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Pollack JC, Hollinger LE, Buchmiller TL, Jancelewicz T. Long-term follow-up in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151443. [PMID: 38972214 DOI: 10.1016/j.sempedsurg.2024.151443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
With improvements in initial care for patients with congenital diaphragmatic hernia (CDH), the number of CDH patients with severe disease who are surviving to discharge has increased. This growing population of patients faces a unique set of long-term challenges, multisystem adverse outcomes, and post-intervention complications requiring specialized multidisciplinary follow-up. Early identification and intervention are essential to mitigate the potential morbidity associated with these challenges. This manuscript outlines a general framework for long-term follow-up for the CDH patient, including cardiopulmonary, gastrointestinal, neurodevelopmental, surgical, and quality of life outcomes.
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Affiliation(s)
- Jessica C Pollack
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, USA; Division of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - Laura E Hollinger
- Division of Pediatric Surgery, Department of Surgery, Medical University of South Carolina, USA
| | | | - Tim Jancelewicz
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, USA.
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Ducrot C, Piffoux M, Rabattu PY, Pourquet A, Peyrot Q, Robert Y, Chotel F, Hameury F. Reconstruction with antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty for pediatric chest wall reconstruction: A 10-case series. Orthop Traumatol Surg Res 2024:103895. [PMID: 38657749 DOI: 10.1016/j.otsr.2024.103895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement. HYPOTHESIS Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction? MATERIAL AND METHODS Consecutive patients who were treated from 2011 to 2023 in our hospital were included. RESULTS Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance. DISCUSSION "Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Coline Ducrot
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France; Team Cell Death and Pediatric Cancer, Cancer Initiation and Tumor Cell Identity Department, Inserm 1052, CNRS5286, Cancer Research Center of Lyon, 69008 Lyon, France.
| | - Max Piffoux
- Medical Oncology - oncologie médicale, centre Léon-Bérard, Lyon, France; Medical Oncology, hospices civils de Lyon, Lyon, France; Laboratoire matière et systèmes complexes (MSC), université de Paris, CNRS UMR7057, 45, rue des Saints-Pères, 75006 Paris, France
| | - Pierre Yves Rabattu
- Department of Pediatric Visceral Surgery, CHU of Grenoble Alpes, Hôpital couple enfant, quai Yermoloff, 38700 La Tronche, France
| | - Anne Pourquet
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
| | - Quoc Peyrot
- Department of Pediatric Thoracic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
| | - Yohann Robert
- Department of Pediatric Visceral Surgery, CHU of Grenoble Alpes, Hôpital couple enfant, quai Yermoloff, 38700 La Tronche, France
| | - Franck Chotel
- Department of Pediatric Orthopedic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
| | - Fréderic Hameury
- Department of Pediatric Thoracic Surgery, Hôpital Femme Mère Enfant, 32, avenue du Doyen-Jean-Lépine, 69677 Lyon cedex, France
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Cimbak N, Buchmiller TL. Long-term follow-up of patients with congenital diaphragmatic hernia. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000758. [PMID: 38618013 PMCID: PMC11015326 DOI: 10.1136/wjps-2023-000758] [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: 12/15/2023] [Accepted: 02/28/2024] [Indexed: 04/16/2024] Open
Abstract
Neonates with congenital diaphragmatic hernia encounter a number of surgical and medical morbidities that persist into adulthood. As mortality improves for this population, these survivors warrant specialized follow-up for their unique disease-specific morbidities. Multidisciplinary congenital diaphragmatic hernia clinics are best positioned to address these complex long-term morbidities, provide long-term research outcomes, and help inform standardization of best practices in this cohort of patients. This review outlines long-term morbidities experienced by congenital diaphragmatic hernia survivors that can be addressed in a comprehensive follow-up clinic.
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Affiliation(s)
- Nicole Cimbak
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Terry L Buchmiller
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, MA, USA
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Borselle D, Grochowski K, Gerus S, Międzybrodzki K, Kołtowski K, Jasińska A, Kamiński A, Patkowski D. Thoracic Musculoskeletal Deformities Following Surgical Treatment of Esophageal Atresia - Thoracoscopic Versus Open Approach: A Retrospective Two Centers Cohort Study. J Pediatr Surg 2024:S0022-3468(24)00175-1. [PMID: 38594136 DOI: 10.1016/j.jpedsurg.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Thoracic musculoskeletal deformities are significant complications following open correction of esophageal atresia (EA) during long-term follow-up. We aimed to compare the frequency and severity of thoracic musculoskeletal deformities after open and thoracoscopic repair of EA. We hypothesized that fewer deformities would occur following the less invasive thoracoscopic approach. METHODS This retrospective study analyzed patients treated at two pediatric surgery departments in Poland between 2005 and 2021. The patient groups differed in surgical approach, operative techniques, indications for multi-staged surgery, and postoperative complications. The study encompassed all types of EA/TEF. The first group comprised 68 patients who underwent thoracoscopic esophageal atresia repair (Wroclaw), while the second group involved 44 patients who underwent open repair (Warsaw). Clinical data were retrospectively reviewed, with results considered significant at p < 0.05. RESULTS The median age at examination was 6 years in the thoracoscopy group and 5.5 years in the thoracotomy group. In the thoracoscopy group, 53 out of 68 patients (77.9%) and in the thoracotomy group - 35 out of 44 patients (79.5%) were treated in one stage. The incidence of thoracic musculoskeletal deformities was significantly lower in the thoracoscopy group (1.5%) compared to the thoracotomy group (34.1%, p < 0.001). Scoliosis occurred significantly more often after thoracotomy (13.6% vs 1.5%, p = 0.016). There was no rib fusion (0% vs 37.1%, p < 0.001) and no scoliosis of =>20° (0% vs 6.8%, p = 0.058) after thoracoscopy. The coincidence of rib fusion and scoliosis was significant (9.1%, p = 0.022) for the open approach. In the thoracotomy group, multi-staged surgery and more frequent reoperations due to major complications were significantly associated with an increased occurrence of deformities. None of the patients after thoracoscopic multi-stage or complicated EA/TEF repair developed scoliosis. CONCLUSIONS The frequency and severity of thoracic musculoskeletal deformities were significantly lower after the thoracoscopic approach. Thoracoscopy may be a more advantageous and preferred surgical approach for the EA/TEF treatment, although further randomized, controlled studies are necessary. Post-thoracotomy scoliosis may progress to a severity requiring surgery.
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Affiliation(s)
- Dominika Borselle
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland.
| | - Konrad Grochowski
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Sylwester Gerus
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Krzysztof Kołtowski
- Department of Pediatric Orthopedics and Traumatology, University Hospital of Jan Mikulicz-Radecki, Wroclaw, Poland
| | - Aleksandra Jasińska
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Kamiński
- Department of Pediatric Surgery, Pediatric Urology and Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Wroclaw Medical University, Wroclaw, Poland
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Pujol O, Moreira F, Balcells J, Nuño R, Moreno A, Pellise F. First surgical experience treating scoliosis using HGT and ECMO: a case report. Spine Deform 2023; 11:507-511. [PMID: 36121561 DOI: 10.1007/s43390-022-00588-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/10/2022] [Indexed: 11/28/2022]
Abstract
CASE PRESENTATION A 13-year-old female with congenital diaphragmatic hernia-associated pulmonary hypertension presented with severe and rapidly progressing scoliosis. The patient suffered from chronic respiratory failure and high risk of hypertensive crisis with potentially life-threating consequences. The scoliosis was treated with a multidisciplinary approach combining preoperative halo-gravity traction, venoarterial extracorporeal membrane oxygenation support and posterior spinal instrumented fusion. After 2 years of follow-up, results are excellent. CONCLUSIONS The treatment combination reported here for the first time aims to limit surgical aggressiveness. It could be an effective and safe approach for treating severe spinal deformities in very fragile patients with high surgical risk.
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Affiliation(s)
- Oriol Pujol
- Spinal Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Felipe Moreira
- Spinal Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Balcells
- Pediatric Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rosario Nuño
- Pediatric Anesthesiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Antonio Moreno
- Pediatric Pneumology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ferran Pellise
- Spinal Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Thoracogenic scoliosis: coronal deformity progression in paediatric patients. 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 2023; 32:639-650. [PMID: 36596912 DOI: 10.1007/s00586-022-07498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To assess the risk of developing thoracogenic scoliosis (THS) in paediatric patients, depending on the side of lateral thoracotomy (LT) and of spine deviation in the coronal plane by means of logistic regression and scoliosis-free survival analyses. METHODS A total of 307 consecutive patients undergoing LT were retrospectively reviewed; 32 patients met the inclusion criteria: 1) underwent LT and developed THS; 2) age < 15 years at LT; 3) clinical and radiographic follow-up ≥ 5 years. Patients were divided into ipsilateral group (convexity ipsilateral to LT) and contralateral group (convexity contralateral to LT). RESULTS The mean follow-up was 10 ± 4.7 in the ipsilateral group (n = 13) and 12 ± 4.8 years in the contralateral group (n = 19). The contralateral group underwent LT at a younger age (4.4 vs 6.4 years, p = 0.55), developed more severe coronal deformity (27.8° vs 18.9°, p = 0.15), had higher rate of THS > 20° (47.5% vs 38.4%; p = 0.34) and > 45° (21.1% vs 0%; p = 0.99). The mean time from LT to THS diagnosis was 4.2 ± 2.9 in ipsilateral group and 5.5 ± 4.2 years in contralateral group. Left-side LT (p = 0.03) and age > 5 years (p = 0.01) showed a lower risk of THS diagnosis. The group variable had a statistically significant effect on the risk of developing THS > 45° (p = 0.03). CONCLUSION In this series, children that developed THS with a convexity contralateral to the side of LT had more severe and progressive coronal spine deformity. LEVEL OF EVIDENCE III.
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Abstract
Congenital diaphragmatic hernia (CDH) is a challenging surgical disease that requires complex preoperative, perioperative, and postoperative care. Survival depends on successful reduction and repair of the defect, and numerous complex decisions must be made regarding timing and preparation for surgery. This review describes the challenges and controversies inherent to surgical CDH care and provides recommendations for management based on the most recent evidence.
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Affiliation(s)
- Matthew T Harting
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, University of Texas McGovern Medical School, 6431 Fannin Street, MSB: 5.233, Houston, TX 77030, USA
| | - Tim Jancelewicz
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap Street Second Floor, Memphis, TN 38105, USA.
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The incidence and prevalence of early-onset scoliosis: a regional multicenter epidemiological study. Spine J 2022; 22:1540-1550. [PMID: 35381360 DOI: 10.1016/j.spinee.2022.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the many advances in understanding and treating early-onset scoliosis, the incidence and prevalence of this disease in the population remains unknown. Such knowledge is important for guiding clinical practice, directing research and raising awareness. PURPOSE To identify the incidence and prevalence of early-onset scoliosis, including all categories, within the population. STUDY DESIGN A regional multicenter retrospective cohort study PATIENT SAMPLE: All patients diagnosed with early-onset scoliosis in the region, who were followed-up between January 2000 and December 2020. OUTCOME MEASURES Frequency distributions for early-onset scoliosis subtypes, demographics, curve patterns and progression statuses. METHODS Relevant population data, for children under 10 years old, was extracted from the official government census for the years 2000 to 2020. Identification of cases was carried out by pediatricians at mandatory government funded regular child wellness check-up visits. Outpatient records were reviewed for all included patients, with extraction of the following: Medical identifier, date of birth, date of initial visit, sex, primary diagnosis, length of follow-up, curve pattern, initial cobb angle, and final cobb angle. Incidence and prevalence values were calculated using population figures and case numbers. Kaplan-Meier survival analysis and Log-rank testing was performed on curve progression data. RESULTS The regional population of children, under the age of 10 years, included a total of 2,295,929 children, 1,170,149 (51.0%) males and 1,125,780 (49.0%) females, between the years 2000 and 2020. Early-onset scoliosis cases followed within the same timeframe, totaled 469 patients, 227 (48.4%) males and 242 (51.6%) females. The annual incidence of early-onset scoliosis was found to be 0.019% (95% CI: 0.015%-0.023%), and the prevalence was 0.077% (95% CI: 0.059%-0.096%). The most common age at first presentation was 6 years old. More females (51.6%) than males (48.4%) were observed, and more left-sided curves (54.2%) than right-sided curves (45.8%) were encountered, with the majority being single thoracic curves (38.2%). Scoliosis curves did not progress in 44.3% of cases, while they progressed in 38% of them. Follow-up was inadequate to determine progression status in 17.7% of cases. Neuromuscular etiologies were the most common, at 40.1%, of which 83.5% had cerebral palsy. CONCLUSIONS Based on the regional population included in this study, the annual incidence of early-onset scoliosis in children under 10 years old was calculated to be 0.019%, while the prevalence of early-onset scoliosis in children under 10 years old was found to be 0.077%.
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Sacco R, Bonnevalle M, Nectoux E, Fron D, Ould-Slimane M, Sharma D, Lucchesi G, Canavese F. Thoracogenic scoliosis: a retrospective review of 129 pediatric patients with a mean follow-up of 10 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 2022; 31:2287-2294. [PMID: 35593932 DOI: 10.1007/s00586-022-07242-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the midterm outcome of lateral thoracotomy (LT) in skeletally immature patients concerning thoracogenic scoliosis development and lung parenchyma resection (LPR) extent. METHODS In total, 129 children met the inclusion criteria: (1) LT during the study period; (2) skeletally immature at the time of LT; (3) clinical and radiographic follow-up of at least 3 years; and (4) no spinal or thoracic deformity on radiographs before LT. Patients were grouped according to their underlying disease, age at LT, and LPR extent. Radiographic parameters were assessed. Kaplan-Meier survival curves and univariate and multivariate analysis were performed. RESULTS Of 129, 108 patients underwent pneumonectomy (9; 9.1%), lobectomy (79; 61.2%), segmentectomy (20; 15.5%) and 21 patients LT without LPR. The mean age at LT and at last radiological follow-up was 5.5 years (birth-17.8) and 15.2 years (3.4-33.2). The mean follow-up was 10 years (3-28.1). Scoliosis developed on average 5.3 years after LT. The mean Cobb angle was 22.1° (11-90°); > 10° in 37/129 patients (28.7%), of whom 5/129 (3.9%) had > 45°. The average vertebral rotation was 16.2° (2-43°; grade 0-II). RVAD was 26.5° (8°-33°) and 15.3° (2-43°) in patients with Cobb > 45° and ≤ 45°. Gender, age at surgery, and extent of LPR were not risk factors for post-thoracotomy scoliosis (p > 0.05), although younger patients developed a more severe deformity. CONCLUSION Although post-thoracotomy scoliosis is not associated with significant rotation, the risk of curve progression > 45° is relatively high. Regular follow-up is required as scoliosis may develop several years after LT with or without LPR.
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Affiliation(s)
- Riccardo Sacco
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Michel Bonnevalle
- Department of Pediatric Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Eric Nectoux
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Damien Fron
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | | | - Dyuti Sharma
- Department of Pediatric Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France
| | - Giovanni Lucchesi
- Department of Surgery and Translational Medicine, Orthopaedic Clinic, University of Florence, Florence, Italy
| | - Federico Canavese
- Department of Pediatric Orthopaedic Surgery, CHU de Lille, Jeanne de Flandre Hospital, Rue Eugène Avinée, 59000, Lille, France.
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Donoho DA, Singer TG, Lazaro T, Bauer DF. Management of Cervical Kyphotic Deformity Associated With Loeys-Dietz Vasculopathy and Cardiac Transplantation: Case Report, Literature Review, and Strategies for Complex Skeletal Dysplasias. Cureus 2021; 13:e20503. [PMID: 35070541 PMCID: PMC8763335 DOI: 10.7759/cureus.20503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/05/2022] Open
Abstract
Seventy-six percent of pediatric patients with Loeys-Dietz syndrome (LDS), a connective tissue disorder driven by a transforming growth factor-beta (TGF-B) pathway mutation, manifest cervical spine malformations. A prior series showed that 16% required surgical stabilization. Spine surgery in LDS is associated with an 88% complication rate due to poor bone quality and cerebrovascular ectasia. Of 77 patients with LDS, one patient who required spine surgery was identified in an institutional database from 2010 to 2020. A 15-year-old with LDS presented with symptomatic cervical myelopathy from a rapidly progressive and unstable cervical deformity. We performed a C5-6 corpectomy and an O-T2 posterior spinal fusion with recombinant human bone morphogenetic protein-2 (rhBMP-2). We achieved correction of her kyphosis and normalization of her neurologic status. She is neurologically well one year postoperatively with bony fusion. The management of a pediatric patient with LDS, orthotopic heart transplantation (OHT), and craniocervical deformity with instability is a novel challenge. Long-segment constructs are beneficial, rather than sparing the occiput or cervicothoracic junction. Off-label BMP may aid an LDS patient with TGF-B mutation and sternotomy. Surgeons should continue immunomodulatory and antiplatelet medications when required for OHT.
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Safa N, Wei S, Saran N, Guadagno E, Laberge JM, Emil S. Musculoskeletal deformities after thoracic surgery in children: An observational long-term follow-up study. J Pediatr Surg 2021; 56:136-141. [PMID: 33168178 DOI: 10.1016/j.jpedsurg.2020.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study reports the incidence, severity, and predictors of musculoskeletal deformities (MD), including scoliosis and chest wall anomalies, following thoracic procedures in children. METHODS Children younger than 14 years who had thoracic surgery between 1997 and 2012 and had no other predispositions to MD, underwent longitudinal follow-ups with dedicated musculoskeletal examination performed in an esophageal atresia, orthopedic, or research clinic. Incidence of MD was calculated, and logistic regression methods were used to determine independent predictors, including sex, gestational age, age at procedure, serratus anterior muscle division, and chest tube placement. RESULTS The study cohort consisted of 104 patients followed for a median of 10.8 years (range 3-21). A total of 56 MD developed in 41 patients (39%), including scapular winging (24; 23%), scoliosis (17; 16%), and chest wall anomalies (15; 14%). The majority of MD were subclinical, with only 8 patients [8% (6 thoracotomies, 2 thoracoscopies)] requiring intervention. Among patients who underwent thoracotomies (93, 89%), serratus anterior muscle division was the only significant predictor of the development of MD [OR 8.9; 95% CI 2.8-32.6]. CONCLUSION Musculoskeletal deformities develop in a significant proportion of children following thoracic surgery, but most are subclinical. A muscle-sparing technique decreases the incidence of these deformities. TYPE OF STUDY Prospective Cohort Study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Nadia Safa
- Harvey E, Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Montréal, QC, H4A 3J1, Canada
| | - Sunny Wei
- Harvey E, Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Montréal, QC, H4A 3J1, Canada
| | - Neil Saran
- Division of Pediatric Orthopedic Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Montréal, QC, H4A 3J1, Canada; Chest Wall Anomalies Center, Shriners Hospital for Children, Canada, 1003 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Elena Guadagno
- Harvey E, Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Montréal, QC, H4A 3J1, Canada
| | - Jean-Martin Laberge
- Harvey E, Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Montréal, QC, H4A 3J1, Canada; Chest Wall Anomalies Center, Shriners Hospital for Children, Canada, 1003 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada
| | - Sherif Emil
- Harvey E, Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Décarie Boulevard, Montréal, QC, H4A 3J1, Canada; Chest Wall Anomalies Center, Shriners Hospital for Children, Canada, 1003 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Abstract
Survivorship of patients with congenital diaphragmatic hernia (CDH) has created a unique cohort of children, adolescents and adults with complex medical and surgical needs. Morbidities specific to this disease benefit from multi-specialty care, and the long term follow up of these patients offers a tremendous opportunity for research and collaboration. Herein we aim to offer an overview of the challenges that modern CDH survivors face, and include a risk-stratified algorithm as a general guideline for a multi-specialty follow up program.
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Affiliation(s)
- Laura E Hollinger
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 613/CSB 417, Charleston SC 29425, USA.
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Langlais T, Pietton R, Laurent R, Cassier S, Constant I, Mimoun M, Vialle R. Stepwise Management of Severe Thoracogenic Scoliosis in Burned Child. World Neurosurg 2019; 136:399-402.e2. [PMID: 31870815 DOI: 10.1016/j.wneu.2019.12.079] [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: 11/12/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Skin and soft tissue retraction secondary to burns of the trunk may induce severe and progressive thoracogenic spinal deformities in children. Its management is rarely described. CASE DESCRIPTION Our study reports a case of severe thoracic scoliosis in a 13-year-old adolescent, secondary to soft tissue retraction due to trunk burn in early childhood. The Cobb angle of the scoliosis was 100 degrees. The 3-stage surgical strategy consisted of scar excision and skin graft in the first stage, halo gravity traction in the second stage, and posterior correction and fusion of the spine in the third and final stage. The postoperative course was satisfactory, and late follow-up at 1 year showed stable correction of the spine, with satisfactory coronal and sagittal balance and good healing of skin and soft tissues. DISCUSSION While spinal deformities secondary to burns are rare, they require specific, sequential, and multidisciplinary medical and surgical management. Our surgical strategy was to treat skin and soft tissues retractions first and then address spinal deformity. We used halo-gravity traction between the 2 surgical stages to help improve the spine deformity correction while reducing the risk of neurologic complications.
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Affiliation(s)
- Tristan Langlais
- The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases-Sorbonne University, Armand Trousseau Hospital, Paris, France; Department of Orthopedics, Children's Hospital, Toulouse, France.
| | - Raphaël Pietton
- The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases-Sorbonne University, Armand Trousseau Hospital, Paris, France
| | - Romain Laurent
- The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases-Sorbonne University, Armand Trousseau Hospital, Paris, France
| | - Sophie Cassier
- Paediatric Burned Children Surgery-Sorbonne University, Armand Trousseau Hospital, Paris, France
| | - Isabelle Constant
- Paediatric Burned Children Intensive Care Unit-Sorbonne University, Armand Trousseau Hospital, Paris, France
| | - Maurice Mimoun
- Plastic, Reconstructive, and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France
| | - Raphaël Vialle
- The MAMUTH Hospital-University Department for Innovative Therapies in Musculoskeletal Diseases-Sorbonne University, Armand Trousseau Hospital, Paris, France
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