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Pérez-Grueso FJS, Moreno-Manzanaro L, Pizones J. The reunion with my patients: their journey and experience 30 years after their intervention for adolescent idiopathic scoliosis via CD instrumentation. Spine Deform 2024:10.1007/s43390-023-00814-7. [PMID: 38305991 DOI: 10.1007/s43390-023-00814-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/23/2023] [Indexed: 02/03/2024]
Abstract
PURPOSE Our objective was to collect the experience and current attitude of those patients, now adults, operated on for adolescent idiopathic scoliosis (AIS) more than 25 years ago with CD instrumentation (CDI). METHODS Prospective qualitative cross-sectional study with interpretive phenomenological analysis approach of AIS patients operated in a single center with CDI between 1985 and 1995. Patients underwent a semi-structured interview with their original surgeon. Seven agreed themes were open for conversation, and several subthemes emerged related to their experience during their journey in life. Filed notes were recorded and transcribed verbatim. We used the method of content, semantic and pragmatic analysis. RESULTS We contacted 103 patients, 100 agreed to participate. Mean age was 47.5 ± 3.3, mean follow-up was 30.9 ± 2.7 years. Three fundamental concerns stood out: discomfort with self-image; low back pain with daily activities; and lack of spinal flexibility. 50% were engaged in continuous physical exercise, and only some referred limitations with load-bearing work. Patients commonly described negative memories of the conservative treatment, but positive memories of the surgical process. In general, there was a good adaptation to social life (occupation, social and family relationships). Two-thirds were married, and 65 women had offspring. A frequent concern was the excess of radiographs over the years, and three developed breast cancer. CONCLUSIONS Factors such as dissatisfaction with self-image, low back pain, and spine stiffness were relevant to patients throughout their journeys. Despite this, the great majority were satisfied with the treatment received, which allowed them to lead an integrated life in society. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | - Lucía Moreno-Manzanaro
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
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Phedy P, Dilogo IH, Indriatmi W, Supriadi S, Prasetyo M, Octaviana F, Noor Z. Scoliocorrector Fatma-UI for correction of adolescent idiopathic scoliosis: Development, effectivity, safety and functional outcome. World J Orthop 2024; 15:61-72. [PMID: 38293260 PMCID: PMC10824068 DOI: 10.5312/wjo.v15.i1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Adolescent idiopathic scoliosis remains a major problem due to its high incidence, high risk, and high cost. One of the aims of the management in scoliosis is to correct the deformity. Many techniques are available to correct scoliosis deformity; however, they are all far from ideal to achieve three-dimensional correction in scoliosis. AIM To develop a set of tools named Scoliocorrector Fatma-UI (SCFUI) to aid three-dimensional correction and to evaluate the efficacy, safety, and functional outcome. METHODS This study consists of two stages. In the first stage, we developed the SCFUI and tested it in finite element and biomechanical tests. The second stage was a single-blinded randomized clinical trial to evaluate the SCFUI compared to direct vertebral rotation (DVR). Forty-four subjects with adolescent idiopathic scoliosis were randomly allocated into the DVR group (n = 23) and SCFUI group (n = 21). Radiological, neurological, and functional outcome was compared between the groups. RESULTS Finite element revealed the maximum stress of the SCFUI components to be between 31.2 - 252 MPa. Biomechanical analysis revealed the modulus elasticity of SCFUI was 9561324 ± 633277 MPa. Both groups showed improvement in Cobb angle and sagittal profile, however the rotation angle was lower in the SCFUI group (11.59 ± 7.46 vs 18.23 ± 6.39, P = 0.001). Neurological and functional outcome were comparable in both groups. CONCLUSION We concluded that SCFUI developed in this study resulted in similar coronal and sagittal but better rotational correction compared to DVR. The safety and functional outcomes were also similar to DVR.
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Affiliation(s)
- Phedy Phedy
- Doctoral Program in Medical Sciences Faculty of Medicine, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Universitas Indonesia, Jakarta 10430, DKI Jakarta, Indonesia
| | - Wresti Indriatmi
- Department of Dermatology and Venereology, Faculty of Medicine, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Sugeng Supriadi
- Faculty of Mechanical Engineering, University of Indonesia, Depok 16424, Jawa Barat, Indonesia
| | - Marcel Prasetyo
- Department of Radiology, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Fitri Octaviana
- Department of Neurology, Faculty of Medicine, University of Indonesia, Jakarta Pusat 10430, DKI Jakarta, Indonesia
| | - Zairin Noor
- Research Center for Osteoporosis, Department of Orthopaedic and Traumatology, Lambung Mangkurat University, Banjarmasin 70123, Kalimantan Selatan, Indonesia
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Morales Ciancio RA, Lucas J, Tucker S, Ember T, Harris M, Broomfield E. Distal level in scoliosis surgery for non-ambulatory patients with cerebral palsy: is L5 an option? A case series study. Spine Deform 2023; 11:1467-1475. [PMID: 37429979 DOI: 10.1007/s43390-023-00722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE This study aimed to determine the radiographic outcomes of patients with cerebral palsy (CP) who underwent posterior spinal fusion from T2/3 to L5 at two quaternary hospitals. METHODS From January 2010 to January 2020, 167 non-ambulatory patients with CP scoliosis underwent posterior spinal fusion using pedicle screws from T2/3 to L5 in both centers, with a minimum of 2 years follow-up (FU). Radiological measurements and chart reviews were performed. RESULTS A total of 106 patients aged 15.6 ± 0.4 years were included. None of the patients was lost to FU. All patients had significant correction of the Cobb angle (MC) and pelvic obliquity (PO), thoracic kyphosis (TK), and lumbar lordosis (LL), without loss of correction at the last FU (LFU). The mean values for preoperative, immediate postoperative, and LFU were MC 93.4°, 37.5°, and 42.8°; PO 25.8°, 9.9°, and 12.7°; TK 52.2°, 44.3°, and 45°; and LL - 40.9°, - 52.4°, and - 52.9°, respectively. Higher residual PO at LFU was associated with more severe MC and PO baselines, lower implant density, and an apex located at L3. CONCLUSIONS CP scoliosis and PO can be corrected, and this correction is maintained over time with posterior spinal fusion using pedicle screws, with L5 as the lowest instrumented vertebra. Larger preoperative MC and PO values associated with the apex at L3 appear to be related to residual PO. Comparative large-scale studies of patient-related clinical outcomes are required to determine whether this intervention is associated with improved surgical outcomes and reduced complication rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Jonathan Lucas
- Paediatric Spine Department, Evelina London Children Hospital, London, UK
| | - Stewart Tucker
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Thomas Ember
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Mark Harris
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
| | - Edel Broomfield
- Orthopaedic and Spine Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK
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Morales Ciancio RA, Gagliardi MJ, Tucker S, Ember T, Harris M, Broomfield E, Craven CL. Distal fusion in Duchenne scoliosis: the relevance of preoperative pelvic obliquity. A case series study. Spine Deform 2023; 11:1261-1270. [PMID: 37280469 DOI: 10.1007/s43390-023-00689-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/08/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to determine clinical and radiographic outcomes for Duchenne Muscular Dystrophy (DMD) patients who underwent posterior spinal fusion from T2/3 to L5 (without pelvic fixation), at this single centre. METHODS From January 2012 to January 2020, 29 consecutive DMD scoliosis patients underwent posterior spinal fusion using pedicle screws from T2/3 to L5 in a single center with a minimum of 3 years follow-up (FU). Radiologic measurements and chart review were performed. RESULTS Twenty nine patients aged 14 ± 1.5 years were included. No patient was lost to FU. All patients had significant correction in Cobb angle, pelvic obliquity (PO) and lumbar lordosis (LL), without loss of correction at last FU. The mean values for preoperative, immediate postoperative and last FU were CA 62o, 15o and 17o, PO: 21o, 8o and 9o; and LL 10o, -41o and -41o respectively. Correction in CA was independent of any variable analysed including implant density, rod diameter, traction, or bone density. Regarding PO, it was inversely related to age and independent of all other variables. Factors associated with postoperative complications were age and respiratory function. CONCLUSIONS It appears from our results that pelvic fixation might not always be required in DMD scoliosis surgery, when using pedicle screws with lowest instrumented vertebra at L5. However, larger preoperative PO values can be related with residual PO. It seems that probably related to the underlying condition, early surgery may decrease incidence of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Stewart Tucker
- Orthopaedic and Spine Department, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Thomas Ember
- Orthopaedic and Spine Department, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Mark Harris
- Orthopaedic and Spine Department, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Edel Broomfield
- Orthopaedic and Spine Department, Great Ormond Street Hospital, London, WC1N 3JH, UK
| | - Claudia L Craven
- Orthopaedic and Spine Department, Great Ormond Street Hospital, London, WC1N 3JH, UK
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Frank S, Piantoni L, Tello CA, Remondino RG, Galaretto E, Falconi BA, Pereyra LN, Noël MA. Evaluation of outpatient halo-gravity traction in patients with severe scoliosis: development of a monitoring device. Spine Deform 2023; 11:351-357. [PMID: 36436117 DOI: 10.1007/s43390-022-00623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/19/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with severe spinal deformities represent a major clinical and surgical challenge. Halo-gravity traction (HGT) is a traditional method to correct the deformity prior to surgery. Typically, children undergoing HGT remain in the hospital until surgery. Therefore, it has been suggested to treat these children at lower level healthcare centers or even at home. The aim of this study was to develop a tool to assess patient adherence to HGT together with a program to analyze traction results. MATERIALS AND METHODS An original recording system was designed with an Arduino Nano®. The data extracted from the memory card were compiled into a text file and then analyzed with the MatLab R2018a MathWorks®. RESULTS Five patients receiving HGT for severe scoliosis were asked to use the device both in the wheelchair and in bed to evaluate its usefulness. CONCLUSIONS A device was developed to monitor the use of HGT at home. The device provides information on the time of HGT use and the traction weight placed throughout the day, as well as on the correct functioning of the system in bed and in the wheelchair.
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Affiliation(s)
- Sofía Frank
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina.
| | - Lucas Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Carlos A Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Rodrigo G Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Eduardo Galaretto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Boris A Falconi
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Leandro N Pereyra
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
| | - Mariano A Noël
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de los Pozos 1881. C1245AAM. CABA, Buenos Aires, Argentina
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Dulfer SE, Lange F, Sahinovic MM, Wapstra FH, Absalom AR, Faber C, Groen RJM, Drost G. Feasibility and optimal choice of stimulation parameters for supramaximal stimulation of motor evoked potentials. J Clin Monit Comput 2023; 37:783-793. [PMID: 36635569 PMCID: PMC10175431 DOI: 10.1007/s10877-022-00972-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/08/2022] [Accepted: 12/31/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE The aim was to investigate the feasibility and optimal stimulation parameters for supramaximal stimulation of muscle recorded transcranial electrical stimulation motor evoked potentials (mTc-MEP). METHODS Forty-seven consecutive patients that underwent scoliosis surgery were included. First, the feasibility of supramaximal stimulation was assessed for two settings (setting 1: pulse duration 0.075ms, interstimulus interval (ISI) 1.5ms; setting 2: pulse duration 0.300ms, ISI 3ms). Thereafter, three mTc-MEP parameters were considered for both settings; (1) elicitability, (2) amplitude, and (3) if supramaximal stimulation was achieved with ≥ 20 V below maximum output. Finally, ISIs (1ms-4ms) were optimized for setting 1. RESULTS Nine patients (19.15%) were excluded. Of the remaining patients, supramaximal stimulation was achieved in all patients for setting 1, and in 26 (68.42%) for setting 2. In one patient, mTc-MEPs were elicitable in more muscles for setting (1) Amplitudes were not significantly different. Stimulation voltage could be increased ≥ 20 V in all 38 patients for setting 1 and in 10 (38.46%) for setting (2) Optimal ISI's differed widely. CONCLUSION We recommend using setting 1 when monitoring mTc-MEPs with supramaximal stimulation, after which an individualized ISI optimization can be performed. Moreover, when using supramaximal stimulation, short ISI's (i.e. 1ms or 1.5ms) can be the optimal ISI for obtaining the highest mTc-MEP amplitude.
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Affiliation(s)
- S E Dulfer
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - F Lange
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M M Sahinovic
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F H Wapstra
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C Faber
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R J M Groen
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Drost
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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de Reuver S, de Block N, Brink RC, Chu WCW, Cheng JCY, Kruyt MC, Castelein RM, Schlösser TPC. Convex-concave and anterior-posterior spinal length discrepancies in adolescent idiopathic scoliosis with major right thoracic curves versus matched controls. Spine Deform 2023; 11:87-93. [PMID: 36098947 PMCID: PMC9767993 DOI: 10.1007/s43390-022-00566-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/30/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The apical deformation in adolescent idiopathic scoliosis (AIS) is a combination of rotation, coronal deviation and passive anterior lengthening of the spine. In AIS surgery, posterior-concave lengthening or anterior-convex shortening can be part of the corrective maneuver, as determined by the individual surgeon's technique. The magnitude of convex-concave and anterior-posterior length discrepancies, and how this needs to be modified to restore optimal spinal harmony, remains unknown. METHODS CT-scans of 80 pre-operative AIS patients with right convex primary thoracic curves were sex- and age-matched to 80 healthy controls. The spinal length parameters of the main thoracic curves were compared to corresponding levels in controls. Vertebral body endplates and posterior elements were semi-automatically segmented to determine the length of the concave and convex side of the anterior column and along the posterior pedicle screw entry points while taking the 3D-orientation of each individual vertebra into account. RESULTS The main thoracic curves showed anterior lengthening with a mean anterior-posterior length discrepancy of + 3 ± 6%, compared to a kyphosis of - 6 ± 3% in controls (p < 0.01). In AIS, the convex side was 20 ± 7% longer than concave (0 ± 1% in controls; p < 0.01). The anterior and posterior concavity were 7 and 22 mm shorter, respectively, while the anterior and posterior convexity were 21 and 8 mm longer compared to the controls. CONCLUSIONS In thoracic AIS, the concave shortening is more excessive than the convex lengthening. To restore spinal harmony, the posterior concavity should be elongated while allowing for some shortening of the posterior convexity.
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Affiliation(s)
- Steven de Reuver
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Nick de Block
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Rob C. Brink
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack C. Y. Cheng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Moyo C. Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - René M. Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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Dinter K, Bretschneider H, Zwingenberger S, Disch A, Osmers A, Vicent O, Thielemann F, Seifert J, Bernstein P. Accelerate postoperative management after scoliosis surgery in healthy and impaired children: intravenous opioid therapy versus epidural therapy. Arch Orthop Trauma Surg 2023; 143:301-309. [PMID: 34302521 PMCID: PMC9886629 DOI: 10.1007/s00402-021-03972-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Postoperative pain is a major concern following scoliosis surgery. CEA (continuous epidural analgesia) is established in postoperative pain therapy as well as intravenous patient-controlled analgesia (IV-PCA). The purpose of this study was to compare the clinical outcomes of both methods. METHODS We retrospectively studied 175 children between 8 and 18 years who were subject to posterior scoliosis correction and fusion. Two main cohorts were formed: CEA with local anesthetic and opioids, and IV-PCA with opioids. Both groups further comprised two sub-cohorts: those who were mentally and/or physically healthy (H; n = 93 vs. n = 30) and those who were impaired (I; n = 26 vs. n = 26). The outcome parameters were the demand for pain medication, parameters of mobilization, and the presence of adverse reactions. RESULTS Healthy children who received CEA started mobilization 1 day earlier than children with IV-PCA (p = 0.002). First postsurgical defecation was seen earlier in all children who received CEA in both groups (H; Day 4 vs. Day 5, p = 0.011, I; Day 3 vs. Day 5, p = 0.044). Healthy children who received CEA were discharged from hospital 4 days earlier than their IV-PCA counterparts (p < 0.001). No statistically significant difference in postoperative nausea nor in vomiting was identified between groups. Transient neurological irritations were seen in 9.7% of the patients in the CEA group. CONCLUSIONS CEA provides appropriate pain management after scoliosis surgery, regardless of the patient's mental status. It allows earlier postoperative defecation for all patients , as well as shorter hospitalization and an earlier mobilization for healthy patients.
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Affiliation(s)
- Katharina Dinter
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Henriette Bretschneider
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Stefan Zwingenberger
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Alexander Disch
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Anne Osmers
- Department of Anesthesiology and Intensive Care Medicine, University Hospital “Carl Gustav Carus”, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Oliver Vicent
- Department of Anesthesiology and Intensive Care Medicine, University Hospital “Carl Gustav Carus”, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Falk Thielemann
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Jens Seifert
- Department of Spine Surgery, AKG Klinik Hohwald GmbH, Hospital for Orthopaedics and Rheumatology, Hohwaldstraße 40, 01844 Neustadt in Sachsen, Germany
| | - Peter Bernstein
- UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine “Carl Gustav Carus” , TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
- Department of Spine Surgery, AKG Klinik Hohwald GmbH, Hospital for Orthopaedics and Rheumatology, Hohwaldstraße 40, 01844 Neustadt in Sachsen, Germany
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Karam M, Vergari C, Skalli W, Bizdikian AJ, Mehanna J, Kawkabani G, Kharrat K, Ghanem I, Assi A. Assessment of the axial plane deformity in subjects with adolescent idiopathic scoliosis and its relationship to the frontal and sagittal planes. Spine Deform 2022; 10:509-14. [PMID: 34817848 DOI: 10.1007/s43390-021-00443-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Investigate the axial plane deformity in the scoliotic segment and its relationship to the deformity in the frontal and sagittal planes. METHODS Two hundred subjects with AIS (Cobb ≥ 20°) underwent low dose biplanar X-rays with 3D reconstruction of the spine and pelvis. All structural curves were considered and were distributed as follows: 142 thoracic (T), 70 thoracolumbar (TL), and 47 lumbar curves (L). Common 3D spino-pelvic and scoliosis parameters were collected such as: frontal Cobb; torsion index (TI); hypokyphosis/lordosis index (HI). Parameters were compared between each type of curvature and correlations were investigated between the 3 planes. RESULTS Frontal Cobb was higher in all T (45 ± 19°) and TL (41 ± 15°) curves compared to L curves (35 ± 14°, p = 0.004). TI was higher in T curves when compared to TL and L curves (TI: 15 ± 8°, 9 ± 6°, 7 ± 5°, p < 0.001). HI was similar between curve types. T curves showed significant correlations between the 3 planes: Cobb vs. TI (r = 0.76), Cobb vs. HI (r = - 0.54) and HI vs. TI (r = - 0.42). The axial plane deformity was related to the frontal deformity and the type of curvature (adjusted-R2 = 0.6). CONCLUSION Beside showing the most severe deformity frontally and axially compared to TL and L curves, the T curves showed strong correlations between the 3 planes of the deformity. Moreover, this study showed that the axial plane deformity cannot be fully determined by the frontal and sagittal deformities, which highlights the importance of 3D assessment in the setting of AIS.
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Dominy CL, Arvind V, Tang JE, Bellaire CP, Pasik SD, Kim JS, Cho SK. Scoliosis surgery in social media: a natural language processing approach to analyzing the online patient perspective. Spine Deform 2022; 10:239-46. [PMID: 34709599 DOI: 10.1007/s43390-021-00433-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study is to analyze posts shared on Instagram, Twitter, and Reddit referencing scoliosis surgery to evaluate content, tone, and perspective. METHODS Public posts from Instagram, Twitter, and Reddit were parsed in 2020-2021 and selected based on inclusion of the words 'scoliosis surgery' or '#scoliosissurgery. 100 Reddit posts, 5022 Instagram posts, and 1414 tweets were included in analysis. The Natural Language Toolkit (NLTK) python library was utilized to perform computational text analysis to determine content and sentiment analysis to estimate the tone of posts across each platform. RESULTS 46.4% of Tweets were positive in tone, 39.4% were negative, and 13.8% were neutral. Positive content focused on patients, friends, or hospitals sharing good outcomes after a patient's surgery. Negative content focused on long wait times to receive scoliosis surgery. 64.7% of Instagram posts were positive in tone, 16.3% were negative, and 19.0% were neutral. Positive content centered around post-operative progress reports and educational resources, while negative content focused on long-term back pain. 37% of Reddit posts were positive in tone, 38% were negative, and 25% were neutral. Positive posts were about personal post-operative progress reports, while negative posts were about fears prior to scoliosis surgery and questions about risks of the procedure. CONCLUSION This study highlights scoliosis surgery content in social media formats and stratifies how this content is portrayed based on the platform it is on. Surgeons can use this knowledge to better educate and connect with their own patients, thus harnessing the power and reach of social media. LEVEL OF EVIDENCE IV.
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Rodriguez VV, Tello CA, Piantoni L, Wilson IAF, Galareto E, Remondino RG, Bersusky SE, Davies R, Noel MA. Chiari 1: Is decompression always necessary previous to scoliosis surgery? Spine Deform 2021; 9:1253-1258. [PMID: 33792837 DOI: 10.1007/s43390-021-00336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
The association between Chiari 1 malformation and scoliosis is well known in the literature. Prevalence has increased after the advent of magnetic resonance imaging. In children with this association, prophylactic suboccipital decompression prior to scoliosis correction is a common surgical procedure although the rationale for this surgical management and whether not performing it may lead to spinal cord injury has not been clearly elucidated. We conducted a systematic review of the literature with the aim to obtain strong data to support the hypothesis that it is safe to proceed with scoliosis correction without prior prophylactic suboccipital decompression for Chiari 1 in an asymptomatic population. Using the Prisma methodology, we analyzed 3250 studies published between 1972 and 2018. Only four studies met the inclusion criteria. None of the studies had a level of evidence high enough to recommend prophylactic decompression previous to correction of the spinal deformity.
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Affiliation(s)
- V Vazquez Rodriguez
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - C A Tello
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - L Piantoni
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina.
| | - I A Francheri Wilson
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - E Galareto
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - R G Remondino
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - S E Bersusky
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - R Davies
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
| | - M A Noel
- Servicio de Patología Espinal, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Combate de Los Pozos 1881CABA, C1245AAM, Buenos Aires, Argentina
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Abstract
5q-spinal muscular atrophy (5q-SMA) is an autosomal recessive neuromuscular disorder caused by a biallelic mutation of the survival of motor neuron 1 SMN1 gene. The resulting lack of SMN protein causes a progressive degeneration of anterior motor neurons and muscular atrophy, which leads to a progressive scoliosis in two-thirds of affected cases. Depending on the disease subtype and severity, affected patients can subsequently develop respiratory insufficiency, leading to a fatal outcome. Ground-breaking research on this devastating disorder has led to the approval of novel therapies that may alter the clinical course of this disease in the future. Here we present a summary of these new therapies, current operative strategies for 5q-SMA associated scoliosis and provide an outlook for possible implications for the future.
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Affiliation(s)
- T-L Vu-Han
- Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Unfallchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - M J Reisener
- Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Unfallchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Putzier
- Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Unfallchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - M Pumberger
- Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Unfallchirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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McNeil N, Bastrom TP, Bartley CE, Yaszay B, Upasani VV, Newton PO. Randomized controlled trial of energy healing effects on pain and anxiety in AIS posterior surgery: a pilot study. Spine Deform 2021; 9:1029-1034. [PMID: 33683643 DOI: 10.1007/s43390-021-00317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Energy healing (EH) is a part of the diverse group of Complementary and Alternative Medicines (CAM). The purpose of this study was to evaluate the effects of EH therapy prior to and following posterior surgical correction for adolescent idiopathic scoliosis (AIS) compared to controls. METHODS Patients were prospectively randomized to one of two groups: standard operative care for surgery (controls) vs. standard care with the addition of three EH sessions. The outcomes included visual analog scales (VAS) for pain and anxiety (0-10), days until conversion to oral pain medication, and length of hospital stay. For the experimental group, VAS was assessed pre- and post-EH session. RESULTS Fifty patients were enrolled-28 controls and 22 EH patients. The controls had a median of 12 levels fused vs. 11 in the EH group (p = 0.04). Pre-operative thoracic and lumbar curve magnitudes were similar (p > 0.05). Overall VAS pain scores increased from pre- to post-operative (p < 0.001), whereas the VAS anxiety scores decreased immediately post-operative (p < 0.001). The control and pre-EH assessments were statistically similar. Significant decreases in VAS pain and anxiety scores from pre to post-EH assessment were noted for the EH group. Both groups transitioned to oral pain medication a median of 2 days post-operative (p = 0.11). The median days to discharge was four in the controls and three in the EH group (p = 0.07). CONCLUSION In this pilot study, EH therapy resulted in a decrease in patient's pre-operative anxiety. Offering this CAM modality may enhance the wellbeing of the patient and their overall recovery when undergoing posterior surgical correction for AIS. LEVEL OF EVIDENCE Therapeutic Level II.
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Affiliation(s)
- Natalie McNeil
- Rady Children's Hospital, 3020 Children's Way, MC 5063, San Diego, CA, 92123, USA.
| | - Tracey P Bastrom
- Rady Children's Hospital, 3020 Children's Way, MC 5063, San Diego, CA, 92123, USA
| | - Carrie E Bartley
- Rady Children's Hospital, 3020 Children's Way, MC 5063, San Diego, CA, 92123, USA
| | - Burt Yaszay
- Rady Children's Hospital, 3020 Children's Way, MC 5063, San Diego, CA, 92123, USA
| | - Vidyadhar V Upasani
- Rady Children's Hospital, 3020 Children's Way, MC 5063, San Diego, CA, 92123, USA
| | - Peter O Newton
- Rady Children's Hospital, 3020 Children's Way, MC 5063, San Diego, CA, 92123, USA
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Akesen S. Predictive factors for postoperative ıntensive care unit admission in pediatric patients undergoing scoliosis correction surgery. Am J Transl Res 2021; 13:5386-5394. [PMID: 34150135 PMCID: PMC8205743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Postoperative intensive care unit (ICU) admission might be required in adolescent patients following posterior fusion and instrumentation surgery for the treatment of scoliosis. We aimed to evaluate the predictive factors for mechanical ventilation and the characteristics of the patients who required an ICU stay following spinal surgery. METHODS We retrospectively reviewed the records of 85 children undergoing primary scoliosis surgery at a university-affiliated general hospital from January 2010 and June 2020 by the same spinal surgeon. The demographic data, pre- and peritoperative variables were collected and recorded. All patients underwent surgery with a combined anesthesia protocol of fentanyl and remifentanil. RESULTS There were 31 males (36.5%) and 54 females (63.5%). In the postoperative period, 13 patients (15.3%) were admitted to the ICU, and six of them required mechanical ventilation. Among these, three patients (50%) were extubated within the postoperative 0-12 hours, two (33.3%) within postoperative 12-24 hours, and one (16.7) after postoperative 24 hours. The major complications included acidosis (4.7%), hemodynamic instability (1.2%), hypercapnia (1.2%), hypoxemia (1.2%), and delayed extubation (1.2%). CONCLUSIONS A smaller bodyweight percentile, neuromuscular etiology, abnormal findings in preoperative chest X-ray, additional comorbidities, and preoperative estimated risk for postoperative mechanical ventilation were among the risk factors for postoperative ICU stay. The age, height, weight, degree of the curvature, and the number of operated segments did not have an association with the postoperative outcomes.
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Affiliation(s)
- Selcan Akesen
- Uludag University Medical Faculty, Department of Anesthesiology and Reanimation Bursa, Turkey
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15
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Shrestha IK, Ruan TY, Lin L, Tan M, Na XQ, Qu QC, Chen JC, Si YY, Tao JP. The efficacy and safety of high-dose tranexamic acid in adolescent idiopathic scoliosis: a meta-analysis. J Orthop Surg Res 2021; 16:53. [PMID: 33446219 PMCID: PMC7807519 DOI: 10.1186/s13018-020-02158-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to evaluate the efficacy and safety of using high-dose intravenous tranexamic acid (TXA) to reduce blood loss in idiopathic scoliosis surgery. Methods This study was a meta-analysis, which consisted of retrospective cohort studies (RCSs) and randomized control trials (RCTs) found by searching electronic databases, namely PubMed, Web of Science, The Cochrane Central Register of Controlled Trials (CENTRAL), and the Google Scholar Database, dating from 1960 to 2019. The points of interest included total blood loss, a need for transfusion and transfusion criteria, surgery time, and the evidence of intraoperative and postoperative complications, such as seizures or thromboembolic events. The weighted mean differences (WMD) and 95% confidence interval (CI) of blood loss in the TXA intervention group compared to the control or placebo group were extracted and combined using the random effects model. Results In this meta-analysis, there was a total of three RCSs and two RCTs, which involved 334 patients. The results showed that blood loss is significantly reduced, with a weighted mean difference in the TXA group (WMD = − 525.14, P = 0.0000, CI ranged from − 839.83, − 210.44, I2 = 82%). Heterogeneity was assessed using the random effects model. Conclusions A high dose of intravenous TXA reduced blood loss during adolescent idiopathic scoliosis surgery and did not lead to any significant thromboembolic event. Therefore, a high dose appears to be effective and safe for adolescent idiopathic scoliosis surgery. However, more high-quality research based on larger randomized controlled trials is still needed.
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Affiliation(s)
- Indra K Shrestha
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Tian-Yi Ruan
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Lan Lin
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Miao Tan
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Xue-Qing Na
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Qi-Cai Qu
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Jian-Chun Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China
| | - Yong-Yu Si
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China.
| | - Jian-Ping Tao
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, No.374 of Dianmian Avenue, Wuhua District, Kunming, 650101, Yunnan, China.
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Li Q, Zeng F, Chen T, Pu C, Liang Y, Zheng C. Anesthetic Management of Patients After Scoliosis Surgery: A Single-Center Retrospective Study. Orthop Surg 2020; 12:1753-1759. [PMID: 33043614 PMCID: PMC7767771 DOI: 10.1111/os.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the effect of anesthetic management on scoliosis surgery and review the incidence rate of perioperative adverse events. METHODS This was a retrospective study and approved by the ethics committee. Patients who underwent scoliosis surgery from April 2011 to March 2018 in the Third Hospital of ChengDu were enrolled in this study. Characteristics of patients were obtained from the hospital's electronic records. The following information on patients was collected: preoperative assessment details, premedication, type of anesthesia and operation, the main postoperative outcome, and complications. Data were presented as the mean ± standard deviations (SD) for normally distributed continuous variables and numbers for categorical variables. Statistical analyses were performed using SPSS version 22.0. RESULTS In total, 513 patients were enrolled in the present study. The main preoperative complication was cardiopulmonary dysfunction (386 cases, 75.24%). Anesthesia induction was performed with conscious tracheal intubation after oral surface anesthesia. In total, the common postoperative complications involved anesthesia (24 cases, 4.68%), surgery (23 cases, 4.48%), the respiratory system (138 cases, 26.90%), and the gastrointestinal tract (nine cases, 1.75%). The majority of postoperative complications were postoperative hypoxemia and hypercapnia, caused by poor cardiopulmonary function. Rare and serious complications still occurred. Three patients died in hospital. CONCLUSION Our study demonstrated a high incidence of complications in scoliosis surgery, especially postoperative complications. Extreme postoperative vigilance is required and high-level monitoring of conditions is highly recommended.
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Affiliation(s)
- Qiang Li
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Fei Zeng
- Center of Cardiac Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's HospitalChengduChina
| | - Tao Chen
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Chun Pu
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Yi‐jian Liang
- Department of Orthopaedics, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
| | - Chuan‐dong Zheng
- Department of Anesthesiology, The Third People's Hospital of ChengduSouthwest Jiao Tong UniversityChengduChina
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Hardacker DM, Myung KS, Hardacker KD, Dammann ER. Acute onset of central diabetes insipidus during adolescent idiopathic scoliosis surgery. Spine Deform 2020; 9:293-295. [PMID: 32827088 DOI: 10.1007/s43390-020-00187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
This is a case report of a 12-year-old female with idiopathic scoliosis undergoing posterior scoliosis reconstruction that developed an acute onset of central diabetes insipidus (CDI) during surgery. The diagnosis was made as a result of an intraoperative increase in urine output to 6.82 ml/kg/hour (550 ml), a serum sodium increase from 139 to 147 mmol/L, a serum osmolality of 299 mOsmol/kg, a rapid response to vasopressin administration and a low vasopressin level of < 0.5 picograms/ml (normal, 1-5 picograms/ml). This is the first reported case of CDI with a documented low vasopressin level that has occurred in a pediatric scoliosis surgical patient.
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Affiliation(s)
| | - Karen S Myung
- Indiana University School of Medicine, Indianapolis, USA
| | - Kyle D Hardacker
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Erin R Dammann
- Indiana University School of Medicine, Indianapolis, USA
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Diwan SM, Yamak Altinpulluk E, Khurjekar K, Nair A, Dongre H, Turan A. Bilateral erector spinae plane block for scoliosis surgery: Case series. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:153-158. [PMID: 32057483 DOI: 10.1016/j.redar.2019.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
Spinal correction surgery is a very invasive surgical procedure and results in severe postoperative pain. We report six cases in which Bilateral Erector Spinae Plane Block was performed for scoliosis surgery. Our aim was to provide an effective perioperative pain management and to achieve intraoperative hemodynamic stability with no interference on neuromonitoring. The technical challenges are also highlighted. An ultrasound guided scout scan is necessarry to identify the bony prominences and determine the possible multiple injection points. Erector Spinae Plane Block in scoliosis surgery is an easier and safer technique compared to epidural anesthesia and can use instrumented complex spinal surgery. This block seems to have a role in perioperative pain pathway complementing the multimodal analgesic regimen and not have interference with evocated potentials in adults. However the diffusion mechanism of the this block is not well known hence it should be awake regarding local anesthetic toxicity.
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Affiliation(s)
| | - E Yamak Altinpulluk
- Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic, Ohio, EE. UU.; Department of Anesthesiology and Reanimation, Istanbul University-Cerrahpaşa, Cerrahpasa Medical Faculty, Estambul, Turquía
| | | | - A Nair
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | | | - A Turan
- Outcomes Research Department, Anesthesiology Institute, Cleveland Clinic, Ohio, EE. UU
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Adams AJ, Refakis CA, Flynn JM, Pahys JM, Betz RR, Bastrom TP, Samdani AF, Brusalis CM, Sponseller PD, Cahill PJ. Surgeon and Caregiver Agreement on the Goals and Indications for Scoliosis Surgery in Children With Cerebral Palsy. Spine Deform 2019; 7:304-311. [PMID: 30660226 DOI: 10.1016/j.jspd.2018.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/03/2018] [Accepted: 07/20/2018] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Prospective multicenter comparative study. OBJECTIVES We aimed 1) to survey surgeons and caregivers to rank the surgical indications for spinal fusion of pediatric patients with neuromuscular scoliosis secondary to cerebral palsy in order of importance and 2) to characterize the agreement of surgeons and caregivers on major (top three) indications. SUMMARY OF BACKGROUND DATA Surgery for spinal deformity in children with cerebral palsy is a multifaceted and individualized decision that may lead to miscommunication during informed consent. Little data exist on communication effectiveness between surgeon and caregiver during preoperative discussion. METHODS This is a multicenter, prospective survey of Harms Study Group patient caregivers and their surgeons. Participants ranked their most important of 15 indications in descending level of importance, where the top 3 selections were considered major indications for surgery for the particular patient in question. Demographic and other perioperative factors were recorded. Surgeon-caregiver agreement on major indications was determined, taking into account preoperative factors and intersurgeon differences. RESULTS 126 surgeon-caregiver pairs responded. The greatest percentage agreement that an indication was major was "to improve sitting" (69.0% major, 0.8% nonmajor), followed by "to prevent pulmonary compromise" (33.3% major, 24.6% nonmajor), "to improve pain" (31.7% major, 20.6% nonmajor), and "to improve head control/position" (20.7% major, 69.0% nonmajor). Preoperative pain showed an association with surgeon-caregiver agreement on pain as a major indication (p=.004), and intersurgeon differences in agreement on gastrointestinal and pain considerations existed (p=.002, p=.007, respectively). CONCLUSIONS Surgeon-caregiver agreement is greater where literature support for a particular surgical indication is strong (ie, spinal fusion's known improvement of sitting posture in children with neuromuscular scoliosis). Stronger literature support may bolster surgeons' confidence in recommending a particular procedure, fostering greater communication, understanding, and agreement on surgical necessity between caregivers and surgeons. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Alexander J Adams
- Division of Orthopaedics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | | | - John M Flynn
- Division of Orthopaedics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Joshua M Pahys
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - Randal R Betz
- Institute for Spine & Scoliosis, 3100 Princeton Pike, Bldg. 1-D, Lawrenceville, NJ 08648, USA
| | - Tracey P Bastrom
- Department of Orthopedics, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA 19140, USA
| | | | - Paul D Sponseller
- Johns Hopkins Institute of Orthopaedics Surgery, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Patrick J Cahill
- Division of Orthopaedics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA.
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21
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Nagarajan L, Ghosh S, Dillon D, Palumbo L, Woodland P, Thalayasingam P, Lethbridge M. Intraoperative neurophysiology monitoring in scoliosis surgery in children. Clin Neurophysiol Pract 2019; 4:11-17. [PMID: 30828671 PMCID: PMC6383123 DOI: 10.1016/j.cnp.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. Methods We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. Results INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. Conclusions INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets - amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. Significance Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option.
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Affiliation(s)
- Lakshmi Nagarajan
- Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.,School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia.,Telethon Kids Institute, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Soumya Ghosh
- Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.,Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA 6009, Australia
| | - David Dillon
- Dept of Orthopaedics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Linda Palumbo
- Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Peter Woodland
- Dept of Orthopaedics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Priya Thalayasingam
- Dept. of Anaesthetics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Martyn Lethbridge
- Dept. of Anaesthetics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
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Pizones J, Martín-Buitrago MP, Sánchez Márquez JM, Fernández-Baíllo N, Baldan-Martin M, Sánchez Pérez-Grueso FJ. Decision Making of Graduation in Patients With Early-Onset Scoliosis at the End of Distraction-Based Programs: Risks and Benefits of Definitive Fusion. Spine Deform 2019; 6:308-313. [PMID: 29735142 DOI: 10.1016/j.jspd.2017.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/30/2017] [Accepted: 10/01/2017] [Indexed: 10/17/2022]
Abstract
STUDY DESIGN Retrospective comparative analysis. OBJECTIVE Study early-onset scoliosis (EOS) graduated patients to establish founded criteria for graduation decision making and determine the risks and benefits of definitive fusion. SUMMARY OF BACKGROUND DATA EOS is treated by growth-friendly techniques until skeletal maturity. Afterwards, patients can be "graduated," either by definitive fusion (posterior spinal fusion [PSF]) or by retaining the previous implants (Observation) with no additional surgery. Criteria for this decision making and the outcomes of definitive fusion are still underexplored. METHODS We analyzed a consecutive cohort of "graduated" patients after a distraction-based lengthening program. We gathered demographic, radiographic, and surgical data. The results of the two final treatment options were compared after 2 years' follow-up. RESULTS A total of 32 patients were included. Four patients had incomplete records. Thirteen underwent PSF, and 15 were observed. The mean age at initial treatment was 8 ± 3 years, with a mean follow-up of 8.3 ± 2.9 years. Both groups had similar preoperative and final radiographic parameters (p > .05). The criteria for undergoing PSF were as follows: implant-related complications, main curve magnitude (PSF = 63.2° ± 9° vs. OBS = 47.9° ± 15°; p = .008), curve progression >10°, and sagittal misalignment (SVA). During PSF 12/13 patients underwent multiple osteotomies, one vertebrectomy, and 3 costoplasties. Surgical time was 291.5 ± 58 minutes; blood loss was 946 ± 375 mL; and the number of levels fused was 13.7. Coronal deformity was corrected 31%, T1-S1 length gained was 31 ± 19.6 mm and T1-T12 length gained was 9.3 ± 39 mm; kyphosis was reduced by 22%. However, coronal balance worsened by 2.3 ± 30.8 mm. No major complications were encountered in these patients. CONCLUSIONS Graduation by PSF depended on unacceptable or progressive major curve deformity, sagittal misalignment, or complications with previous implants. Observation depended on curve stabilization, Cobb <50°, and coronal misalignment <20 mm. Definitive fusion effectively corrected coronal and sagittal deformity and increased trunk height. However, it exposed patients to a very demanding surgery without improvement in coronal balance. LEVEL OF EVIDENCE Level III, therapeutic.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
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Grabala P, Helenius I, Buchowski JM, Larson AN, Shah SA. Back Pain and Outcomes of Pregnancy After Instrumented Spinal Fusion for Adolescent Idiopathic Scoliosis. World Neurosurg 2019; 124:e404-e410. [PMID: 30610987 DOI: 10.1016/j.wneu.2018.12.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We hypothesized that women undergoing scoliosis surgery who became pregnant would go to full term, have uncomplicated pregnancies, and similar patient-reported outcome measures than non-pregnant patients and healthy controls. METHODS Two hundred five women with adolescent idiopathic scoliosis (AIS) undergoing scoliosis surgery between 1998 and 2015 at several institutions in 1 country and 173 healthy women, without AIS, parous and nulliparous, were selected at random. RESULTS One hundred eight women with scoliosis surgery and no pregnancy (SNP), 97 women with scoliosis surgery and pregnancy (SP), 91 healthy controls and no pregnancy, and 82 healthy controls and pregnancy (HP) were reviewed. Mean follow-up was 5 years in the SNP, 6 years in the SP, 5 years in the healthy controls and no pregnancy, and 5 years in the HP. The average time from surgery to childbirth was 5 years. Back pain (BP) during pregnancy was observed in 48% of the SP and 34% of the HP. BP after childbirth was present in 43% of the SP and 42% of the HP. Patients fused to L3 or L4 experienced more frequent low BP during pregnancy (40%) than those fused above L3 (P < 0.05). Cesarean section (CS) was performed for 64% and 33% in SP and HP, respectively (P < 0.05). As the lowest instrumented vertebra moved caudal to L4, the frequency of CS increased (P < 0.05; R = 0.8). The majority of CS in SP were performed in patients fused to L4 (55%) versus patients fused above and to L3 (45%) (P < 0.05). The most common analgesia for CS was spinal block (75% in SP and 86% in HP). Patients fused to L4 required general anesthesia significantly more often (7%) versus those fused above L4 (4%, P < 0.05). The health-related quality of life after spinal fusion showed general satisfaction and were similar for SNP and SP (mean 3.84 and 3.91, respectively). No sexual dysfunction was reported. CONCLUSIONS Women with a history of spinal fusion for AIS fused to L3 or L4 reported a higher incidence of low BP, and CSs are more frequently required. This risk increased to 55% when spinal fusion to L4 was performed. The quality of life and sexual function were at the same level in women after scoliosis surgery than in healthy controls.
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Affiliation(s)
- Pawel Grabala
- Department of Pediatric Orthopaedics and Traumatology, Faculty of Medicine, Medical University of Bialystok, Bialystok, Poland; Department of Pediatric Orthopaedic with Scoliosis Service, Regional Specialized Children's Hospital, Olsztyn, Poland.
| | - Ilkka Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Jacob M Buchowski
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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Crostelli M, Mazza O, Mariani M, Mascello D, Iorio C. Adolescent idiopathic scoliosis correction by instrumented vertebral arthrodesis with autologous bone graft from local harvesting without bone substitute use: results with mean 3 year follow-up. Eur Spine J 2018; 27:175-181. [PMID: 29675675 DOI: 10.1007/s00586-018-5597-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/11/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE Bone substitutes' advantage is enhancing arthrodesis biologic support without further autologous bone graft harvested from other skeleton sites, as from posterior iliac crests; however, in our experience, bone substitutes' integration is often incomplete. METHODS From 2012 to 2017, we operated 108 patients by posterior instrumented vertebral arthrodesis in adolescent idiopathic scoliosis (AIS) correction, mean main curve 80° Cobb, and mean age 12 years and 6 months, with all pedicle screws instrumentation in main curve/curves area and hooks at upper tip of implant; bone graft has been harvested only at vertebral level, without bone substitutes or autologous graft from other patient sites or allogenic bone graft. We matched this group with 98 patients previously operated in which we used calcium triphosphate. RESULTS At 3 year mean follow-up, all patients in group treated with autologous bone graft only have complete and stable arthrodesis without loss of correction (mean curve 27° Cobb) or instrumentation failure. At 6 year mean follow-up in the group treated with autologous bone graft augmented by calcium triphosphate, 96 patients have stable arthrodesis without loss of correction (mean curve 24°), 1 case has implant break, and 1 case has 8° Cobb loss of correction. CONCLUSION Bone substitutes are a further cost in arthrodesis surgery and suboptimal integration leaves foreign bodies on vertebras. Our experience shows that all pedicle screw instrumentation and bracing after surgery obtain stable correction showing in time a solid arthrodesis with autologous bone only, harvested at local site, without bone substitutes or further bone graft.
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Affiliation(s)
- Marco Crostelli
- Spine Surgery Unit, Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Osvaldo Mazza
- Spine Surgery Unit, Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
| | - Massimo Mariani
- Spine Surgery Unit, Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Dario Mascello
- Spine Surgery Unit, Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Carlo Iorio
- Spine Surgery Unit, Bambino Gesù Pediatric Hospital, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
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Bureta C, Tominaga H, Yamamoto T, Kawamura I, Abematsu M, Yone K, Komiya S. Risk Factors for Postoperative Ileus after Scoliosis Surgery. Spine Surg Relat Res 2018; 2:226-229. [PMID: 31440673 PMCID: PMC6698524 DOI: 10.22603/ssrr.2017-0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/16/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION One complication after scoliosis surgery is ileus; however, few reports have described the frequency of and risk factors for this complication. We conducted a retrospective clinical study with logistic regression analysis to confirm the frequency of and risk factors for ileus after scoliosis surgery. METHODS After a retrospective review of data from patients who underwent surgical correction of spinal deformity from 2009 to 2014, 110 cases (age range, 4-73 yr; median, 14 yr) were included in the study. We defined postoperative ileus (POI) as a surgical complication characterized by decreased intestinal peristalsis and the absence of stool for more than 3 days postoperatively. Various parameters were compared between patients with POI and those without POI. Logistic regression analysis was performed to assess the risk factors associated with ileus; a P value of <0.05 was considered statistically significant. RESULTS Fifteen of 110 (13.6%) cases developed POI. The median height, weight, operation time, and blood loss volume of the patients with versus without POI were 146 versus 152 cm, 39.0 versus 44.0 kg, 387 versus 359 min, and 1590 versus 1170 g, respectively. There were no significant differences between patients with versus without POI in the measured parameters, with the exception of patient height, bed rest period, and presence of neuromuscular scoliosis. Multiple logistic regression analysis revealed neuromuscular scoliosis as a significant risk factor for POI (odds ratio, 4.21; 95% CI, 1.23-14.40). CONCLUSIONS Our findings indicate a high probability of POI after scoliosis surgery, with an incidence of 13.6%. Neurogenic scoliosis, but not lowest instrumented vertebra or correction rate, was a risk factor for POI after scoliosis surgery. Digestive symptoms should be carefully monitored after surgery, particularly in patients with neuromuscular scoliosis.
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Affiliation(s)
- Costansia Bureta
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
- Department of Neurosurgery, Muhimbili Orthopaedic and Neurosurgical Institute, Dar es Salaam, Tanzania
| | - Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Masahiko Abematsu
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
| | - Kazunori Yone
- Department of Physical Therapy, Kagoshima University, Kagoshima, Japan
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
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Calderón P, Deltenre P, Stany I, Kaleeta Maalu JP, Stevens M, Lamoureux J, Bellemans M, Dujardin S, Van der Linden P, Dachy B. Clonidine administration during intraoperative monitoring for pediatric scoliosis surgery: Effects on central and peripheral motor responses. Neurophysiol Clin 2017; 48:93-102. [PMID: 29248202 DOI: 10.1016/j.neucli.2017.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the effect of clonidine administrated as a co-analgesic during scoliosis surgery, on the neuromonitoring of spinal motor pathways. METHODS Using standardized intraoperative monitoring, we compared the time course of peripherally and transcranially electrically evoked motor potentials (TcEMEPs) before and after injection of a single bolus of clonidine in children under total intravenous anesthesia (TIVA). MEP data were obtained from 9 patients and somatosensory evoked potentials (SSEPs) were obtained from 2 patients. The potential effect of clonidine on mean blood pressure (BP) was controlled. RESULTS TcEMEPs from upper and lower limbs rapidly showed significant drops in amplitude after the injection of clonidine. Amplitudes reached minimal values within five minutes and remained very weak for at least 10-20minutes during which monitoring of the central motor pathways was severely compromised. SSEPs were not altered during maximal amplitude depression of the TcEMEPS. CONCLUSIONS This is the first report showing that clonidine severely interferes with neuromonitoring of the spinal cord motor pathways. The results are discussed in light of the literature describing the effects of dexmedetomidine, another α-2 adrenergic agonist. The experimental and literature data point to central mechanisms taking place at both the spinal and cerebral levels. Therefore, clonidine as well as other α-2 adrenergic agonists should be used with extreme caution in patients for whom neuromonitoring of the motor pathways is required during surgery.
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Affiliation(s)
- Pedro Calderón
- Department of neurology, université libre de Bruxelles, CHU Brugmann, 4, place Van-Gehuchten, 1020 Brussels, Belgium
| | - Paul Deltenre
- Department of neurology, université libre de Bruxelles, CHU Brugmann, 4, place Van-Gehuchten, 1020 Brussels, Belgium; Laboratory of sensory and cognitive neurophysiology, université libre de Bruxelles, CHU Brugmann, place Van-Gehuchten, 4, 1020 Brussels, Belgium.
| | - Ida Stany
- Department of anesthesiology, CHU Brugmann, Queen-Fabiola Children's university hospital, université libre de Bruxelles, 15, avenue JJ Crocq, 1020 Brussels, Belgium
| | - Jean-Paul Kaleeta Maalu
- Department of orthopaedic surgery, Queen-Fabiola Children's university hospital, université libre de Bruxelles, 15, avenue J-J-Crocq, 1020 Brussels, Belgium
| | - Magali Stevens
- Department of neurology, université libre de Bruxelles, CHU Brugmann, 4, place Van-Gehuchten, 1020 Brussels, Belgium
| | - Jean Lamoureux
- Department of orthopaedic surgery, Queen-Fabiola Children's university hospital, université libre de Bruxelles, 15, avenue J-J-Crocq, 1020 Brussels, Belgium
| | - Michel Bellemans
- Department of orthopaedic surgery, Queen-Fabiola Children's university hospital, université libre de Bruxelles, 15, avenue J-J-Crocq, 1020 Brussels, Belgium
| | - Sylvie Dujardin
- Department of neurology, université libre de Bruxelles, CHU Brugmann, 4, place Van-Gehuchten, 1020 Brussels, Belgium
| | - Philippe Van der Linden
- Department of anesthesiology, CHU Brugmann, Queen-Fabiola Children's university hospital, université libre de Bruxelles, 15, avenue JJ Crocq, 1020 Brussels, Belgium
| | - Bernard Dachy
- Department of neurology, université libre de Bruxelles, CHU Brugmann, 4, place Van-Gehuchten, 1020 Brussels, Belgium
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Turturro F, Montanaro A, Calderaro C, Labianca L, Di Sanzo V, Ferretti A. Rate of complications due to neuromuscular scoliosis spine surgery in a 30-years consecutive series. Eur Spine J 2017; 26:539-45. [PMID: 28314995 DOI: 10.1007/s00586-017-5034-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the rate of intraoperative and postoperative complications in a large series of patients affected by neuromuscular scoliosis. METHODS It was a monocentric retrospective study. In this study have been considered complications those events that significantly affected the course of treatment, such as getting the hospital stay longer, or requiring a subsequent surgical procedure, or corrupting the final result of the treatment. RESULTS Of the 358 patients affected by neuromuscular scoliosis treated from January 1985 to December 2010, 185 that met the inclusion criteria were included in the study. There were recorded 66 complications in 55/185 patients. Of that 66 complications, 54 complications occurred in 46/120 patients with Luque's instrumentation, while only 12 complications occurred in 9/65 patients with hybrid instrumentation and this difference was statistically significant (p < 0.05); 11/126 patients with pelvic fixation and 5/59 without pelvic fixation, as well as 45/156 patients treated by posterior approach alone and 10/29 patient that underwent combined anterior-posterior approach suffered complications but both this did not result in a statistical significant difference (p > 0.05). CONCLUSIONS The surgical treatment in neuromuscular scoliosis is burdened by a large number of complications. An accurate knowledge of possible complications is mandatory to prepare strategies due to prevent adverse events. A difference in definitions could completely change results in good or bad as well as in our same series the adverse events amounted at almost 30% of cases, but complications that due to complete failure would amount at 9.19% of patients.
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Lysenko M, Law P, Jarvis J, Wright JG. Improving education and coping of scoliosis patients undergoing surgery, and their families, using e-health. J Child Orthop 2016; 10:673-83. [PMID: 27714604 DOI: 10.1007/s11832-016-0772-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/22/2016] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Healthcare providers have limited time to spend with scoliosis patients who are considering surgery and their families. The purpose of this study was to evaluate an e-health strategy to increase knowledge and coping in patients with scoliosis who are surgical candidates and their families. METHODS We enrolled patients with scoliosis who were candidates for surgery and their families. Patients and their families completed the scoliosis knowledge questionnaire, meaning of illness questionnaire, social support and coping questionnaires before and after access to a comprehensive evidence-based scoliosis website ( http://www.aboutkidshealth.ca/scoliosis ). RESULTS Seventy-four patients and 71 parents completed the evaluation. While both patients and parents improved their knowledge of scoliosis (p = 0.001 and p = 0.003, respectively), the scores of patients were consistently lower than those of the parents both before and after website use (p = 0.0001). Only parents demonstrated a change in the meaning of illness questionnaire, with a small increase in the negative attitude towards illness and a small decrease in the positive attitude towards illness (p = 0002 and p = 0.01, respectively). Of the 12 coping methods examined on the Adolescent Coping Orientation for Problem Experiences (A-COPE) instrument, patients were slightly more likely than parents to use relaxing and solving family problems as tools to cope following website access (p = 0.02 and p = 0.09, respectively). Parents demonstrated no significant changes in the four methods of coping on the Coping Health Inventory for Parents (CHIP) after website exposure. While the majority of patients and parents reported receiving sufficient support, over half of the patients indicated a need for more support in social participation. CONCLUSION An evidence-based website increased the knowledge of patients and parents but simply providing access to the website had minimal impact on their coping and perceptions of social support. The website, however, provides users with the opportunity to absorb vital information about scoliosis across several media.
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Dadure C, Sola C, Capdevila X. Preoperative nutrition through a prehabilitation program: A key component of transfusion limitation in paediatric scoliosis surgery. Anaesth Crit Care Pain Med 2015; 34:311-2. [PMID: 26702481 DOI: 10.1016/j.accpm.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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El Bouyousfi M, Leveque C, Miladi L, Irtan S, Hamza J, Oualha M. Acute pancreatitis following scoliosis surgery: description and clinical course in 14 adolescents. Eur Spine J 2016; 25:3316-3323. [PMID: 27155826 DOI: 10.1007/s00586-016-4595-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 04/28/2016] [Accepted: 04/29/2016] [Indexed: 01/11/2023]
Abstract
PURPOSE Acute pancreatitis is a possible complication after scoliosis surgery. Although some risk factors have been documented in the literature, clinical description of pancreatitis diagnosis and ensuing course still remain very poor. The aim of this study was to describe characteristics of acute pancreatitis after scoliosis surgery. METHODS A descriptive, retrospective and single-center study of fourteen adolescents with postoperative acute pancreatitis after spine fusion surgery in scoliosis management between April 2003 and August 2012 was performed. RESULTS Acute pancreatitis occurred within 9.5 days (4-51) after surgery. Abdominal pain was atypical and was expressed in only half of the children. Ileus, nausea and vomiting were the most frequent signs. None of the acute pancreatitis cases was severe. CONCLUSION Acute pancreatitis is an early complication of scoliosis surgery. Clinical signs are atypical and non-severe and can induce misleading forms. Presence of delayed digestive problems should alert the clinician to the risk of pancreatitis in the aftermath of scoliosis surgery.
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Affiliation(s)
- Maalik El Bouyousfi
- Surgical Pediatric Intensive Care Unit, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France.
| | - Christine Leveque
- Mobile Team of Palliative Care and Pain Consultation, Nanterre Hospital (Adults), Nanterre, France
- Nursery Paul Parquet Neuilly/Seine (Children), Paris, France
| | - Lotfi Miladi
- Pediatric Orthopaedic Service, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - Sabine Irtan
- Paediatric Surgery Department, Trousseau Hospital, Paris, France
- Sorbonne Universités, UPMC, Paris 06 University, Paris, France
| | - Jamil Hamza
- Surgical Pediatric Intensive Care Unit, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - Mehdi Oualha
- Surgical and Medical Pediatric Intensive Care Unit, Necker-Enfants Malades Hospital, Paris Descartes, Paris, France
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Gomes C, Kuchenbuch M, Lucas G, Argaud S, Violas P, Sauleau P. Validity and utility of monopolar spinal cord stimulation in pediatric scoliosis surgery. Eur Spine J 2016; 25:3201-3207. [PMID: 26957100 DOI: 10.1007/s00586-016-4504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the validity and utility of monopolar stimulation (between a peridural needle and a large adhesive anode placed in the sternal area) for intraoperative monitoring in scoliosis surgery. METHODS This procedure was assessed during 41 operations involving either arthrodesis with posterior instrumentation or a Vertical Expandable Prosthetic Titanium Rib (VEPTR). Responses evoked by monopolar stimulation were compared with those evoked by bipolar stimulation between two epidural needle electrodes. Potentials evoked by monopolar stimulation in the upper limbs were compared with those evoked in the lower limbs during the same stimulation procedure. RESULTS Monopolar stimulation yielded equivalent and, if anything, more stable responses in the lower limbs. Recording in the upper limbs was satisfactory and allowed a decrease in responses to be detected in two patients. Acceptable thresholds for changes in amplitude relative to baseline were 40 % for upper limbs and 30 % for lower limbs. CONCLUSIONS Monopolar stimulation can be used to monitor the spinal cord during surgery for scoliosis correction. This procedure is more convenient for the surgeon and allows for the combined recording of responses in all four limbs, which can be useful in the case of surgical techniques such as those involving a VEPTR.
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Affiliation(s)
- Constantin Gomes
- Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France
| | - Mathieu Kuchenbuch
- Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France
| | - Grégory Lucas
- Department of Pediatric Orthopedic Surgery, Rennes University Hospital, 35033, Rennes, France
| | - Soizic Argaud
- "Behavior and Basal Ganglia" Research Unit (EA 4712), EA 4712 "Comportement et Noyaux Gris Centraux", Faculté de Médecine, Université de Rennes 1, Avenue Léon Bernard, 35043, Rennes, France
| | - Philippe Violas
- Department of Pediatric Orthopedic Surgery, Rennes University Hospital, 35033, Rennes, France
| | - Paul Sauleau
- Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France.
- "Behavior and Basal Ganglia" Research Unit (EA 4712), EA 4712 "Comportement et Noyaux Gris Centraux", Faculté de Médecine, Université de Rennes 1, Avenue Léon Bernard, 35043, Rennes, France.
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McArthur N, Conlan DP, Crawford JR. Radiation exposure during scoliosis surgery: a prospective study. Spine J 2015; 15:S33-S36. [PMID: 25576903 DOI: 10.1016/j.spinee.2014.12.149] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/28/2014] [Accepted: 12/30/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The present literature on the cancer risks related to radiation exposure in patients and surgeons during scoliosis surgery is sparse. PURPOSE To assess the radiation exposure in patients and surgeons during scoliosis surgery and estimate the increased cancer risk of both groups. STUDY DESIGN Over a 6-month period, we conducted a prospective study to monitor the intraoperative radiation dose received by both patients and surgeons during scoliosis cases. PATIENT SAMPLE It included 30 consecutive patients undergoing scoliosis surgery by a team of two surgeons (S1 and S2). OUTCOME MEASURES We measured the radiation exposure to the eyes, thyroid, and hands for each surgeon; measured the difference of radiation exposure between the two surgeons; the difference in radiation exposure with respect to the proximity of the surgeon to the X-ray tube, and the radiation exposure for each patient. METHODS An electronic dosimeter was attached over the thyroid guard and a thermoluminescent dosimeter ring on both hands of each surgeon. The patients were monitored using the dose area product (DAP) measurements from the image intensifier, and their radiation exposure was calculated with the Monte Carlo calculation. RESULTS The mean eye dose per procedure for the two surgeons S1 and S2 was 0.8 μSv and 1.3 μSv, respectively. The mean thyroid dose for S2 and S1 was 1.2 μSv and 1.4 μSv, respectively. The dose recorded by the surgeon on the same side of the patient as the X-ray tube was significantly higher than for the surgeon on the far side (p<.05). Mean DAP per procedure was 91.3 cGycm(2) and the mean radiation dose for patients was 252.9 μSv. The increase in cancer risk for patients and surgeons was 0.001% and 0.0005%, respectively, for each year of exposure. CONCLUSIONS A significantly higher dose of radiation during scoliosis surgery was received by the surgeon standing on the same side as the X-ray tube. However, both surgeons received a total radiation dose of less than 1% of the recommended dose limit per year and, therefore, the total radiation exposure in both surgeons and patients was well within the recommended safe limits.
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Affiliation(s)
- Nicholas McArthur
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Hills Rd., Cambridge, CB2 0QQ, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Hills Rd., Cambridge, CB2 0QQ, United Kingdom.
| | - David P Conlan
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Hills Rd., Cambridge, CB2 0QQ, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Hills Rd., Cambridge, CB2 0QQ, United Kingdom
| | - John R Crawford
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Hills Rd., Cambridge, CB2 0QQ, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Hills Rd., Cambridge, CB2 0QQ, United Kingdom
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Lakhal W, Loret JE, de Bodman C, Fournier J, Bergerault F, de Courtivron B, Bonnard C. The progression of lumbar curves in adolescent Lenke 1 scoliosis and the distal adding-on phenomenon. Orthop Traumatol Surg Res 2014; 100:S249-54. [PMID: 24721249 DOI: 10.1016/j.otsr.2014.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The postoperative deterioration of the curve below spinal fusion instrumentation resulting in a distal adding-on (AO) phenomenon in idiopathic adolescent scoliosis (IAS) frequently requires surgical revision with disappointing secondary clinical results. HYPOTHESIS Analysis of AP (coronal) range of motion (cROM) and lateral (sagittal) range of motion (sROM) on dynamic (side-bending, flexion, extension) X-rays to determine the choice of the lowest instrumented vertebra (LIV) can help reduce distal adding-on. The goal of this study was to study the postoperative progression of the lumbar curve in Lenke 1 scoliosis operated on with a LIV based on dynamic X-ray results. MATERIALS AND METHODS Right-sided Lenke 1 IAS that was treated surgically by posterior arthrodesis alone with a follow-up of at least 2 years was included in the study. The following radiographic parameters were evaluated: the Cobb angles of the curves, reducibility of the curves, the apex of the scoliosis, the central sacral vertical line, the stable vertebra (SV), the neutral vertebra (NV), the distances between the CSVL and the centroids of the LIV and of the first vertebra below instrumentation, as well as the tilt of the superior endplates. sROM and cROM were determined on dynamic X-rays. RESULTS Fifty IAS were evaluated/185 files. Only three cases fulfilled the criteria for AO including two that were secondary to peri- or postoperative complications. The lumbar curve presented with a loss of correction of 0.9° at one year and 1.14° at the final follow-up. None of the parameters studied were correlated to the deterioration of the lumbar curve. DISCUSSION The choice of the LIV has been shown to influence the deterioration of the lumbar curve and the development of AO. The choice of the LIV based on an analysis of AP (coronal) and lateral (sagittal) range of motion seems to prevent the development of AO. LEVEL OF EVIDENCE 4, retrospective study.
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Affiliation(s)
- W Lakhal
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France.
| | - J-E Loret
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France
| | - C de Bodman
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France
| | - J Fournier
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France
| | - F Bergerault
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France
| | - B de Courtivron
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France
| | - C Bonnard
- Service de chirurgie orthopédique pédiatrique, hôpital de Clocheville, centre hospitalier universitaire, boulevard Béranger, 37044 Tours, France
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Pizones J, Rodríguez-López T, Zúñiga L, Sánchez-Mariscal F, Álvarez-González P, Izquierdo E. [Treatment of juvenile scoliosis: Increasing the lengthening interval with the growing rod technique should not necessarily compromise thoracic growth]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2014; 58:297-302. [PMID: 24857049 DOI: 10.1016/j.recot.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 03/25/2014] [Accepted: 03/26/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. MATERIAL AND METHODS Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. RESULTS Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. CONCLUSION For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.
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Affiliation(s)
- J Pizones
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España.
| | - T Rodríguez-López
- TR Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Marqués de Valdecilla, Santander, España
| | - L Zúñiga
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| | - F Sánchez-Mariscal
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| | - P Álvarez-González
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
| | - E Izquierdo
- Unidad de Columna, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Getafe, Madrid, España
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Kim JH, Kim YH, Yang JY, Son SC. Anesthetic experience performing intraoperative monitoring of motor evoked potentials during scoliosis surgery in adolescent patients: report on 7 cases: Seven cases report. Korean J Anesthesiol 2009; 57:780-784. [PMID: 30625968 DOI: 10.4097/kjae.2009.57.6.780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Intraoperative monitoring of motor evoked potential (MEP) is a modality for preventing spinal cord injury during spinal surgery. However, inhalation anesthetics and muscle relaxants depressing MEP responses, must be restricted for monitoring MEP. Therefore, anesthetic management needs careful attention for preventing recall and unintentional movements during surgery and special techniques for monitoring adequate MEP. We report here on 7 cases of successful intraoperative monitoring of MEP with total intravenous anesthesia using propofol and remifentanil for scoliosis surgery in adolescent patients.
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Affiliation(s)
- Jeong Hyun Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
| | - Yoon Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
| | - Jun Young Yang
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
| | - Soo Chang Son
- Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
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