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Bessaguet H, Rousseau MC, Gautheron V, Ojardias E, Dohin B. Impact of spinal fusion on severity health status in scoliotic adolescents with polyhandicap. PLoS One 2024; 19:e0300065. [PMID: 38451892 PMCID: PMC10919586 DOI: 10.1371/journal.pone.0300065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Scoliosis constitutes a prevalent comorbidity in adolescents with polyhandicap and frequently leads to other severe impairments, impacting abilities and requiring complex caregiving strategies. Therefore, spinal fusion surgeries are commonly performed to alleviate pain and provide more comfort. However, spine stabilization has not previously been proven to improve the severity health status of adolescents with polyhandicap according to specific clinical scales. OBJECTIVE This study describes and compares the severity health status of adolescents with polyhandicap before and after they underwent spinal fusion. METHODS A monocentric retrospective observational study was conducted in the university hospital centre of Saint-Etienne, France. We included between 2009 to 2020, 30 scoliotic adolescents with polyhandicap who underwent spinal fusion performed with the same surgical technique and the same surgeon. The main outcome was the variation in the Polyhandicap Severity Scale (PSS) score after surgery. Secondary outcomes were variations in PSS subscores, quality of life scores, fronto-sagittal X-ray parameters, and measures of surgical complication rates and lengths of stay. RESULTS Among 30 adolescents, 27 PSS analyses were performed. We found a significant improvement between pre- and postoperative PSS scores, mainly for pain and respiratory, digestive, and skin disabilities. These improvements were accompanied by significant reductions in pelvic obliquity, in frontal and sagittal curves. The mean hospital length of stay was 45 days. During postoperative period, patients received a personalized postoperative rehabilitation procedure with spasticity and pain treatments, physiotherapy, and verticalization (wheelchair sitting and positioning devices such as contoured seat intended to increase postural stability). The mortality rate was estimated at 7%. At least 1 complication per patient occurred. CONCLUSIONS We show that spinal fusion surgeries confer a significant improvement in the severity health status in scoliotic adolescents with polyhandicap.
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Affiliation(s)
- Hugo Bessaguet
- Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
- Saint-Etienne University Jean Monnet, Lyon 1, Savoie Mont-Blanc University, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint Etienne, France
| | - Marie-Christine Rousseau
- EA 3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, San Salvadour Hospital, University Hospital of Paris, Hyères, France
| | - Vincent Gautheron
- Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
- Saint-Etienne University Jean Monnet, Lyon 1, Savoie Mont-Blanc University, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint Etienne, France
| | - Etienne Ojardias
- Department of Physical and Rehabilitation Medicine, University Hospital of Saint-Etienne, Saint-Etienne, France
- Lyon Neuroscience Research Center, Trajectoires Team, Inserm UMR-S 1028, CNRS UMR 5292, Lyon1 & Saint-Etienne Universities, Saint-Étienne, France
| | - Bruno Dohin
- Saint-Etienne University Jean Monnet, Lyon 1, Savoie Mont-Blanc University, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint Etienne, France
- Department of Pediatric Orthopedic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
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Huang SG, Wilson PL, Worrall HM, Ramo BA, Kapadia A, Ellis HB. Elective musculoskeletal surgery is associated with postoperative weight changes in pediatric and adolescent patients. J Child Orthop 2023; 17:489-496. [PMID: 37799309 PMCID: PMC10549699 DOI: 10.1177/18632521231198250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Patients of elective orthopedic surgeries often reduce activity levels during postoperative recovery. It is unclear whether these extended periods of modified activities lead to weight changes. The purpose of this study was to evaluate changes in body mass index percentile in pediatric patients over 2.5 years following primary musculoskeletal surgeries. Methods Institutional records for utilized current procedural terminology codes were used to identify patients aged 21 years or younger who underwent elective surgery at a single pediatric orthopedic institution between October 2016 and December 2018. Non-primary surgeries and patients without preoperative body mass index measurements were excluded. Demographic characteristics, height, weight, and body mass index within 30 months of surgery were collected. Body mass index relative to age was calculated. Analysis of body mass index changes at follow-up intervals of 3-7, 9-18, and 24-30 months after surgery was performed for the overall sample, within surgical categories, and within preoperative weight classifications. Results A total of 1566 patients (53.1% female, average age 12.4 years) were included. Over one-third of patients were overweight or obese at presentation. The average change in body mass index percentile relative to baseline was increased at all follow-up intervals. Values reached significance at 9-18 months (p = .002) and 24-30 months (p = .001). While underweight and normal-weight patients had increased body mass index at all three timepoints, overweight or obese patients decreased. Conclusions Patients undergoing elective orthopedic procedures may experience significant changes in body mass index percentile postoperatively. At extremes of weight, patients experience improvement toward the mean, but most patients may undergo body mass index increases beyond what would be expected during normal growth. Level of evidence Retrospective level III.
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Affiliation(s)
- Sharon G Huang
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Philip L Wilson
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Scottish Rite for Children, Dallas, TX, USA
- Children’s Medical Center Dallas, Dallas, TX, USA
| | | | - Brandon A Ramo
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Scottish Rite for Children, Dallas, TX, USA
- Children’s Medical Center Dallas, Dallas, TX, USA
| | - Ami Kapadia
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Henry B Ellis
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- Scottish Rite for Children, Dallas, TX, USA
- Children’s Medical Center Dallas, Dallas, TX, USA
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Nakamura N, Oba M, Momose T, Machida J, Inaba Y, Kawabe Y. Transition of Caregiver Perceptions after Pediatric Neuromuscular Scoliosis Surgery. Spine Surg Relat Res 2022; 6:373-378. [PMID: 36051682 PMCID: PMC9381082 DOI: 10.22603/ssrr.2021-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Spinal fusion for children with neuromuscular scoliosis has been known to improve sitting balance and quality of life as well as for high caregiver satisfaction. However, most studies performed were single surveys, and it remains unclear whether high satisfaction levels are maintained. Thus, in this article, we report the short- and medium-term improvements in caregiver standing assessment after neuromuscular scoliosis surgery in children with Gross Motor Function Classification System (GMFCS) level IV or V. Methods In total, 18 patients with GMFCS levels IV and V were included in this study. The underlying diseases were typical cerebral palsy in 12 cases, chromosomal abnormalities in 5 cases, and congenital myopathy in 1 case. The median age at the time of surgery was 14.5 years. The medians for the first and second follow-up surveys were after 1.4 and 5.9 years, respectively. All the patients had undergone posterior spinal fusion, whereas 12 had undergone pelvic fixation. These patients were assessed using a caregiver questionnaire, in addition to patient demographic data and radiographic assessments. Results The median BMI was 15.4 kg/m2 preoperatively, 16.6 kg/m2 at the first survey, and 17.1 kg/m2 at the second survey. The main Cobb angles were 97.5°, 36.5°, and 37.0° and the spino-pelvic obliquity angles were 22.5°, 6.0°, and 6.5° preoperatively, at the first survey and at the second survey, respectively. In the questionnaire, most domains were rated similarly in the first and second surveys, but the ratings for the “children's QOL” and “digestion and defecation” domains were noted to increase, while that for the “transfer” and “satisfaction with treatment” domains have decreased. Conclusions Neuromuscular scoliosis surgery in children has been associated with extremely high treatment satisfaction in the early postoperative period. However, some caregivers showed a decline in the “transfer” and “treatment satisfaction” domains over time.
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Affiliation(s)
- Naoyuki Nakamura
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center
| | - Masatoshi Oba
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center
| | - Takako Momose
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center
| | - Jiro Machida
- Department of Orthopedic Surgery, Kanagawa Children's Medical Center
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University
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Meltzer-Bruhn AT, Landrum MR, Spiegel DA, Cahill PJ, Anari JB, Baldwin KD. Does nutrition consultation in the year leading up to neuromuscular scoliosis surgery result in significant weight gain, or just a larger magnitude curve? Spine Deform 2022; 10:151-158. [PMID: 34427892 DOI: 10.1007/s43390-021-00401-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 08/14/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Patients with neuromuscular scoliosis undergoing posterior instrumented spinal fusion can be underweight, malnourished, and have higher complication rates. A nutrition consult is common in this population and it is unclear if weight gain occurs from the consult or surgery. The purpose of the study was to determine if nutrition consultation in the year prior to spinal fusion resulted in significant differences in weight gain or percentile on the CP growth chart. The secondary aim was to determine if there would be deformity progression during that time. METHODS Retrospective chart and radiograph review was performed for all patients with neuromuscular spinal deformity treated with posterior instrumented spinal fusion at one institution between January 1, 2009 and August 1, 2015. Inclusion criteria included < 20 years old, diagnosis of neuromuscular scoliosis, and 1-year pre-operative percentile on the CP growth chart < 50. Patient demographics, GMFCS level, weight, percentile on appropriate CP growth chart, major curve and pelvic obliquity at 1 year pre-operatively and at surgery were recorded. RESULTS Sixty-eight patients met inclusion criteria. Thirty-seven patients had a nutrition appointment within 1 year pre-operatively, 31 patients did not. There were no significant differences between the groups when comparing increase in weight (p = 0.9), percentile on CP growth charts (p = 0.3), major deformity (p = 0.1), and pelvic obliquity (p = 0.2). Overall, there was a mean 3.2 kg weight gain, 5.2% increase on CP growth charts, 40° increase in major curve, and 5° worsening of pelvic obliquity in the year before surgery. There was an average overall increase in the pre-operative albumin value, but this was not different between groups (p = 0.6). Children who were tube fed gained on average 10.8 percentiles on the CP growth chart, whereas children without gained only 0.5 percentiles (p = 0.002). CONCLUSIONS Nutrition consultations in the year preceding posterior instrumented spinal fusion do not lead to weight optimization prior to surgery in comparison to patients without nutrition consults. Gastrostomy tubes were found to be helpful for weight optimization and should be considered as an alternative nutrition option in pre-operative planning in underweight patients. LEVEL OF EVIDENCE III-therapeutic study: retrospective comparative study.
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Affiliation(s)
| | - Matthew R Landrum
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David A Spiegel
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick J Cahill
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason B Anari
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Keith D Baldwin
- Department of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Verhofste BP, Berry JG, Miller PE, Crofton CN, Garrity BM, Fletcher ND, Marks MC, Shah SA, Newton PO, Samdani AF, Abel MF, Sponseller PD, Glotzbecker MP. Risk factors for gastrointestinal complications after spinal fusion in children with cerebral palsy. Spine Deform 2021; 9:567-578. [PMID: 33201495 DOI: 10.1007/s43390-020-00233-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 10/15/2020] [Indexed: 01/20/2023]
Abstract
DESIGN Prospective cerebral palsy (CP) registry review. OBJECTIVES (1) Evaluate the incidence/risk factors of gastrointestinal (GI) complications in CP patients after spinal fusion (SF); and (2) investigate the validity of the modified Clavien-Dindo-Sink classification. BACKGROUND Perioperative GI complications result in increased length of stay (LOS) and patient morbidity/mortality. However, none have analyzed the outcomes of GI complications using an objective classification system. METHODS A prospective/multicenter CP database identified 425 children (mean, 14.4 ± 2.9 years; range, 7.9-21 years) who underwent SF. GI complications were categorized using the modified Clavien-Dindo-Sink classification. Grades I-II were minor complications and grades III-V major. Patients with and without GI complications were compared. RESULTS 87 GI complications developed in 69 patients (16.2%): 39 minor (57%) and 30 major (43%). Most common were pancreatitis (n = 45) and ileus (n = 22). Patients with preoperative G-tubes had 2.2 × odds of developing a GI complication compared to oral-only feeders (OR 2.2; 95% CI 0.98-4.78; p = 0.006). Similarly, combined G-tube/oral feeders had 6.7 × odds compared to oral-only (OR 6.7; 95% CI 3.10-14.66; p < 0.001). The likelihood of developing a GI complication was 3.4 × with normalized estimated blood loss (nEBL) ≥ 3 ml/kg/level fused (OR 3.41; 95% CI 1.95-5.95; p < 0.001). Patients with GI complications had more fundoplications (29% vs. 17%; p = 0.03) and longer G-tube fasting periods (3 days vs. 2 days; p < 0.001), oral fasting periods (5 days vs. 2 days; p < 0.001), ICU admissions (6 days vs. 3 days; p = 0.002), and LOS (15 days vs. 8 days; p < 0.001). LOS correlated with the Clavien-Dino-Sink classification. CONCLUSION Gastrointestinal complications such as pancreatitis and ileus are not uncommon after SF in children with CP. This is the first study to investigate the validity of the modified Clavien-Dindo-Sink classification in GI complications after SF. Our results suggest a correlation between complication severity grade and LOS. The complexity of perioperative enteral nutritional supplementation requires prospective studies dedicated to enteral feeding protocols. LEVEL OF EVIDENCE Therapeutic-level III.
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Affiliation(s)
- Bram P Verhofste
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jay G Berry
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Charis N Crofton
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigid M Garrity
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas D Fletcher
- Department of Orthopaedic Surgery, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Suken A Shah
- Department of Orthopaedic Surgery, A. I. DuPont Institute, Wilmington, DE, USA
| | - Peter O Newton
- Department of Orthopaedic Surgery, UC San Diego University of California, San Diego, CA, USA
| | - Amer F Samdani
- Department of Orthopaedic Surgery, Shriner's Hospital for Children, Philadelphia, PA, USA
| | - Mark F Abel
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, John Hopkins Hospital, Baltimore, MD, USA
| | | | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, University Hospital Cleveland Medical Center, Rainbow Babies and Children's Hospital, 201 Adelbert Road, Cleveland, OH, 44106, USA.
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BMI change following spinal fusion for neuromuscular scoliosis surgery. Spine Deform 2020; 8:1081-1087. [PMID: 32394323 DOI: 10.1007/s43390-020-00109-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/19/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective descriptive, multi-center study. OBJECTIVES We hypothesize that a post-operative weight gain will result in patients who are underweight prior to surgery. Cachexia and low body mass index is common among children with cerebral palsy (CP). Many interventions are undertaken to assist the child in nourishment and to obtain a more normal body mass. Additionally, scoliosis is common among children with CP. In our practice we have noted weight gain post operatively in severely underweight children after spinal fusion. METHODS We underwent a retrospective review of a CP cohort from a multicenter prospective registry. Percentiles on the CP specific growth chart for which each child belonged were plotted based on the patients' age, weight, gender, GMFCS level, and tube feeding status. We then assessed percentile change in patients between pre-op visit, 1 year, 2 years and for those with available data, 5 years follow up visits. Patients with under two years of follow up, patients with GMFCS III and below, and patients without weight data were excluded. RESULTS We identified a total of 211 potentially eligible patients from a multicenter prospective registry. 109 had complete 2 years data to analyze and 37 patients had full 5 years data to analyze. We found that patients under the 50th percentile pre-operatively increased their percentile on the CP growth chart for weight 12.1 percentiles (95% CI 6.7, 17.5 p value < 0.001) whereas patients that began at the 50th percentile or above on average lost 2.2 percentiles (95% CI -6.8, 2.3) though the change was not statistically significant (p value 0.330). These changes appeared stable at 5 years. Although regression analysis showed that Cobb correction and pelvic obliquity correction, and hyperlordosis were not independent predictors of the change, we noted that patients with residual curves after surgery of 40° or more experienced 13.3 percentile less weight gain than those with better corrections. CONCLUSIONS Patients with CP are at risk for cachexia, malnutrition, reflux and other GI disorders. Data presented here suggests that corrective spinal surgery may improve weight percentile in patients who start out at 50th percentile and lower. Patients with 40° or greater of residual scoliosis may benefit less from spinal fusion than those with a better correction. LEVEL OF EVIDENCE II; Prognostic retrospective cohort study.
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