeons to achieve consistent and reproducible operative performance that is comparable with their more experienced peers. [Orthopedics. 2021;44(3):e347-e352.].
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Taniguchi Y, Ohara T, Suzuki S, Watanabe K, Suzuki T, Uno K, Yamaguchi T, Yanagida H, Nakayama K, Kotani T, Watanabe K, Hirano T, Yamamoto T, Kawamura I, Sugawara R, Takeshita K, Demura S, Oku N, Sato T, Fujiwara K, Akazawa T, Murakami H, Kakutani K, Matsubayashi Y, Kawakami N. Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study with Minimum 2-year Follow-Up. Spine (Phila Pa 1976) 2021; 46:E498-E504. [PMID: 33186273 DOI: 10.1097/brs.0000000000003822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter cohort study. OBJECTIVE The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity. SUMMARY OF BACKGROUND DATA Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology. METHODS We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR. RESULTS We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR. CONCLUSION The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.
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Affiliation(s)
- Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Yamaguchi
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Haruhisa Yanagida
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Keita Nakayama
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Norihiro Oku
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Sato
- Department of Orthopedic Surgery, School of Medicine, Juntendo University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenta Fujiwara
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, Morioka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Noriaki Kawakami
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Devision of Spine Surgery, Department of Orthopedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
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Fruergaard S, Ohrt-Nissen S, Pitter FT, Høy K, Lindberg-Larsen M, Eiskjær S, Dahl B, Gehrchen M. Revision risk after pediatric spinal deformity surgery: a nationwide study with 2-year follow-up. Spine J 2021; 21:642-652. [PMID: 33340758 DOI: 10.1016/j.spinee.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Revision risk after pediatric spine surgery is not well established and varies between deformity etiologies. PURPOSE To report the 2-year revision risk following surgery for primary pediatric spinal deformity in a nationwide cohort and to evaluate potential risk factors and reasons for revision surgery. DESIGN Retrospective nationwide cohort study. PATIENT SAMPLE A national registry study of all pediatric spinal deformity patients undergoing surgery during 2006-2015 (n=1310). OUTCOME MEASURES Two-year revision risk. METHODS All patients ≤21 years of age undergoing spinal deformity surgery in Denmark during 2006-2015 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Data on revision surgery were retrieved from the DNPR. Patients were categorized in six groups according to etiology. Medical records were reviewed for reason for revision in all patients. Potential risk factors for revision were assessed with multiple logistic regression analyses and included age, etiology, sex, Charlson comorbidity index (CCI), and growth-preserving treatment. RESULTS Patients were categorized according to etiology: idiopathic deformity (53%), neuromuscular deformity (23%), congenital/structural deformity (9%), spondylolisthesis (7%), Scheuermann's kyphosis (5%), and syndromic deformity (3%). Of 1,310 included patients, 9.2% underwent revision surgery within 2 years and 1.5% was revised more than once. Median time to revision was 203 (interquartile range 35-485) days. The multivariable logistic regression found significantly higher odds ratio (OR) for revision in patients with growth-preserving treatment (OR=5.1, 95% confidence interval [CI] 2.6-10.1), congenital deformity (OR=2.7, 95% CI 1.3-5.3), spondylolisthesis (OR=3.5, 95% CI 1.9-6.7), Scheuermann kyphosis (OR=3.9, 95% CI 1.9-8.3), and CCI score ≥3 (OR=2.5 95% CI 1.1-5.6). The most common reason for revision was implant failure (32.5%) followed by residual deformity and/or curve progression (15.8%). CONCLUSIONS In this nationwide study, the 2-year revision risk after primary pediatric spinal deformity surgery is 9.2%. Risk factors for revision are etiology of congenital deformity, spondylolisthesis, Scheuermann kyphosis as well as patients with growth-preserving treatment and higher CCI. The most common reason for revision is implant failure.
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Affiliation(s)
- Sidsel Fruergaard
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Søren Ohrt-Nissen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Frederik Taylor Pitter
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kristian Høy
- Spine Unit, Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
| | - Martin Lindberg-Larsen
- Orthopedic Research Unit, Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J.B. Winsløvsvej 4, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense C, Denmark
| | - Søren Eiskjær
- Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Benny Dahl
- Department of Orthopedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX 77030, USA
| | - Martin Gehrchen
- Spine Unit, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Darnis A, Grobost P, Roussouly P. Very long-term clinical and radiographic outcomes after posterior spinal fusion with pedicular screws for thoracic adolescent idiopathic scoliosis. Spine Deform 2021; 9:441-449. [PMID: 33030700 DOI: 10.1007/s43390-020-00217-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To report radiographic and functional outcomes, with an average follow-up of 20 years, of adolescents treated surgically for thoracic idiopathic scoliosis by hybrid construct using only pedicular screws for the distal fixation. METHODS We retrospectively reviewed 109 patients. Radiographic data were evaluated on fullspine radiographs (Cobb angle, pelvic incidence, sacral slope, pelvic tilt, thoracic kyphosis, lumbar lordosis). Clinical data were evaluated with ODI, SF-12, SRS-30 and Analog Pain Scale. Disc height and listhesis below the arthrodesis were measured. RESULTS We analyzed 90 women and 19 men with a mean age of 16.9 y.o. at surgery. Radiographic data were assessed for 46 patients after 17.4 years. Mean preoperative Cobb angle was 58°, mean correction 40.1% with 5.3° of loss at final FU. Lumbar lordosis and thoracic kyphosis increased significantly at last FU. Degenerative changes below the arthrodesis were reported in 5 cases. Clinical data were assessed for 42 patients after 19.9 years: SRS-30 3.8; ODI 12.3%; SF-12 PCS 48.6 and MCS 46. Low back pain was reported in 69% of cases with low intensity (3.1). The lowest instrumented vertebrae did not influence significantly the functional outcome. CONCLUSIONS The correction of thoracic AIS with lumbar or thoracolumbar pedicle screw instrumentation provides good radiological and clinical outcomes at very long term. The reduction in the coronal plane is stable; the HRQoL is quite as good as the general population. The degenerative evolution below remain relatively rare, therefore global sagittal balance is not modified.
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Affiliation(s)
- Alice Darnis
- Department of Orthopedic Surgery, Centre Médico-Chirurgical de Réadaptation Des Massues, 92 rue du Dr Edmond Locard, 69005, Lyon, France.
| | - Pierre Grobost
- Department of Orthopedic Surgery, Centre Médico-Chirurgical de Réadaptation Des Massues, 92 rue du Dr Edmond Locard, 69005, Lyon, France
| | - Pierre Roussouly
- Department of Orthopedic Surgery, Centre Médico-Chirurgical de Réadaptation Des Massues, 92 rue du Dr Edmond Locard, 69005, Lyon, France
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Perfetti D, Atlas AM, Galina J, Satin A, Hasan S, Amaral T, Sarwahi V. Surgeon volume affects short- and long-term surgical outcomes in idiopathic scoliosis. Spine Deform 2020; 8:455-461. [PMID: 32096129 DOI: 10.1007/s43390-020-00058-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/26/2019] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective review of New York Statewide Planning and Research Cooperative System (SPARCS) Inpatient Database. OBJECTIVE To identify the differences in short- and long-term complications, following long-segment pediatric spinal fusion in idiopathic scoliosis surgery, between surgeons with low versus high annual surgical volume. Spinal deformity surgery is complex and requires significant training and repetition to master. Surgeon and hospital volume have been shown to correlate with outcomes following cervical and lumbar spine surgery. However, there is limited literature regarding the impact of surgeon volume on long-term outcomes following pediatric idiopathic spinal deformity correction. METHODS This is a retrospective review of the SPARCS inpatient database from 2004 to 2013 of pediatric patients who underwent idiopathic scoliosis surgery. Surgeons were stratified into high (> 15 cases/year)- and low (≤ 15 cases/year)-volume cohorts by aggregating all cases completed over the study period until 50% of the total cases were captured above and below an average case per-year threshold. This threshold occurred at 15 cases/year. Short-term and long-term readmission and medical/surgical complications were collected. Multivariate logistic regression models assessed the risk of short- and long-term complications between cohorts. RESULTS 3910 pediatric patients underwent a primary arthrodesis from a total of 223 surgeons. More high-volume surgeons operated at academic teaching hospitals (p < 0.001), used a combined AP surgical approach (p < 0.001), and fewer utilized rhBMP (p < 0.001). High-volume surgeons had shorter lengths of stay (p < 0.001). Low-volume surgeons had increased odds of inpatient surgical complications (OR 1.55, 95% CI 1.00-2.45). Low-volume surgeons had increased odds of revision at 5 and 10 years (5 years. OR 1.56, 95% CI 1.05-2.31; 10 years. OR 1.59, 95% CI 1.09-2.31). Low-volume surgeons had increased odds of implant malfunction at 10 years (OR 1.81, 95% CI 1.15-2.86). CONCLUSIONS High-volume surgeons had decreased odds of short- and long-term complications compared to low volume when performing primary spinal arthrodesis in idiopathic scoliosis. Low-volume surgeons experienced significantly greater odds of inpatient surgical complications, as well as increased risk of revision during long-term follow-up with a significantly increased risk of implant malfunction at 10 years post-operatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dean Perfetti
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA.
| | - Aaron M Atlas
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Jesse Galina
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Alexander Satin
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Sayyida Hasan
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Terry Amaral
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
| | - Vishal Sarwahi
- Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen's Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA
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Al-Mohrej OA, Aldakhil SS, Al-Rabiah MA, Al-Rabiah AM. Surgical treatment of adolescent idiopathic scoliosis: Complications. Ann Med Surg (Lond) 2020; 52:19-23. [PMID: 32153775 PMCID: PMC7052396 DOI: 10.1016/j.amsu.2020.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/23/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022] Open
Abstract
Despite the fact that spinal surgeries for adolescent idiopathic scoliosis (AIS) result in good outcomes for most patients, they are not without complications either medically or surgically. Neurologic injury represents the most severe complication and is, as such, the most feared. Further complications include dural tears, peripheral neuropathy, surgical-site infections, implant-related issues, thromboembolic events, visual loss, pseudarthrosis, Crankshaft phenomenon, flatback phenomenon, proximal junctional kyphosis, and mortality. It is vital that all spine surgeons to be fully conversant with the possible complications and the proper responses for each of them. Surgeons should know how to manage complications of surgery for AIS. Patients should know about potential complications prior to surgery. Neurologic injury represents the most severe complication.
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Affiliation(s)
- Omar A Al-Mohrej
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Sahar S Aldakhil
- Department of Orthopedic Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Anwar M Al-Rabiah
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Dannenbaum JH, Tompkins BJ, Bronson WB, McMulkin ML, Caskey PM. Secondary Surgery Rates After Primary Fusion for Adolescent Idiopathic Scoliosis. Orthopedics 2019; 42:235-239. [PMID: 31136675 DOI: 10.3928/01477447-20190523-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/16/2019] [Indexed: 02/03/2023]
Abstract
Instrumented spinal fusion is the gold standard treatment for surgical magnitude adolescent idiopathic scoliosis (AIS), with the goal being stable fusion without the need for additional procedures. The purpose of this study was to define the surgical return rates of AIS at a single center with respect to various instrumentation constructs used during initial spinal fusion. A retrospective chart review was performed of all patients with AIS who underwent instrumented fusion with a minimum of 2-year follow-up. Demographic information, implant type, and surgical approach for the primary surgery and all subsequent secondary operations were recorded. Four hundred eleven patients who underwent instrumented fusion for AIS during the study period met inclusion criteria. Sixty-six secondary operations were performed in 50 patients (12.2%). Symptomatic hardware, pseudarthrosis, and infection were the most common indications for secondary surgery. Posterior pedicle screw constructs had a lower secondary surgery rate (5.8%) compared with hybrid and combined fusions (P<.05). The all hook, hybrid, anterior only, and combined fusions had secondary surgery rates of 13.0%, 18.5%, 10.0%, and 20.8%, respectively, which were not statistically different. When specifically comparing pedicle screw with hook constructs, there was a statistically lower pseudarthrosis rate (P=.03) favoring pedicle screw instrumentation. Patients undergoing instrumented fusion for AIS are at some risk for subsequent surgery. To lessen that risk, pedicle screw constructs should be considered, as they have shown an overall lower secondary surgery rate and in particular a lower rate of pseudarthrosis. [Orthopedics. 2019; 42(4):235-239.].
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Cost-Utility Analysis of Operative Versus Nonoperative Treatment of Thoracic Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2019; 44:309-317. [PMID: 30475341 DOI: 10.1097/brs.0000000000002936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cost-utility analysis OBJECTIVE.: To compare the cost utility of operative versus nonoperative treatment of adolescent idiopathic scoliosis (AIS) and identity factors that influence cost-utility estimates. SUMMARY OF BACKGROUND DATA AIS affects 1% to 3% of children aged 10 to 16 years. When the major coronal curve reaches 50°, operative treatment may be considered. The cost utility of operative treatment of AIS is unknown. METHODS A decision-analysis model comparing operative versus nonoperative treatment was developed for a hypothetical 15-year-old skeletally mature girl with a 55° right thoracic (Lenke 1) curve. The AIS literature was reviewed to estimate the probability, health utility, and quality-adjusted life years (QALYs) for each event. For the conservative model, we assumed that operative treatment did not result directly in any QALYs gained, and the health utility in AIS patients was the same as the age-matched US population mean. Costs were inflation-adjusted at 3.22% per year to 2015 US dollars. Costs and benefits were discounted at 3%. Probabilistic sensitivity analysis was performed using mixed first-order and second-order Monte Carlo simulations. Incremental cost utility ratio (ICUR) and incremental net monetary benefit were calculated. One-way sensitivity analyses were performed by varying cost, probability, and QALY estimates. RESULTS Operative treatment was favored in 98.5% of simulations, with a median ICUR of $20,600/QALY (95% confidence interval, $20,500-$21,900) below the societal willingness-to-pay threshold (WTPT) of $50,000/QALY. The median incremental net monetary benefit associated with operative treatment was $15,100 (95% confidence interval, $14,800-$15,700). Operative treatment produced net monetary benefit across various WTPTs. Factors that most affected the ICUR were net costs associated with uncomplicated operative treatment, undergoing surgery during adulthood, and development of pulmonary complications. CONCLUSION Cost-utility analysis suggests that operative treatment of AIS is favored over nonoperative treatment and falls below the $50,000/QALY WTPT for patients with Lenke 1 curves. LEVEL OF EVIDENCE 2.
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17
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Arnin U, El-Hawary R, Betz RR, Lonner BS, Floman Y. Preclinical Bench Testing on a Novel Posterior Dynamic Deformity Correction Device for Scoliosis. Spine Deform 2019; 7:203-212. [PMID: 30660213 DOI: 10.1016/j.jspd.2018.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/07/2018] [Accepted: 08/19/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Biomechanical test. OBJECTIVE To summarize the preclinical tests performed to assess the durability of a novel fusionless dynamic device for the treatment of adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The minimal invasive deformity correction (MID-C) system is a distractible posterior dynamic deformity correction device designed to reduce scoliosis for AIS patients, to maintain curve correction, and to preserve spinal motion. To overcome the challenges of wear and fatigue of this procedure, the system has two unique features: polyaxial joints at the rod-screw interface and a ceramic coating of the moving parts. METHODS Five biomechanical tests were performed: Static compression to failure, fatigue loading per ASTM F 1717 with 5.5-mm screws for 10 million cycles (MC) at 5 Hz, wear assessment, wear test of the polyaxial joint under 100 N load for 10 MC, and wear particle implantation in rabbits. RESULTS The system failed through buckling of the rod with loads over 3000 N (400% of human body weight). Dynamically, the system maintained 700 N for 10 MC with 5.5 mm screws. The maximum total steady-state wear rate was 0.074 mg/MC (0.03 per polyaxial joint and 0.014 mg/MC for the ratchet mechanism). Histologic evaluation of the particle injection sites indicated no difference in the local tissue response between the control and test articles. At 3 and 6 months postinjection, there were neither adverse local effects nor systemic effects observed. CONCLUSIONS The unique design features of the MID-C system, based on polyaxial joints and ceramic coating, resulted in favorable static, fatigue, and wear resistance properties. Wear properties were superior to those published for artificial spinal discs. Long-term outcomes from clinical use will be required to correlate these bench tests to the in vivo reality of clinical use. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- U Arnin
- Israel Spine Center, Assuta Hospital, Tel Aviv, Israel
| | | | - R R Betz
- Institute for Spine and Scoliosis Lawrenceville, USA
| | | | - Y Floman
- Israel Spine Center, Assuta Hospital, Tel Aviv, Israel
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Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev 2018; 42:319-336. [PMID: 29411177 DOI: 10.1007/s10143-018-0951-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
Abstract
We conducted a systematic review with meta-analysis and qualitative synthesis. This study aims to characterize pseudarthrosis after long-segment fusion in spinal deformity by identifying incidence rates by etiology, risk factors for its development, and common features. Pseudarthrosis can be a painful and debilitating complication of spinal fusion that may require reoperation. It is poorly characterized in the setting of spinal deformity. The MEDLINE, EMBASE, and Cochrane databases were searched for clinical research including spinal deformity patients treated with long-segment fusions reporting pseudarthrosis as a complication. Meta-analysis was performed on etiologic subsets of the studies to calculate incidence rates for pseudarthrosis. Qualitative synthesis was performed to identify characteristics of and risk factors for pseudarthrosis. The review found 162 articles reporting outcomes for 16,938 patients which met inclusion criteria. In general, the included studies were of medium to low quality according to recommended reporting standards and study design. Meta-analysis calculated an incidence of 1.4% (95% CI 0.9-1.8%) for pseudarthrosis in adolescent idiopathic scoliosis, 2.2% (95% CI 1.3-3.2%) in neuromuscular scoliosis, and 6.3% (95% CI 4.3-8.2%) in adult spinal deformity. Risk factors for pseudarthrosis include age over 55, construct length greater than 12 segments, smoking, thoracolumbar kyphosis greater than 20°, and fusion to the sacrum. Choice of graft material, pre-operative coronal alignment, post-operative analgesics, and sex have no significant impact on fusion rates. Older patients with greater deformity requiring more extensive instrumentation are at higher risk for pseudarthrosis. Overall incidence of pseudarthrosis requiring reoperation is low in adult populations and very low in adolescent populations.
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Yang J, Andras LM, Broom AM, Gonsalves NR, Barrett KK, Georgiadis AG, Flynn JM, Tolo VT, Skaggs DL. Preventing Distal Junctional Kyphosis by Applying the Stable Sagittal Vertebra Concept to Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis. Spine Deform 2018; 6:38-42. [PMID: 29287815 DOI: 10.1016/j.jspd.2017.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 04/25/2017] [Accepted: 06/15/2017] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Multicenter retrospective review. OBJECTIVE To assess the effectiveness of using the stable sagittal vertebra (SSV) for selecting the lowest instrumented vertebrae (LIV) to prevent distal junctional kyphosis (DJK) in selective thoracic fusions. SUMMARY OF BACKGROUND DATA Cho et al. reported that including the SSV in a fusion decreased the rate of DJK in thoracic hyperkyphosis. METHODS A retrospective review was performed of patients from two pediatric hospitals with adolescent idiopathic scoliosis who underwent selective posterior thoracic fusion with the LIV at L2 or above from 2000 to 2012. Patients with less than 2 years' follow-up were excluded. The primary outcome measure was DJK, defined radiographically as ≥10° between the superior end plate of the LIV and the inferior end plate of the vertebra below on a standing lateral radiograph. We investigated the SSV, which was defined as the vertebral level at which 50% of the vertebral body was in front of the posterior sacral vertical line (PSVL) on a standing lateral radiograph. This particular definition was referred to as SSV. RESULTS A total of 113 patients met the inclusion criteria. Mean age was 14.4 years. Mean Cobb angle was 58°. The overall rate of DJK was 7% (8/113). When the LIV was superior to SSV, the rate of DJK was 17% (8/46) versus 0% (0/67) when the LIV was at or inferior to SSV (p=.01). The rates of DJK for patients with the LIV one, two, and three levels above SSV were 17% (4/24), 7% (1/14), and 43% (3/7), respectively. There was no significant association between preoperative or postoperative maximum kyphosis, thoracic kyphosis, thoracolumbar kyphosis, pelvic incidence, sagittal balance or coronal balance, and development of DJK. CONCLUSION Although LIV selection is complex, choosing the LIV at or below the SSV is a simple rule that minimizes the risk of DJK. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Joshua Yang
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA
| | - Alexander M Broom
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA
| | - Nicholas R Gonsalves
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA
| | - Kody K Barrett
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA
| | - Andrew G Georgiadis
- Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA
| | - John M Flynn
- Children's Hospital of Philadelphia, 34th St and Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Vernon T Tolo
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA 90027, USA.
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Abstract
STUDY DESIGN An actuarial "survivorship" analysis. OBJECTIVE The aim of this study was to define the incidence and cause of surgical revision 5 years after scoliosis surgery. SUMMARY OF BACKGROUND DATA Data on contemporary revision surgery rates after idiopathic scoliosis surgery beyond the 2 years postoperatively in the adolescent and young adult population are limited. METHODS Patients enrolled in a prospective, multicenter, idiopathic scoliosis surgical registry from 1995 to 2009 were reviewed. Any spine reoperation was defined as a "terminal event." An actuarial survivorship analysis that adjusts for patients lost to follow-up was performed to determine cumulative survival. Time intervals were defined as 0 to <3 months, 3 months to <1 year, 1 to <2 years, 2 to <5 years, and 5 to 10 years. Registry data and radiographs were reviewed and five categories for reoperation assigned: 1) implant failure and/or pseudarthrosis, 2) implant misplacement and/or prominence, 3) wound complication and/or infection, 4) residual deformity and/or progression, and 5) other. RESULTS One thousand four hundred thirty-five patients from 12 sites were included. The majority were female (80%), with major thoracic curves (76% Lenke 1-4), and average age of 15 ± 2 years (10-22) at surgery. Most had posterior spinal instrumentation and fusion (81%). At this time, 75 (5.2%) patients required reoperation. Twenty-two occurred within 3 months postop, 10 more before 1 year, 12 more before 2 years, another 20 by 5 years, and 10 more after 5 years. This corresponded to an actuarial cumulative survival of 98.3% at 3 months, 97.5% at 1 year, 96.6% at 2 years, 93.9% at 5 years, and 89.8% at the final interval (5-10 yrs). CONCLUSION Revisions for scoliosis continue to occur well after 2 years with a 5-year survivorship of 93.9%. Reasons for reoperation are not uniformly distributed over time, with implant-related issues and infection the leading cause for early revision, while late infection was the most common cause after 2 years. Long-term follow-up of these postoperative patients remains important. LEVEL OF EVIDENCE 3.
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Fu X, Sun XL, Harris JA, Sheng SR, Xu HZ, Chi YL, Wu AM. Long fusion correction of degenerative adult spinal deformity and the selection of the upper or lower thoracic region as the site of proximal instrumentation: a systematic review and meta-analysis. BMJ Open 2016; 6:e012103. [PMID: 27852709 PMCID: PMC5128941 DOI: 10.1136/bmjopen-2016-012103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare outcomes when the upper and lower thoracic regions were used as the site of proximal instrumentation to treat adult spinal deformity. METHODS MEDLINE, Embase and Cochrane library searches were performed to identify studies that compared outcome measures when the upper and lower thoracic vertebrae (UTV and LTV, respectively) were used as the site of proximal instrumentation. The weighted mean difference (WMD) was calculated for continuous outcomes, and the relative risk (RR) was calculated for dichotomous outcomes. RESULTS Seven articles (n=554 patients) met the final inclusion criteria, and we compared the outcome measures of a long fusion extending to the upper and lower thoracic regions. The pooled analysis revealed that extending fixation into the upper thoracic region decreased the risk of proximal junctional kyphosis (PJK) revision surgery (RR: 0.36, 95% CI 0.14 to 0.90, p<0.05). The operation time (WMD: 0.93, 95% CI 0.48 to 1.39, p<0.05) and estimated blood loss (WMD: 0.59, 95% CI 0.33 to 0.85, p<0.05) were significantly greater in the UTV group than in the LTV group. No significant differences were found in the Scoliosis Research Society pain, self-image, function, mental health, subtotal, satisfaction or total scores; the total number of complications or the total number of revision surgeries. CONCLUSIONS Long posterior fixation extending into the upper thoracic region reduces the incidence of revision surgery related to PJK; however, it increased the operative level resulting in a longer operative time and greater estimated blood loss. This initial analysis indicates that extending fixation to the upper thoracic region is appropriate for patients who are likely to develop PJK following initial scoliosis correction.
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Affiliation(s)
- Xin Fu
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xiao-Lei Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Jonathan A Harris
- Division of Globus Medical, Musculoskeletal Education and Research Centre (MERC), Audubon, Pennsylvania, USA
| | - Sun-Ren Sheng
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
| | - Hua-Zi Xu
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
| | - Yong-Long Chi
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
| | - Ai-Min Wu
- Department of Orthopaedics, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Centre, Wenzhou, Zhejiang, China
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Mancini F, Ippolito E. Surgical Procedure to Treat Adult Spinal Deformity: Importance of an Informed Decision-Making Process: Commentary on an article by Peter G. Passias, MD, et al.: "Predictors of Revision Surgical Procedure Excluding Wound Complications in Adult Spinal Deformity and Impact on Patient-Reported Outcomes and Satisfaction. A Two-Year Follow-up". J Bone Joint Surg Am 2016; 98:e26. [PMID: 27053592 DOI: 10.2106/jbjs.15.01292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Ernesto Ippolito
- Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
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Passias PG, Soroceanu A, Yang S, Schwab F, Ames C, Boniello A, Smith J, Shaffrey C, Boachie-Adjei O, Mundis G, Burton D, Klineberg E, Hart R, Hamilton DK, Sciubba DM, Bess S, Lafage V. Predictors of Revision Surgical Procedure Excluding Wound Complications in Adult Spinal Deformity and Impact on Patient-Reported Outcomes and Satisfaction: A Two-Year Follow-up. J Bone Joint Surg Am 2016; 98:536-43. [PMID: 27053581 DOI: 10.2106/jbjs.14.01126] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The surgical procedure to treat adult spinal deformity is challenging, with high rates of complications, including revision procedures performed to repair instrumentation failure or unplanned surgical complications. This study quantifies the incidence of, identifies predictors for, and determines health-related quality-of-life changes associated with revision procedures to treat adult spinal deformity. METHODS We analyzed a multicenter database of patients who underwent a surgical procedure for adult spinal deformity, which was defined as having an age of eighteen years or older and scoliosis of ≥20°, sagittal vertical axis of ≥5 cm, pelvic tilt of ≥25°, and/or thoracic kyphosis of >60°. We focused on demographic, radiographic, health-related quality-of-life, and operative data at the two-year follow-up. Patients with primary infections were excluded. Predictive and confounding variables for revisions were identified using univariate analysis and multivariate logistic regression modeling. RESULTS Two hundred and forty-three patients were included in this study; of these patients, forty (16.5%) underwent a revision surgical procedure (15% of these at six weeks, 38% between six weeks and one year, and 48% between one and two years). Screw or cage-related implant complications were the most common indications for revision, followed by proximal junctional kyphosis and rod failure. Positive predictors for a revision surgical procedure included total body mass, with an odds ratio of 1.33 (95% confidence interval, 1.04 to 1.70) per 10-kg increase, and preoperative sagittal vertical axis, with an odds ratio of 1.15 (95% confidence interval, 1.04 to 1.28) per 2-cm increase. Factors associated with lower risk of revision included use of bone morphogenetic protein-2 (BMP-2) (odds ratio, 0.16 [95% confidence interval, 0.05 to 0.47]) and greater diameter rods (odds ratio, 0.51 [95% confidence interval, 0.29 to 0.89]). Body mass index, although initially considered a potential predictor for a revision surgical procedure, was not significantly different between primary and revision cohorts on univariate analysis and was therefore not input into the multivariate model. All patients improved in two-year health-related quality-of-life scores; revision subjects had lower overall improvement (Scoliosis Research Society [SRS] score; p = 0.016) from baseline. Revision status did not predict two-year patient satisfaction (p = 0.726), as measured by the SRS Satisfaction domain (SRS-22r). CONCLUSIONS Patients with greater preoperative sagittal vertical axis and high total body mass are at a higher risk for a revision surgical procedure following procedures to treat adult spinal deformity. Larger diameter rods and BMP-2 were associated with decreased revision odds. Revisions did not impact patient satisfaction at two years. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Sun Yang
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Frank Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Christopher Ames
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Anthony Boniello
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Justin Smith
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | | | - Gregory Mundis
- San Diego Center for Spinal Disorders, La Jolla, California
| | - Douglas Burton
- Department of Orthopaedic Surgery, The University of Kansas Hospital, Kansas City, Kansas
| | - Eric Klineberg
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon
| | - D Kojo Hamilton
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Daniel M Sciubba
- Department of Pediatric Neurological Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Shay Bess
- Colorado Orthopaedic & Spine Surgery, Denver, Colorado
| | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
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de Mendonça RGM, Sawyer JR, Kelly DM. Complications After Surgical Treatment of Adolescent Idiopathic Scoliosis. Orthop Clin North Am 2016; 47:395-403. [PMID: 26772948 DOI: 10.1016/j.ocl.2015.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Even with current techniques and instrumentation, complications can occur after operative treatment of adolescent idiopathic scoliosis. The most dreaded complications-neurologic deficits-are relatively infrequent, occurring in 1% or less of patients. Nonneurologic deficits, such as infection, pseudarthrosis, curve progression, and proximal junctional kyphosis, are more frequent, but are much less likely to require reoperation or to cause poor functional outcomes. Understanding the potential complications of surgical treatment of pediatric spinal deformity is essential for surgical decision-making.
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Affiliation(s)
| | - Jeffrey R Sawyer
- University of Tennessee-Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, Le Bonheur Children's Hospital, 1400 South Germantown Road, Germantown, TN 38138, USA.
| | - Derek M Kelly
- University of Tennessee-Campbell Clinic, Department of Orthopaedic Surgery & Biomedical Engineering, Le Bonheur Children's Hospital, 1400 South Germantown Road, Germantown, TN 38138, USA
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Risk of revision surgery for adult idiopathic scoliosis: a survival analysis of 517 cases over 25 years. 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 2016; 25:2527-34. [PMID: 26964785 DOI: 10.1007/s00586-016-4505-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Little is known about the long-term status of patients operated for spine deformities. The aim of this study was to determine the survival of primary fusion in adult idiopathic scoliosis and identify the risk factors of revision surgery. METHODS Adult patients who underwent primary fusion for idiopathic scoliosis between 1983 and 2011 were included in a continuous monocentric retrospective series. Any additional surgery was registered for survival analysis. Survival and follow-up were estimated by the Kaplan-Meier method and an analysis was performed to identify the risk factors of revision surgery. RESULTS This series included 447 women (86.5 %) and 70 men (13.5 %) reviewed after a mean follow-up of 7 years (range 0-26.4). Mean age was 44.4 years. Fusion was performed on a median 11 levels (range 3-15); revision rate was 13 % (CI 10-17), 18 % (CI 14-23) and 20 % (CI 16-26) at 5, 10 and 15 years, respectively. Revision surgery was associated with age, anterior release, length of fusion, the inferior limit of fusion, post-operative sagittal balance and junctional kyphosis. The length of fusion (HR 1.13 per vertebrae fused, p = 0.007) and the lower limit of fusion (HR 5.9, p < 0.001) remained independent predictors of revision surgery on multivariate analysis. CONCLUSION This series evaluated the risk of revision surgery following spinal fusion for idiopathic scoliosis. Our results show that the risk seemed to increase linearly with a rate of nearly 20 % after 10 years. The length and lower limit of fusion are the main risk factors for revision surgery. Level IV (e.g. case series).
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Abstract
BACKGROUND One of the main goals of scoliosis surgery is to obtain a balanced fused spine. Although preoperative planning remains essential, intraoperative posteroanterior radiographs are the only available tool during the procedure to verify shoulder and coronal spinal balance and, if necessary, adjust the construct. The aim of this study was to quantify the direct influence of intraoperative radiographs on the surgical procedure itself during correction of adolescent idiopathic scoliosis. METHODS Retrospective analysis of prospectively collected data on a monocentric cohort of adolescent idiopathic scoliosis patients undergoing corrective surgery. A total 148 consecutive patients operated in the same department following the same validated preoperative planning method were included in this prospective radiologic study. The mean follow-up averaged 33 months. Frontal Cobb angles, T1 tilt, shoulder tilt, iliolumbar angle, and frontal balance were measured and compared on intraoperative, early postoperative, and latest follow-up radiographs. Any intraoperative modification of the correction performed after analysis of the intraoperative radiograph were recorded. RESULTS The analysis of all radiologic parameters was possible in 90.5% of the cases. In 9.5% of the cases, shoulders could not be properly distinguished. Significant modifications on the upper thoracic curve to correct T1 tilt or shoulder balance were performed in 29% of the patients, and changes at the distal levels were recorded in 19%, underlining planification imperfections. On postoperative standing radiographs, the average coronal parameters were neutral, without loss of correction at follow-up. CONCLUSIONS Intraoperative radiographs remain necessary to ensure compensation of the shortcomings of the modern preoperative planification method.
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Verla T, Adogwa O, Toche U, Farber SH, Petraglia F, Murphy KR, Thomas S, Fatemi P, Gottfried O, Bagley CA, Lad SP. Impact of Increasing Age on Outcomes of Spinal Fusion in Adult Idiopathic Scoliosis. World Neurosurg 2015; 87:591-7. [PMID: 26546999 DOI: 10.1016/j.wneu.2015.10.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 10/11/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the role of advancing age on postoperative complications and revision surgery after fusion for scoliosis. METHODS A retrospective, cohort study was performed using the Thomson Reuters MarketScan database, examining patients with adult scoliosis who underwent spinal fusion from 2000 to 2009. Primary outcomes included infection, hemorrhage and pulmonary embolism (PE) within 90 days of surgery, and refusion. The effect of increasing age was estimated using the odds ratio (OR) of complications in a multivariate logistic regression analysis, and a Cox proportional hazard model estimated the hazard ratio of refusion. RESULTS A total of 8432 patients were included in this study. Overall, the average age was 53.3 years, with 26.90% males and 39% with a Charlson Comorbidity Score of ≥ 1. Most patients had commercial insurance (66.81%), with 26.03% and 7.16% covered by Medicare and Medicaid, respectively. Increasing age (per 5-year increment) was a significant predictor of hemorrhagic complication (OR, 1.06; confidence interval [CI], 1.01-1.11; P = 0.0196), PE (OR, 1.09; CI, 1.03-1.16; P = 0.0031), infection (OR, 1.04; CI, 1.01-1.07; P = 0.0053), and refusion (hazard ratio, 1.07; CI, 1.02-1.13; P = 0.0103). CONCLUSIONS In this study, age was associated with increased risk of hemorrhage, PE, infection, and refusion. With the aging population, the role of patient age on postoperative healing and outcomes deserves deeper investigation after repair of adult idiopathic scoliosis.
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Affiliation(s)
- Terence Verla
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Owoicho Adogwa
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Ulysses Toche
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Frank Petraglia
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelly R Murphy
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven Thomas
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Parastou Fatemi
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Oren Gottfried
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Carlos A Bagley
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Shivanand P Lad
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
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Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE The aim of this study is to reveal the effectiveness of HBO therapy in iatrogenic spinal infections intractable to antibiotic therapy alone. SUMMARY OF BACKGROUND DATA The efficiency of hyperbaric oxygen (HBO) therapy, which is currently being used in many areas, has been proven in infections in deep and superficial locations and in osteomyelitis. The aim of this study is to reveal effectives of HBO therapy in iatrogenic spinal infections intractable to antibiotic alone therapy. METHODS HBO therapy was given to 19 cases of iatrogenic spinal infection between 2008 and 2013. Adjuvant HBO therapy was applied to cases that had exhibited no improvement in clinical and laboratory findings despite medical treatment for at least 3 weeks. Several parameters including demographic characteristics, surgical area, etiology and the surgical treatment modality, microbiology (culture material and causative organism), clinical and laboratory results, duration of HBO therapy, and outcome were reviewed. RESULTS The mean age was 54.6 years (range: 32-75 years). Iatrogenic spinal infections were most frequent in the lumbar region. It occurred after spine instrumentation in 12 cases and after micro-discectomy in 7 cases. The average number of HBO therapy sessions applied was 20.1 (range: 10-40). Wound discharge and clinical and laboratory findings recovered in all cases at the end of the therapy course. No revision or removal of the instrumentation was necessary in the instrumented cases. CONCLUSION HBO therapy is a treatment modality, which is safe and efficient as an adjuvant therapy in the treatment of infections. It was also seen to be effective in the prevention of revision procedures and instrumentation failures in iatrogenic osteomyelitis cases, which had occurred following spinal instrumentation. LEVEL OF EVIDENCE 4.
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Adult Spinal Deformity Patients Recall Fewer Than 50% of the Risks Discussed in the Informed Consent Process Preoperatively and the Recall Rate Worsens Significantly in the Postoperative Period. Spine (Phila Pa 1976) 2015; 40:1079-85. [PMID: 25946720 DOI: 10.1097/brs.0000000000000964] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Recall of the informed consent process in patients undergoing adult spinal deformity surgery and their family members was investigated prospectively. OBJECTIVE To quantify the percentage recall of the most common complications discussed during the informed consent process in adult spinal deformity surgery, assess for differences between patients and family members, and correlate with mental status. SUMMARY OF BACKGROUND DATA Given high rates of complications in adult spinal deformity surgery, it is critical to shared decision making that patients are adequately informed about risks and are able to recall preoperative discussion of possible complications to mitigate medical legal risk. METHODS Patients undergoing adult spinal deformity surgery underwent an augmented informed consent process involving both verbal and video explanations. Recall of the 11 most common complications was scored. Mental status was assessed with the mini-mental status examination-brief version. Patients subjectively scored the informed consent process and video. After surgery, the recall test and mini-mental status examination-brief version were readministered at 5 additional time points: hospital discharge, 6 to 8 weeks, 3 months, 6 months, and 1 year postoperatively. Family members were assessed at the first 3 time points for comparison. RESULTS Fifty-six patients enrolled. Despite ranking the consent process as important (median overall score: 10/10; video score: 9/10), median patient recall was only 45% immediately after discussion and video re-enforcement and subsequently declined to 18% at 6 to 8 weeks and 1 year postoperatively. Median family recall trended higher at 55% immediately and 36% at 6 to 8 weeks postoperatively. The perception of the severity of complications significantly differs between patient and surgeon. Mental status scores showed a transient, significant decrease from preoperation to discharge but were significantly higher at 1 year. CONCLUSION Despite being well-informed in an optimized informed consent process, patients cannot recall most surgical risks discussed and recall declines over time. Significant progress remains to improve informed consent retention. LEVEL OF EVIDENCE 3.
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To investigate the rates and reasons for unplanned readmissions and reoperation after pediatric spinal fusion surgery at our institution and to identify risk factors by analyzing patient and surgical characteristics. Unplanned readmission and reoperation were defined as unplanned events within 90 days of the index surgery. SUMMARY OF BACKGROUND DATA The rate of unplanned readmission and reoperation after pediatric spinal fusion surgery is not well established. METHODS Clinical records were reviewed for all children who underwent spinal fusion surgical procedures for spinal deformity correction performed by 1 surgeon from 2000 through 2013 at our institution. Inclusion criteria were age of 10 to 18 years at surgery, fusion spanning more than 5 vertebral levels, and 3 months of clinical or radiographical follow-up (1002 patients met these criteria). Univariate and multivariate logistic regression models were created. Statistical significance was set at a P value of less than 0.05 for all analyses. RESULTS The overall 90-day unplanned readmission and reoperation rates were 8.0% and 3.8%, respectively. The most common causes of readmission were wound dehiscence (1.8%), deep wound infection (1.5%), pulmonary complications (1%), and superficial wound infection (0.9%). Univariate analysis showed that readmission was significantly associated with a higher number of levels fused, greater estimated blood loss, longer length of stay, and certain diagnoses; reoperation was significantly associated with a higher number of levels fused and certain diagnoses. On multivariate analysis, only patient diagnosis was found to be significantly associated with readmission and reoperation; patients with congenital scoliosis, genetic or syndromic scoliosis, cerebral palsy, and other neuromuscular disorders had significantly higher rates. CONCLUSION Unplanned readmission rate after pediatric spinal fusion surgery was 8%, most commonly for wound dehiscence and deep and superficial infections. Increased intraoperative blood loss, higher number of levels fused, and certain diagnoses are risk factors for unplanned readmission. LEVEL OF EVIDENCE 4.
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Abstract
BACKGROUND Revision spinal deformity surgery is a considerable undertaking and should never be taken lightly. The complication rates are typically higher than index surgery and technical difficulties are of greater magnitude. METHODS A review of the literature on revision surgery on pediatric spine deformities is provided with technical details of vertebral column resection. CONCLUSIONS Careful planning and preparation as well as previous experience with such deformities are of utmost importance to achieve satisfactory results.
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Unanticipated revision surgery in adult spinal deformity: an experience with 815 cases at one institution. Spine (Phila Pa 1976) 2014; 39:B36-44. [PMID: 24979146 DOI: 10.1097/brs.0000000000000463] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE This study reviewed the overall prevalence and indications of revision surgical procedures for adult scoliosis in a single institution. In this largest single-institution series, revision surgery in adult scoliosis was required for a relatively low proportion of cases (7.61%). The main indications were implant breakage, deformity progression, and infection. SUMMARY OF BACKGROUND DATA Spine fusion is considered as the final therapeutic intervention in the management of adult scoliosis. However, reports on the repeat surgical intervention of adult scoliosis predate the use of advanced instrumentation systems. METHODS The scoliosis database of our center was searched, and all cases with index spinal fusion surgical procedures performed for adult scoliosis from 1998 to 2011 with the follow-up period of more than 2 years were identified. The clinical data and radiographs of patients were reviewed to provide information on the indication of initial operation and any subsequent revision surgery. A total of 815 patients were identified, with a mean age of 30.49 years (range, 20-76 yr). The mean follow-up periods were 6.4 years (range, 2-15 yr) for the entire cohort and 7.6 years (range, 2.5-12 yr) for the subset of the cohort requiring revision. RESULTS The patients exhibiting multiple reasons for revision were classified under primary reason and subjected to subsequent analysis. Among the 815 patients, 62 (7.61%) underwent at least 1 revision surgery. The most common reasons for revision were implant breakage (23/62; 37.1%), deformity progression (10/62; 16.1%), and infection (9/62; 14.5%). The other indications were pseudarthrosis (n = 8), implant dislodgement (n = 6), junctional kyphosis (n = 5), and neurological deficit (n = 1). Revision rate was significantly higher in patients older than 40 years (15.23% vs. 5.87%), in patients with degenerative or congenital scoliosis (15.12% vs. 12.82%), or in patients with hybrid constructs (12.12% vs. 5.82%). CONCLUSION In this largest single-institution series, revision surgery after index spinal fusion in patients with adult scoliosis was required for a relatively low proportion of surgical cases (7.61%). The main indications for revision were implant breakage, deformity progression, and infection.
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Shau DN, Bible JE, Gadomski SP, Samade R, Armaghani S, Mencio GA, Devin CJ. Utility of Postoperative Radiographs for Pediatric Scoliosis: Association Between History and Physical Examination Findings and Radiographic Findings. J Bone Joint Surg Am 2014; 96:1127-1134. [PMID: 24990978 DOI: 10.2106/jbjs.l.01357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Postoperative radiographs are routinely obtained following surgery for the correction of scoliosis in pediatric patients. The purpose of this study was to comprehensively evaluate the utility of obtaining routine postoperative radiographs in the management of these patients. METHODS A total of 1969 clinic notes and corresponding radiographs regarding 451 consecutive patients with scoliosis (age range, ten to eighteen years) who had surgical correction over a ten-year period at a single institution were retrospectively reviewed. Curve etiology, preoperative curve characteristics, and surgical procedures performed were recorded. All postoperative clinic notes and radiographs were reviewed for abnormalities and changes in treatment course. It was then determined whether clinical signs and symptoms and/or abnormal radiographic findings led to a change in treatment course, which was defined as a therapeutic intervention or further diagnostic testing. RESULTS Of the 451 patients in this study (average age [and standard deviation], 14.7 ± 2.4 years), 72.5% had adolescent idiopathic scoliosis, 23.3% had neuromuscular scoliosis, and 4.2% had other underlying causes of scoliosis. A change in treatment course occurred in the cases of forty-two patients, all of whom had symptomatic findings on postoperative history and physical examination and only fifteen of whom had supportive abnormal findings on postoperative radiographs. Curve etiology and surgical procedures performed had no impact on radiographic utility. A significant increase in utility was seen for radiographs obtained at visits one year or more following surgery compared with those obtained at visits less than one year following surgery (1.7% compared with 0.3%, p = 0.001). The overall sensitivity, specificity, positive predictive value, and negative predictive value of routine postoperative radiographs in guiding treatment course were 35.7%, 98.1%, 28.8%, and 98.6%, respectively. CONCLUSIONS Routine radiographs provide low utility in guiding the course of treatment for asymptomatic pediatric patients following surgery for scoliosis. The results of this study suggest that patient or caregiver complaints, comorbidities, and clinical suspicion should be considered before obtaining radiographs at postoperative visits in order to minimize radiation exposure in pediatric patients and reduce medical costs without compromising care. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David N Shau
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
| | - Jesse E Bible
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
| | - Stephen P Gadomski
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
| | - Richard Samade
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
| | - Sheyan Armaghani
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
| | - Gregory A Mencio
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
| | - Clinton J Devin
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 4200, MCE-South Tower, Nashville, TN 37232-8618. E-mail address for C.J. Devin:
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Comparison of the Combined Anterior-Posterior Approach versus Posterior-Only Approach in Scoliosis Treatment. Asian Spine J 2014; 8:8-12. [PMID: 24596599 PMCID: PMC3939375 DOI: 10.4184/asj.2014.8.1.8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/29/2012] [Accepted: 10/31/2012] [Indexed: 11/23/2022] Open
Abstract
Study Design This is descriptive analytical study. Purpose The present study aims at comparing treatment results found between the two groups comprising of patients who underwent posterior spinal fusion using thoracic pedicle screws and the ones who underwent combined anterior-posterior method, respectively. Overview of Literature There was controversy about surgical techniques including anterior, posterior, or a combined anterior-posterior approaches are applied to treat non-congenital scoliosis with surgical indications. Methods Medical records of 50 patients suffering from thoracic non-congenital scoliosis with curves exceeding 70° were reviewed. In this study, 25 patients who underwent posterior spinal fusion using thoracic pedicle screws were compared with 25 patients who underwent combined anterior-posterior method. Results Patients treated through posterior-only and combined approaches were respectively hospitalized for 11.84±5.18 and 26.5±5.2 days (p=0.001). There was a significant difference between these two groups considering intensive care unit admission duration (p=0.001), correction in sagittal view of X-ray (p=0.01), and number of days the patients underwent traction (0.001). Finally, coronal view was corrected without any significant difference (p=0.2). Conclusions According to our findings, it is hypothesized that posterior-only method is associated with some significant advantages and is an advisable method in patients with severe scoliosis over than 70°.
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Pang L, Watanabe K, Toyama Y, Matsumoto M. Massive hemothorax caused by Gelpi retractor during posterior correction surgery for adolescent idiopathic scoliosis: a case report. SCOLIOSIS 2014; 9:17. [PMID: 25904971 PMCID: PMC4406011 DOI: 10.1186/1748-7161-9-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/19/2014] [Indexed: 11/23/2022]
Abstract
Background context Gelpi retractors are used in surgery because they can reduce paravertebral muscle damage during retraction. No pleural injuries associated with their use in posterior spine surgery have been reported. Purpose To describe a patient who suffered a massive postoperative hemothorax caused by a Gelpi retractor used during posterior correction surgery for adolescent idiopathic scoliosis (AIS). Study design Case report. Methods A case report of a rare hemothorax complication due to a Gelpi retractor is reported. The relevant literature was reviewed. Results A 12-year-old girl with Lenke type 2 AIS, with curves of 60° at T2-7 and 75° at T7-L1, underwent posterior correction and fusion surgery using a segmental pedicle screw construct placed between T2 and L2. Although the patient’s vital signs were stable during and soon after the surgery, a chest x-ray taken one day later revealed a massive left hemothorax. Her hemoglobin concentration was decreased to 5.5g/dl, and SpO2 remained as low as 92% even with oxygen administration. Thoracoscopy revealed subpleural hemorrhaging at several points in the left upper intercostal area (T3-6), and a penetration of the pleura between the left 4th and 5th ribs. Active bleeding had already stopped. The tip of the Gelpi retractor appeared to have penetrated the pleura. A chest tube was placed in the patient to treat the hemothorax. Conclusions A pleural injury by the Gelpi retractor was determined to be the cause of the hemothorax in this case. The patient’s prominent thoracic hump may have increased the risk of such an injury because the tip of a Gelpi retractor might easily have become stuck in the intercostal space rather than the paravertebral muscles.
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Affiliation(s)
- Long Pang
- Department of Orthopedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - Kota Watanabe
- Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
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Scheer JK, Tang JA, Smith JS, Klineberg E, Hart RA, Mundis GM, Burton DC, Hostin R, O'Brien MF, Bess S, Kebaish KM, Deviren V, Lafage V, Schwab F, Shaffrey CI, Ames CP, _ _. Reoperation rates and impact on outcome in a large, prospective, multicenter, adult spinal deformity database. J Neurosurg Spine 2013; 19:464-70. [DOI: 10.3171/2013.7.spine12901] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Complications and reoperation for surgery to correct adult spinal deformity are not infrequent, and many studies have analyzed the rates and factors that influence the likelihood of reoperation. However, there is a need for more comprehensive analyses of reoperation in adult spinal deformity surgery from a global standpoint, particularly focusing on the 1st year following operation and considering radiographic parameters and the effects of reoperation on health-related quality of life (HRQOL). This study attempts to determine the prevalence of reoperation following surgery for adult spinal deformity, assess the indications for these reoperations, evaluate for a relation between specific radiographic parameters and the need for reoperation, and determine the potential impact of reoperation on HRQOL measures.
Methods
A retrospective review was conducted of a prospective, multicenter, adult spinal deformity database collected through the International Spine Study Group. Data collected included age, body mass index, sex, date of surgery, information regarding complications, reoperation dates, length of stay, and operation time. The radiographic parameters assessed were total number of levels instrumented, total number of interbody fusions, C-7 sagittal vertical axis, uppermost instrumented vertebra (UIV) location, and presence of 3-column osteotomies. The HRQOL assessment included Oswestry Disability Index (ODI), 36-Item Short Form Health Survey physical component and mental component summary, and SRS-22 scores. Smoking history, Charlson Comorbidity Index scores, and American Society of Anesthesiologists Physical Status classification grades were also collected and assessed for correlation with risk of early reoperation. Various statistical tests were performed for evaluation of specific factors listed above, and the level of significance was set at p < 0.05.
Results
Fifty-nine (17%) of a total of 352 patients required reoperation. Forty-four (12.5%) of the reoperations occurred within 1 year after the initial surgery, including 17 reoperations (5%) within 30 days.
Two hundred sixty-eight patients had a minimum of 1 year of follow-up. Fifty-three (20%) of these patients had a 3-column osteotomy, and 10 (19%) of these 53 required reoperation within 1 year of the initial procedure. However, 3-column osteotomy was not predictive of reoperation within 1 year, p = 0.5476). There were no significant differences between groups with regard to the distribution of UIV, and UIV did not have a significant effect on reoperation rates. Patients needing reoperation within 1 year had worse ODI and SRS-22 scores measured at 1-year follow-up than patients not requiring operation.
Conclusions
Analysis of data from a large multicenter adult spinal deformity database shows an overall 17% reoperation rate, with a 19% reoperation rate for patients treated with 3-column osteotomy and a 16% reoperation rate for patients not treated with 3-column osteotomy. The most common indications for reoperation included instrumentation complications and radiographic failure. Reoperation significantly affected HRQOL outcomes at 1-year follow-up. The need for reoperation may be minimized by carefully considering spinal alignment, termination of fixation, and type of surgical procedure (presence of osteotomy). Precautions should be taken to avoid malposition or instrumentation (rod) failure.
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Affiliation(s)
| | | | - Justin S. Smith
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric Klineberg
- 3Department of Orthopaedic Surgery, University of California, Davis
| | - Robert A. Hart
- 4Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Douglas C. Burton
- 6Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Richard Hostin
- 7Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Michael F. O'Brien
- 7Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Shay Bess
- 8Rocky Mountain Hospital for Children, Denver, Colorado
| | - Khaled M. Kebaish
- 9Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and
| | | | - Virginie Lafage
- 11Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Frank Schwab
- 11Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Christopher I. Shaffrey
- 2Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
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Unplanned return to the operating room in patients with adolescent idiopathic scoliosis: are we doing better with pedicle screws? Spine (Phila Pa 1976) 2013; 38:1842-7. [PMID: 23873241 DOI: 10.1097/brs.0b013e3182a42a99] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, longitudinal cohort. OBJECTIVE To evaluate the incidence, timing, and risk factors for reoperation in patients with adolescent idiopathic scoliosis (AIS) treated with pedicle screws (PSs) compared with hybrid (Hb) constructs. SUMMARY OF BACKGROUND DATA Rates of return to the operating room (OR) after definitive fusion for AIS vary, with a paucity of data on PS constructs. METHODS A prospective multicenter database was retrospectively queried to identify consecutive patients with AIS who underwent posterior spinal fusion with either PS or Hb constructs with a minimum 2-year follow-up. All reoperations were stratified into an early group (<60 d) or a late group (>60 d). Univariate and multivariate logistical analyses were performed to identify potential risk factors related to reoperation. RESULTS A total of 627 patients met the inclusion criteria (PS = 540, Hb = 87). There was a statistically significant difference in the rate of reoperations between the PS (3.5%) and Hb groups (12.6%), P < 0.001. Early return to the OR occurred in 2.0% of the patients with PS compared with 3.4% in the Hb group, P = 0.43. Late returns to the OR occurred in 1.5% of PS group versus 9.2% of the Hb group, P < 0.001. Multivariate analysis revealed longer operating time as an independent risk factor for an unplanned return to the OR in patients treated with PSs (P < 0.05). CONCLUSION Our results suggest that patients with AIS treated with PS have decreased rates of unplanned return to the OR when compared with patients with Hb constructs. The majority of returns to the OR were early (<60 d) for the PS group compared with late (>60 d) for the Hb group. Longer operative times increased the risk of unplanned reoperation for the PS group. LEVEL OF EVIDENCE 3.
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Radcliff KE, Kepler CK, Jakoi A, Sidhu GS, Rihn J, Vaccaro AR, Albert TJ, Hilibrand AS. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J 2013; 13:1339-49. [PMID: 23773433 DOI: 10.1016/j.spinee.2013.03.020] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 11/26/2012] [Accepted: 03/07/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Adjacent segment disease (ASD) is symptomatic deterioration of spinal levels adjacent to the site of a previous fusion. A critical issue related to ASD is whether deterioration of spinal segments adjacent to a fusion is due to the spinal intervention or due to the natural history of spinal degenerative disease. PURPOSE The purpose of this review is to summarize the recent clinical literature on adjacent segment disease in light of the natural history, patient-modifiable risk factors, surgical risk factors, sagittal balance, and new technology. STUDY DESIGN This review will evaluate the recent literature on genetic and hereditary components of spinal degenerative disease and potential links to the development of ASD. METHODS After a meticulous search of Medline for relevant articles pertaining to our review, we summarized the recent literature on the rate of ASD and the effect of various interventions, including motion preservation, sagittal imbalance, arthroplasty, and minimally invasive surgery. RESULTS The reported rate of ASD after decompression and stabilization procedures is approximately 2% to 3% per year. The factors that are consistently associated with adjacent segment disease include laminectomy adjacent to a fusion and a sagittal imbalance. CONCLUSIONS Spinal surgical interventions have been associated with ASD. However, whether such interventions may lead to an acceleration of the natural history of the disease remains questionable.
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Affiliation(s)
- Kristen E Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Abstract
Surgery in a child with spinal deformity is challenging. Although current orthopedic practice ensures good long-term surgical results, complications occur. Idiopathic scoliosis represents the most extensively investigated deformity of the pediatric spine. Nonidiopathic deformities of the spine are at higher risk for perioperative and long-term complications, mainly because of underlying comorbidities. A multidisciplinary treatment strategy is helpful to assure optimization of medical conditions before surgery. Awareness of complications that occur during or after spine surgery is essential to avoid a poor outcome and for future surgical decision making. This article summarizes the complications of surgical treatment of the growing spine.
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Yagi M, King AB, Kim HJ, Cunningham ME, Boachie-Adjei O. Outcome of Revision Surgery in Pediatric Spine Deformity Patients. Spine Deform 2013; 1:59-67. [PMID: 27927324 DOI: 10.1016/j.jspd.2012.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 10/09/2012] [Accepted: 10/11/2012] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To report the complications and outcomes of pediatric revision spine surgery and review the surgical indications and treatment methods. BACKGROUND SUMMARY Recent reports have shown the necessity of revision spine surgery for pediatric deformities. Many reports have shown the result of revision surgery for pediatric spinal deformity. MATERIALS AND METHODS We conducted a retrospective review of 638 patients with pediatric spinal deformity who were treated with surgery from 1996 to 2007. We identified 50 patients who underwent revision spinal fusion surgery with a minimum of 3 years of follow-up. RESULTS Mean follow-up was 4 years (range, 3-8.3 years). The diagnosis at index surgery was idiopathic scoliosis in 18 patients, congenital scoliosis in 13, neuromuscular scoliosis in 13, tumor and spinal arteriovenous malformation in 4, burst fracture in thoracic spine in 1, and Scheuermann kyphosis in 1. The primary surgeries were 1 hemi epiphysiodesis, 3 anterior spinal fusions, 4 posterior decompressions, 8 combined anterior and posterior spinal fusions, and 34 posterior spinal fusions. A total of 16 patients had pseudarthrosis, 12 decompensation, 11 progressive kyphosis, 8 crankshaft phenomenon, 2 infections, and 1 junctional degeneration. All 50 reoperations included spinal instrumentation and fusion. The revision surgeries were 2 anterior spinal fusions, 14 posterior fusions, and 34 combined anterior and posterior spinal fusions. Spine arthrodesis was obtained in 98% of patients (49 of 50) and complications occurred in 14% of patients (7 of 50). The Scoliosis Research Society Patient Questionnaire outcomes at the latest follow-up were as follows: total 3.95, function 3.88, pain 3.83, self-image 3.98, and mental health 4.04. CONCLUSION Pseudarthrosis was the most common indication for revision surgery, and bony union was achieved in 98% with revision surgery. Despite the complications, pediatric revision spine surgery can achieve successful outcomes.
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Affiliation(s)
- Mitsuru Yagi
- Department of Adult and Pediatric Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 East 70th Street New York, NY 10021, USA; National Hospital Organization Murayama Medical Center, 2-37-1 Musashi Murayama, Tokyo, Japan
| | - Akilah B King
- Department of Adult and Pediatric Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 East 70th Street New York, NY 10021, USA
| | - Han Jo Kim
- Department of Adult and Pediatric Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 East 70th Street New York, NY 10021, USA
| | - Matthew E Cunningham
- Department of Adult and Pediatric Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 East 70th Street New York, NY 10021, USA
| | - Oheneba Boachie-Adjei
- Department of Adult and Pediatric Spine and Scoliosis Surgery, Hospital for Special Surgery, 535 East 70th Street New York, NY 10021, USA.
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Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: five-year update on a previously published cohort. Spine (Phila Pa 1976) 2012; 37:1211-7. [PMID: 22310095 DOI: 10.1097/brs.0b013e31824b6b05] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE To identify the overall reoperation rate and factors contributing to reoperation in a recent 5-year cohort of patients (2003-2007) undergoing spinal deformity surgery. These patients were compared with a previously published 15-year cohort of consecutive patients (1988-2002) from the same institution to assess for any significant differences in reoperation rates. SUMMARY OF BACKGROUND DATA In a previously published report from this institution, the reoperation rate for patients with idiopathic scoliosis treated during a 15-year period (1988-2002) was 12.9%. That group was predominantly treated with first-generation TSRH (Medtronic, Memphis, TN) implants and CD implants. Lower profile, more rigid implant systems are now used along with refined techniques for correction of scoliosis deformity. We hypothesized that these factors would lead to lower rates of reoperation. METHODS.: The medical records of 452 consecutive patients (older than 9 yr) surgically treated for idiopathic scoliosis at one institution during 5 years (2003-2007) were reviewed to identify those who required reoperation. RESULTS The reoperation rate for this cohort was 7.5% (34 of 452 patients). Compared with the prior cohort, significant decreases were noted with regard to total reoperation rate as well as reoperation due to infection and pseudarthrosis. Trends were noted toward decreased rates of reoperation due to prominent implants, dislodged implants, and implant proximity to vital structures. Within the newer cohort, a trend toward decreased reoperation rate was also noted for lower profile implant systems compared with first-generation TSRH implants. CONCLUSION With the evolution of newer lower profile segmental implant systems that provide more rigid fixation and with the advancements in techniques for deformity correction, the repeat surgical intervention rate for idiopathic scoliosis has decreased.
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Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE The objective of this study was to share our experience in the surgical treatment of adolescent idiopathic scoliosis (AIS), specifically the rate of revision surgeries and their indications. SUMMARY OF BACKGROUND DATA Minimizing AIS surgical morbidity includes prevention of short- and long-term complications that could require an unanticipated revision. There have been an increasing number of reports about revision rates and their causes in AIS. This study summarizes the experience of a large patient population treated by a single surgeon in a single institution. METHODS All patients who underwent surgical treatment for AIS between 10 and 20 years of age during 1983 to 2005 were reviewed. All revision surgeries performed during the same period were searched. The indications for revision and type of procedure performed were recorded. RESULTS A total of 502 patients with AIS underwent spinal fusion with instrumentation at an average age of 14.3 years at initial surgery. In 485 patients, the surgery consisted of posterior-only spinal fusion. A total of 24 revision surgeries were performed for 23 patients (4.9%; cumulative probability of revision = 8%). The primary indications for revision were residual rib deformity (n = 8), instrumentation dislodgement (n = 4), compensatory curve progression (n = 3), junctional kyphosis (n = 3), and symptomatic implants (n = 3). One patient had a late infection. There was 1 case of pseudoarthrosis. One patient requested scar revision. There were no cases of neurological deficit. CONCLUSION In this single-surgeon series, revision after the index spinal fusion was required for a relatively low proportion of patients. The main indications for revision were residual rib deformity, hook dislodgment, and progression of the unfused compensatory curve.
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Does a long-fusion "T3-sacrum" portend a worse outcome than a short-fusion "T10-sacrum" in primary surgery for adult scoliosis? Spine (Phila Pa 1976) 2012; 37:884-90. [PMID: 21971131 DOI: 10.1097/brs.0b013e3182376414] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinicoradiographic analysis. OBJECTIVE To compare the upper thoracic (UT) and lower thoracic (LT) spines as the upper instrumented vertebra in primary fusions to the sacrum for adult scoliosis. SUMMARY OF BACKGROUND DATA The optimal level at which a fusion to the sacrum is terminated proximally for adult scoliosis remains controversial. We hypothesized that (1) UT spine would have an increased pseudarthrosis, more perioperative complications, and worse outcomes and (2) LT spine would have more proximal junctional kyphosis. METHODS Patients who underwent primary surgery for adult scoliosis between 2002 and 2006 were studied. UT and LT groups were matched cohorts. Minimum follow-up for all patients was 2 years. Scoliosis Research Society scores and Oswestry Disability Index were the clinical outcome measures. RESULTS Fifty-eight patients (UT = 20, LT = 38) with a mean age of 55.7 years were followed for an average of 3.0 ± 1.1 years. The UT group had greater preoperative thoracic kyphosis and coronal Cobb values (P < 0.05). Diagnoses were idiopathic scoliosis (75.9%) and degenerative scoliosis (24.1%). The UT cohort had a greater number of levels fused (15.8 vs. 8.6) and higher blood loss (1350 mL vs. 811 mL). Operative time, recombinant human bone morphogenetic protein-2 per level, and caudal interbody grafting (80.0% UT vs. 89.5% LT) were similar. The UT group experienced an increased number of perioperative complications (30.0% vs. 15.8%), more pseudarthrosis (20.0% vs. 5.3%), and a higher prevalence of revision surgery (20.0% vs. 10.5%). The LT group had more proximal junctional kyphosis (18.4% vs. 10.0%). Scoliosis Research Society scores and Oswestry Disability Index were improved in both cohorts in all domains (P < 0.001), except function (P = 0.07) and mental health (P = 0.27), which were not significantly improved in the UT group. CONCLUSION With long fusions to the sacrum, one should anticipate more perioperative complications, a higher pseudarthrosis rate, and perhaps more revision surgery than short fusions. Short fusions may result in a more proximal junctional kyphosis, only rarely requiring revision surgery.
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Trobisch PD, Ricart PA, Verma K. Clinical and demographic characteristics of online community members--does it represent reality? Spine J 2011; 11:826-31. [PMID: 21802997 DOI: 10.1016/j.spinee.2011.06.011] [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] [Received: 11/26/2010] [Revised: 02/18/2011] [Accepted: 06/15/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND The decision to undergo surgery for scoliosis is shared between the physician, patient, and family. In an effort to obtain objective data regarding scoliosis surgery, patients often use the Internet, which includes sharing experiences in online communities. To this end, physicians have limited knowledge about disease-specific online communities. PURPOSE To analyze the clinical and demographic characteristics of patients who use disease-specific online communities. STUDY DESIGN A retrospective clinical study. PATIENT SAMPLE One hundred ninety-five patients with scoliosis who are also members of a popular scoliosis-specific online community. MAIN OUTCOME MEASURES Five domains of the Scoliosis Research Society-22 (SRS-22) quality-of-life questionnaire: function, pain, mental health, self-image, and satisfaction. METHODS An online questionnaire was submitted by members of a scoliosis-specific online community. One hundred ninety-five patients with scoliosis fulfilled the inclusion criteria, which represented 54% of all active members who have logged into this community during the time of data collection. A descriptive analysis was performed for demographic and clinical characteristics. RESULTS Analysis revealed a bimodal age distribution. Most online members were female (74%) and underwent surgical treatment (78%). Of all surgical patients, 52% had surgery between the age of 10 and 18 years. The average time since surgery (follow-up) was 10 years and 9 months. A revision rate of 17% was calculated, which increased with longer follow-up. Five of nine surgical subgroups significantly outperformed nonsurgical patients in regards of SRS-22 total scores. CONCLUSION This study supports that members from an online scoliosis community may be the representative sample of the general scoliosis patient population. The information obtained may be useful for physicians to understand patient concerns and mitigate treatment expectations when counseling patients.
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Affiliation(s)
- Per D Trobisch
- Orthopaedic Hospital Berlin at Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, Germany.
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Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine (Phila Pa 1976) 2011; 36:1484-91. [PMID: 21037528 DOI: 10.1097/brs.0b013e3181f3a326] [Citation(s) in RCA: 278] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of a multicenter database. OBJECTIVE To determine the complication rates associated with surgical treatment of pediatric scoliosis and to assess variables associated with increased complication rates. SUMMARY OF BACKGROUND DATA Wide variability is reported for complications associated with the operative treatment of pediatric scoliosis. Limited number of patients, surgeons, and diagnoses occur in most reports. The Scoliosis Research Society Morbidity and Mortality (M&M) database aggregates deidentified data, permitting determination of complication rates from large numbers of patients and surgeons. METHODS Cases of pediatric scoliosis (age ≤18 years), entered into the Scoliosis Research Society M&M database between 2004 and 2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed. RESULTS A total of 19,360 cases fulfilled inclusion criteria. Of these, complications occurred in 1971 (10.2%) cases. Overall complication rates differed significantly among idiopathic, congenital, and neuromuscular cases (P < 0.001). Neuromuscular scoliosis had the highest rate of complications (17.9%), followed by congenital scoliosis (10.6%) and idiopathic scoliosis (6.3%). Rates of neurologic deficit also differed significantly based on the etiology of scoliosis (P < 0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%) and idiopathic scoliosis (0.8%). Neur-omuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurologic deficits were associated with revision procedures (P < 0.001) and with the use of corrective osteotomies (P < 0.001). The rates of new neurologic deficit were significantly higher for procedures using anterior screw-only constructs (2.0%) or wire-only constructs (1.7%), compared with pedicle screw-only constructs (0.7%) (P < 0.001). CONCLUSION In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups. These data may be useful for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.
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Trobisch P, Suess O, Schwab F. Idiopathic scoliosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:875-83; quiz 884. [PMID: 21191550 DOI: 10.3238/arztebl.2010.0875] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 09/27/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scoliosis is a three-dimensional deviation of the spinal axis. The main diagnostic criterion is spinal curvature exceeding 10° on a plain anteroposterior X-ray image. Scoliosis is called idiopathic when no other underlying disease can be identified. METHODS Selective literature review and recommendations of the relevant medical societies in Germany and abroad. RESULTS Scoliosis in children of school age and above primarily occurs in girls. Its prevalence is 1% to 2% among adolescents, but more than 50% among persons over age 60. The therapeutic goal in children is to prevent progression. In children, scoliosis of 20° or more should be treated with a brace, and scoliosis of 45° or more with surgery. The treatment of adults with scoliosis is determined on an individual basis, with physiotherapy and braces playing a relatively minor role. Adults (even elderly adults) who have scoliosis and sagittal imbalance may be best served by surgical treatment. CONCLUSION Scoliosis is common. Early diagnosis makes a major difference in the choice of treatment.
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Affiliation(s)
- Per Trobisch
- Shriners Hospital for Children, 3551 N Broad Street, Philadelphia, PA 19140, USA.
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