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Mraja HM, Gök H, Daadour IMF, Ulusoy OL, Şanlı T, Karadereler S, Enercan M, Hamzaoglu A. Cement Augmented Pedicle Screw Instrumentation In Pediatric Spine Surgery. World Neurosurg 2023:S1878-8750(23)00301-7. [PMID: 36894000 DOI: 10.1016/j.wneu.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Osteoporosis is a rare entity in pediatrics. Osteomalacia and osteoporosis are known to develop in syndromic or neuromuscular scoliosis (NMS) childrens. Spinal deformity surgery for pediatric patients with osteoporosis is challenging associated with pedicle screw (PS) failure and compression fractures. Cement augmentation of PS is one of the several measures to prevent screw failure. It provides additional pull-out strength to the PS in the osteoporotic vertebra. METHODS From 2010 through 2020, an analysis of pediatric patients who had cement-augmented PS with a minimum follow-up of two years was performed. Radiological and clinical evaluations were analyzed. RESULTS Seven patients (4 F, 3M), average age was 13 years (range, 10-14yrs) with a mean follow-up of 3 years (range, 2-3yrs). Only two patients were undergoing revision surgery. The total number of cement-augmented PS was 52 with an average of 7/patient. Only one patient had lower instrumented vertebra (LIV) vertebroplasty. There were no PS pull-out in the cement augmented levels nor neurological deficits or pulmonary cement embolisms in this series. One patient developed a PS pull-out in uncemented levels. Two patients developed compression fractures, one (OI patient) in the supra-adjacent levels (UIV+1 and UIV+2) and the other (NMS patient) in the uncemented segments. CONCLUSION In our study, all the cement-augmented pedicle screws provided satisfactory radiological outcomes without pedicle screw pull-out and adjacent vertebral compression fracture. In pediatric spine surgery, osteoporotic patients with a poor bone purchase may be augmented using cement, especially in risk patients (ie OI, neuromuscular scoliosis, and syndromic scoliosis).
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Oba H, Uehara M, Ikegami S, Hatakenaka T, Kamanaka T, Miyaoka Y, Kurogouchi D, Fukuzawa T, Mimura T, Tanikawa Y, Koseki M, Ohba T, Takahashi J. Tips and pitfalls to improve accuracy and reduce radiation exposure in intraoperative CT navigation for pediatric scoliosis: a systematic review. Spine J 2023; 23:183-196. [PMID: 36174926 DOI: 10.1016/j.spinee.2022.09.004] [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: 07/09/2022] [Revised: 09/03/2022] [Accepted: 09/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT An increasing number of medical centers are adopting an intraoperative computed tomography (iCT) navigation system (iCT-Navi) to provide three-dimensional navigation for pediatric scoliosis surgery. While iCT-Navi has been reported to provide higher pedicle screw (PS) insertion accuracy, it may also result in higher radiation exposure to the patient. What innovations and studies have been introduced to reduce radiation exposure and further improve PS insertion? PURPOSE Evaluate the level of evidence and quality of papers while categorizing the tips and pitfalls regarding pediatric scoliosis surgery using iCT-Navi. Compare iCT-Navi with other methods, including preoperative CT navigation. STUDY DESIGN Systematic review. PATIENT SAMPLE Articles on pediatric scoliosis surgery with iCT-Navi published through to June 2022. OUTCOME MEASURES PS perforation rate and patient intraoperative radiation dose. METHODS Following PRISMA guidelines, the Cochrane Library, Google Scholar, and PubMed databases were searched for articles satisfying the criteria of iCT-Navi use and pediatric scoliosis surgery. The level of evidence and quality of the articles meeting the criteria were evaluated according to the guidelines of the North American Spine Society and American Academy of Orthopedic Surgeons, respectively. The articles were also categorized by theme and summarized in terms of PS insertion accuracy and intraoperative radiation dose. The origins and characteristics of five major classification methods of PS perforation grade were summarized as well. RESULTS The literature search identified 811 studies, of which 20 papers were included in this review. Overall, 513 pediatric scoliosis patients (381 idiopathic, 44 neuromuscular, 39 neurofibromatosis type 1, 28 congenital, 14 syndromic, seven other) were evaluated for PS perforations among 6,209 iCT-Navi insertions. We found that 232 (3.7%) screws were judged as major perforations (G2 or G3), 55 (0.9%) screws were judged as dangerous deviations (G3), and seven (0.1%) screws were removed. There were no reports of neurovascular injury caused by PSs. The risk factors for PS perforation included more than six vertebrae distance from the reference frame, more than nine consecutive insertions, upper thoracic level, thinner pedicle, upper instrumented vertebra proximity, short stature, and female. The accuracy of PS insertion did not remarkably decrease when the radiation dose was reduced to 1/5 or 1/10 by altering the iCT-Navi protocol. CONCLUSIONS iCT-Navi has the potential to reduce PS perforation rates compared with other methods. The use of low-dose radiation protocols may not significantly affect PS perforation rates. Although several risk factors for PS perforation and measures to reduce radiation dose have been reported, the current evidence is limited by a lack of consistency in classifying PS perforation and evaluating patient radiation dose among studies. The standardization of several outcome definitions is recommended in this rapidly developing field.
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Affiliation(s)
- Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Masashi Uehara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Terue Hatakenaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takayuki Kamanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yoshinari Miyaoka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Daisuke Kurogouchi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takuma Fukuzawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Yusuke Tanikawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Michihiko Koseki
- Faculty of Textile Science and Technology, Shinshu University, 3-15-1 Tokida, Ueda, Nagano 386-8567, Japan
| | - Tetsuro Ohba
- Department of Orthopaedic Surgery, University of Yamanashi School of Medicine, School of Medicine, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Rudisill SS, Saleh NZ, Hornung AL, Zbeidi S, Ali RM, Siyaji ZK, Ahn J, Nolte MT, Lopez GD, Sayari AJ. YouTube as a source of information on pediatric scoliosis: a reliability and educational quality analysis. Spine Deform 2023; 11:3-9. [PMID: 35986883 DOI: 10.1007/s43390-022-00569-7] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 08/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the reliability and educational quality of YouTube videos related to pediatric scoliosis. METHODS In December 2020, searches of "pediatric scoliosis", "idiopathic scoliosis", "scoliosis in children", and "curved spine in children" were conducted using YouTube. The first 50 results of each search were analyzed according to upload source and content. The Journal of the American Medical Association (JAMA) Benchmark Criteria were used to assess reliability (score 0-4), and educational quality was evaluated using the Global Quality Score (GQS; score 0-5) and Pediatric Scoliosis-Specific Score (PSS; score 0-15). Differences in scores based on upload source and content were determined by Analysis of Variance (ANOVA) or Kruskal-Wallis tests. Multivariate linear regressions identified any independent predictors of reliability and educational quality. RESULTS After eliminating duplicates, 153 videos were analyzed. Videos were viewed 28.5 million times in total, averaging 186,160.3 ± 1,012,485.0 views per video. Physicians (54.2%) and medical sources (19.0%) were the most common upload sources, and content was primarily categorized as disease-specific (50.0%) and patient experience (25.5%). Videos uploaded by patients achieved significantly lower JAMA scores (p = 0.004). Conversely, academic or physician-uploaded videos scored higher on PSS (p = 0.003) and demonstrated a trend towards improved GQS (p = 0.051). Multivariate analysis determined longer video duration predicted higher scores on all measures. However, there were no independent associations between upload source or content and assessment scores. CONCLUSION YouTube contains a large repository of videos concerning pediatric scoliosis; however, the reliability and educational quality of these videos were low. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Samuel S Rudisill
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA.
| | - Nour Z Saleh
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Alexander L Hornung
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Shadi Zbeidi
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Roohi M Ali
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Zakariah K Siyaji
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Junyoung Ahn
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Michael T Nolte
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Gregory D Lopez
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
| | - Arash J Sayari
- Division of Spine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison Street, Chicago, IL, 60612, USA
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Machida M, Rocos B, Zabjek K, Lebel DE. A comparison of the reliability and vulnerability of 3D sterEOS and 2D EOS when measuring the sagittal spinal alignment of patients with adolescent idiopathic scoliosis. Spine Deform 2022; 10:1029-34. [PMID: 35384609 DOI: 10.1007/s43390-022-00499-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/11/2021] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE An essential component of making the diagnosis of adolescent idiopathic scoliosis (AIS) is standing anteroposterior and lateral radiographs. Two-dimensional (2D) radiographs inevitably fail to reflect every plane of the three-dimensional (3D) deformity in scoliosis. We have tested the hypothesis that there is no difference in the assessment of the sagittal plane deformity when measured with either 2D or 3D EOS radiography. METHODS A retrospective radiographic analysis was performed on patients diagnosed with AIS, with subdivided into three groups according to the coronal angular deformity (mild group: 45°-69°, moderate group: 70°-89°, and severe group: 90° +). The sagittal parameters were compared between manual measurement with 2D sterEOS and those made using computer-aided 3D reconstruction. RESULTS Fifty-two patients were included in each group. The inter-study reliability when measuring the thoracic Kyphosis (TK) and lumbar lordosis (LL) between the two study modalities was excellent in mild group (ICC: 0.90, 95% CI 0.82 ~ 0.94 and ICC: 0.84, 95% CI 0.74 ~ 0.91), excellent in TK and fair in LL in moderate group (ICC: 0.76, 95% CI 0.61 ~ 0.85 and ICC: 0.70, 95% CI 0.53 ~ 0.81), and fair in TK and LL in severe group, respectively (ICC: 0.74, 95% CI 0.57 ~ 0.84 and ICC: 0.65, 95% CI 0.46 ~ 0.84). A Bland-Altman plot showed proportional bias in TK measurements in each group and LL in moderate group, which means the measured value is underestimated in 2D method when the angle is small. CONCLUSION 3D sterEOS is less vulnerable to the influence of coronal plane than 2D EOS in evaluating the sagittal spinal parameters of patients with a coronal deformity exceeding 70°.
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Burke CA, Speirs JN, Nelson SC. Maximizing mechanical advantage: surgical technique increases stiffness in spinal instrumentation. Spine Deform 2022; 10:295-299. [PMID: 34748141 DOI: 10.1007/s43390-021-00425-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/18/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE While there has been a great improvement in the treatment of adolescent idiopathic scoliosis, sagittal deformity correction has remained challenging. Increased rod stiffness has been shown to reduce thoracic flattening. We propose that the surgical technique can increase rod stiffness. A mechanical study was created to quantify the effect this has on construct stiffness. METHODS The sagittal bending stiffness of a constrained over contoured rod was measured using four different commonly used instrumentation systems. Pedicle screws were secured into custom printed blocks. One block was completely immobilized, while the other block was subject to four levels of constraint. This includes no constraint, mild constraint, moderate constraint, and maximal constraint with both blocks immobilized. The rod apex was loaded until 1 cm of displacement occurred. The stiffness was then calculated and compared between groups. RESULTS All four rod types showed increased bending stiffness as the construct became more constrained. The moderately constrained and the maximally constrained groups had a significantly higher stiffness compared to the unconstrained groups in all rod types (p < 0.05). The 6.0 mm titanium circular rods showed the highest increase in stiffness between maximal and no constraint, which became 3.02 × stiffer. CONCLUSIONS Rod stiffness is not only determined by size, shape, and metal alloy, but also by surgical technique. Constraining the spinal instrumentation by first locking the rod to the proximal and distal anchors significantly increases the sagittal bending stiffness. In a mechanical model this technique increases rod bending stiffness regardless of the material or shape.
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Affiliation(s)
- Corey A Burke
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
| | - Joshua N Speirs
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA.
| | - Scott C Nelson
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
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Ramos O, Speirs J, Morrison M, Danisa O. Effect of narcotic prescription limiting legislation on opioid utilization following pediatric spinal fusion for scoliosis. Spine Deform 2022; 10:335-341. [PMID: 34449074 DOI: 10.1007/s43390-021-00406-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/13/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND CONTEXT Since 2016, 35 of 50 US states have approved opioid-limiting and monitoring laws. The impact on postoperative opioid prescribing and secondary outcomes following pediatric scoliosis deformity correction surgery remains unknown. PURPOSE To evaluate the effect of CURES 2.0 opioid-limiting regulations on postoperative opioid prescriptions and unplanned readmissions following pediatric scoliosis deformity correction surgery. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Two patient cohorts (pre-CURES January 1, 2017-October 22, 2018 and post-CURES September 1, 2018-May 30, 2020) that included all patients undergoing pediatric scoliosis deformity surgery at a single institution. METHODS Demographic, medical, surgical, clinical, and pharmacological data was collected from all patients. Total morphine milligram equivalents (MMEs) prescribed was compared at 30-day postoperative intervals. Readmission rates were calculated. Categorical variables were evaluated with Chi squared analysis and continuous variables were evaluated with t test or Mann-Whitney U test as appropriate. Logistic regression was used to evaluate risk factors for increased postoperative opioid. RESULTS Of 108 identified patients, 94 (49 pre-CURES, 45 post-CURES) were included in the study. Post-CURES patients were older (p = 0.001). All other demographic, medical, and surgical factors were similar between pre-CURES and post-CURES patients (all p > 0.05). Post-CURES, patients received fewer pills in their first postoperative prescription (43.4 vs. 57.4 pills, p = 0.006), less opioids (MMEs) during the first 0 to 30-day and 31 to 60-day postoperative intervals (261.8 MMEs vs. 337.6 MMEs, p = 0.028 and 17.8 MMEs vs. 59.7 MMEs, p = 0.016, respectively). Increased 120-day opioid utilization was associated with surgery in the pre-CURES period, age, BMI, and decreased number of levels fused (all p < 0.05). Postoperative readmission within 90 days was associated with age, BMI, number of levels fused, and length of stay. CONCLUSIONS Implementation of CURES 2.0 has resulted in a reduction in the opioid prescription following pediatric scoliosis deformity surgery without an increase in readmissions. Further studies are needed to evaluate how legislations of this kind affect patient reported outcomes, satisfaction, and quality of life.
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Affiliation(s)
- Omar Ramos
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA.
| | - Joshua Speirs
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
| | - Martin Morrison
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA, 02354, USA
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Bauer JM. The body image disturbance questionnaire-scoliosis better correlates to quality of life measurements than the spinal assessment questionnaire in pediatric idiopathic scoliosis. Spine Deform 2021; 9:1509-1517. [PMID: 33929714 DOI: 10.1007/s43390-021-00358-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/11/2020] [Accepted: 04/19/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Idiopathic scoliosis (IS) patients can have body dissatisfaction which can affect their perception of health. Two body image measures, the Spinal Appearance Questionnaire (SAQ) and the Body Image Disturbance Questionnaire-Scoliosis (BIDQ-S), have been used in pediatric IS with variable correlation to the SRS-22r and radiographs, but have not been compared to each other. As patient reported outcomes (PROs) continue to be highlighted in large database studies and national hospital ranking system scoring, we should narrow use to the best and most efficient. We aim to determine which of two better correlates to pediatric IS patients' radiographs and quality of life (QoL) scores. METHODS Consecutive IS patients aged 10-19 years old without surgery prospectively completed BIDQ-S, SAQ, SRS-22r, and PedsQL self-reported outcome measures. BIDQ-S and SAQ were compared in correlation to the two QoL surveys, as well as to radiographic major curve, shoulder asymmetry, lateral upright ribcage offset at apex, and coronal/sagittal balance. Spearman's r was used for correlations. RESULTS 104 surveys with mean age 14.4 years and mean major curve 42° (14°-74°) were included. BIDQ-S and SAQ scores strongly correlated to each other (r = 0.76), but BIDQ-S had a stronger correlation to total SRS-22r (- 0.75 vs - 0.61 SAQ), PedsQL total (- 0.76 vs - 0.55) and better or no difference in each SRS-22r and PedsQL domain. Both poorly correlated to radiographs (main curve: r = 0.32 BIDQ-S, 0.31 SAQ). CONCLUSION The BIDQ-S correlates better to SRS-22r and PedsQL for pediatric IS patients than the SAQ. Neither correlate well to radiographs. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jennifer M Bauer
- Department of Orthopaedic Surgery, Seattle Children's Hospital, 4800 Sand Point Way NE, 98105, Seattle, USA.
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, USA.
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Kanuparthi SPV, Pahys JM, Samdani AF, Grace J, Hwang SW. Use of postoperative neurophysiological testing to help guide management in a case of delayed neurological injury. Childs Nerv Syst 2021; 37:2911-6. [PMID: 33782729 DOI: 10.1007/s00381-021-05071-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/03/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Bimodal intraoperative neuromonitoring (IONM), combining transcranial motor-evoked potentials (tcMEP) and somatosensory-evoked potentials (SSEP), enables real-time detection and prevention of spinal cord injury during pediatric spinal deformity correction. Although rare, false-positive and false-negative signal alerts have been reported. However, no previously published accounts have described the use of postoperative neurophysiological testing to both identify new-onset neurological injury and guide reintervention. Here, we describe the case of an 18-year-old young man with achondroplasia, thoracolumbar kyphosis, and L2 wedge vertebra who underwent T12-L4 posterior spinal fusion with L2 vertebral column resection. Despite two intraoperative decreases in tcMEP amplitude, corrective measures on both occasions produced a return of IONM signal. Curiously, despite movement of the bilateral lower extremities upon waking, continued observation demonstrated minimal movement of the left lower extremity. Postoperative neurophysiological testing then identified limited muscle group activation below the left quadriceps, prompting operative reintervention. After cage removal and laminectomy lengthening, the patient recovered bilateral lower extremity function. He later returned to surgery for repeat cage placement at L2 via a retroperitoneal exposure, with no noted IONM changes and subsequent neurological improvement.
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Roberto RF, Rowan FA, Nallur D, Durbin-Johnson B, Javidan Y, Klineberg EO. Povidone-iodine irrigation combined with Vancomycin powder lowers infection rates in pediatric deformity surgery. Spine Deform 2021; 9:1315-1321. [PMID: 33970432 PMCID: PMC8363528 DOI: 10.1007/s43390-021-00333-3] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgical site infection is a morbid, devastating complication after spinal procedures. Studies have investigated the effect of wound lavage with 3.5% Povidone-iodine solution or the use of intrawound Vancomycin powder. We examined the effect of Povidone-iodine irrigation, intrawound Vancomycin powder, or a combination of both agents in a tertiary care Pediatric Hospital. METHODS We queried our health system database for patients undergoing spinal surgery over an eight-year span between January 2008 and June 2016 and identified patient cohorts who received no intervention, intrawound Vancomycin alone, Povidone-iodine irrigation alone, or a combination of both agents. Infection rates were determined. The effect of treatment on outcome was analyzed using a logistic regression model. RESULTS 475 patients were identified who met study inclusion criteria. 88 non-neuromuscular patients received no intra-operative agent. The surgical site infection (SSI) rate in this group of patients was 10%. For the 194 non-neuromuscular scoliosis patients who received Povidone-iodine and Vancomycin powder, the infection rate was reduced to 0.7%. The SSI rate in the 180 non-neuromuscular patients who were treated with Vancomycin powder alone was 1.4%. 13 patients were treated with Povidone-iodine lavage only, with a small sample size precluding statistical comparison. Infection rate in the 132 neuromuscular disease patients decreased from 14 to 7% overall during this time span: while the odds ratio of infection was reduced in all neuromuscular treatment groups receiving intra-operative measures, statistical significance was not reached in any neuromuscular group studied. CONCLUSIONS A protocol using combined 3.5% weight/volume Povidone-iodine and Vancomycin powder was associated with the lowest infection rate in our non-neuromuscular patient population and should be considered as a low cost intervention in pediatric patients undergoing spinal deformity procedures. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Rolando Figueroa Roberto
- Department of Orthopedics University of California, Davis, Sacramento, USA. .,Shriners Hospitals for Children Northern California, Sacramento, CA, USA.
| | | | - Deepak Nallur
- Department of Orthopedics University of California, Davis, Sacramento, USA
| | | | - Yashar Javidan
- Department of Orthopedics University of California, Davis, Sacramento, USA ,Shriners Hospitals for Children Northern California, Sacramento, CA USA
| | - Eric Otto Klineberg
- Department of Orthopedics University of California, Davis, Sacramento, USA ,Shriners Hospitals for Children Northern California, Sacramento, CA USA
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Liu CW, Lenke LG, Tan LA, Oh T, Chao KH, Lin SD, Pan RY. Selection of the Lowest Instrumented Vertebra and Relative Odds Ratio of Distal Adding-on for Lenke Type 1A and 2A Curves in Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis. Neurospine 2020; 17:902-909. [PMID: 33401869 PMCID: PMC7788412 DOI: 10.14245/ns.2040234.117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/19/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To examine existing literature and pool the data to determine the relative odds ratio of “adding-on” (AO) based on various reported criteria for lower instrumented vertebra (LIV) selection in Lenke type 1A and 2A curves.
Methods Using electronic databases, studies reporting on AO and LIV selection in Lenke type 1A and 2A curves were identified. Studies were excluded if they failed to meet the following criteria: ≥ 30 patients, Lenke type 1A or 2A curves, thoracic-only fusions, and inclusion of outcome differences in AO and non-AO groups. Review articles, letters, and case reports were excluded.
Results Six studies were identified reporting on 732 patients with either Lenke type 1A or 2A curves treated with thoracic-only fusions. Five different landmarks were used for LIV selection in these studies including the stable vertebra (SV) -1, end vertebra (EV) +1, neutral vertebra (NV), touched vertebra (TV), and substantially touched vertebra (STV) versus nonsubstantially touched vertebra (nSTV) +1. The pooled odds ratios of AO for choosing LIV at levels above the afore landmarks (i.e., ending the construct “short”) versus at the landmarks were 2.59 (SV-1), 2.43 (EV+1), 3.05 (NV), 3.40 (TV), and 4.52 (STV/nSTV+1), all at 95% confidence interval.
Conclusion Five landmarks shared a similar characteristic in that the incidence of AO was significantly higher if the LIV was proximal to the chosen landmark. In addition, choosing STV/(nSTV+1) as the LIV have the lowest absolute risk of AO and the greatest risk reduction. If additional levels were fused (i.e., LIV distal to the landmark), there was no statistically significant benefit in further reducing the risk of AO. Selection of the optimal LIV is a complex issue and spine surgeons must balance the risk of AO with the need for motion preservation in young patients.
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Affiliation(s)
- Che-Wei Liu
- Department of Orthopedics, Cathay General Hospital, Taipei City, Taiwan
| | - Lawrence G Lenke
- The Daniel and Jane Och Spine Hospital, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA
| | - Lee A Tan
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Taemin Oh
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Kou-Hua Chao
- Department of Orthopedics, Tri-Service General Hospital, Taipei City, Taiwan
| | - Shi-Ding Lin
- Department of Orthopedics, Cathay General Hospital, Taipei City, Taiwan
| | - Ru-Yu Pan
- Department of Orthopedics, Tri-Service General Hospital, Taipei City, Taiwan
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Bauer JM, Shah SA, Sponseller PD, Samdani AF, Newton PO, Marks MC, Lonner BS, Yaszay B. Comparing short-term AIS post-operative complications between ACS-NSQIP and a surgeon study group. Spine Deform 2020; 8:1247-1252. [PMID: 32720267 DOI: 10.1007/s43390-020-00170-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/13/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Prospective cohort review. OBJECTIVE To compare two AIS databases to determine if a performance improvement-based surgeon group has different outcomes compared to a national database. The American College of Surgeon's National Quality Improvement Program (ACS-NSQIP) and a surgeon study group (SG) collect prospective data on AIS surgery outcomes. NSQIP offers open enrollment to all institutions, and SG membership is limited to 15 high-volume institutions, with a major initiative to improve surgeon performance. While both provide important outcome benchmarks, they may reflect outcomes that are not relatable nationwide. METHODS The ASC-NSQIP Pediatric Spine Fusion and SG database were queried for AIS 30- and 90-day complication data for 2014 and 2015. Prospective enrollment and a dedicated site coordinator with rigorous data quality assurance protocols existed for both registries. Outcomes were compared between groups with respect to superficial and deep surgical site infections (SSI), neurologic injury, readmission, and reoperation. RESULTS There were a total of 2927 AIS patients included in the ASC-NSQIP data and 721 in the SG database. Total complication rate was 9.4% NSQIP and 3.6% SG. At 90 days, there were fewer surgical site infections reported by SG than ASC-NSQIP (0.6% vs. 1.6%, p = 0.03). Similarly, there were less spinal cord injuries (0.8% vs 1.5%, p = 0.006), 30-day readmissions (0.8% vs. 2.6%, p = 0.002), and 30-day reoperations (0.6% vs. 1.7%, p = 0.02) in the SG cohort. CONCLUSIONS Comparison of these two data sets suggests a range of complications and readmission rates, with the SG demonstrating lower values. These results are likely multi-factorial with the performance improvement initiative of the SG playing a role. Understanding the rate and ultimate risk factors for readmission and complications from big data sources has the potential to further drive quality improvement. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jennifer M Bauer
- Dept. of Orthopaedic Surgery, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattel, WA, 98105, USA.
| | - Suken A Shah
- Nemours/AI duPont Hospital for Children, Wilmington, USA
| | | | - Amer F Samdani
- Philadelphia Shriners Hospital for Children, Philadelphia, USA
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Wu AM, Cheung JPY, Cheung KMC, Lin JL, Jin HM, Chen D, Wang XY, Zhao J, Kwan KYH. Minimum 2-Year Experience with Magnetically Controlled Growing Rods for the Treatment of Early-Onset Scoliosis: A Systematic Review. Asian Spine J 2019; 13:682-693. [PMID: 30909674 PMCID: PMC6680029 DOI: 10.31616/asj.2018.0272] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/20/2018] [Accepted: 12/13/2018] [Indexed: 12/23/2022] Open
Abstract
Magnetically controlled growing rods have been used to treat early-onset scoliosis for the last 9 years; however, few studies have been published, with only short-term follow-up. The aim of the present study is to systematically review the outcomes of magnetically controlled growing rods in the treatment of early-onset scoliosis with a minimum of 2-year follow-up. Studies were included if patients with early-onset scoliosis (scoliosis diagnosed before 10 years of age) underwent implantation of magnetically controlled growing rods with a minimum of 2-year follow-up. The literature review and data extraction followed the established preferred reporting items for systematic review and meta-analysis guidelines. Data of distraction frequency, number of distractions, distracted length, Cobb angle, kyphosis, T1-T12 length, and T1-S1 length preoperatively, postoperatively, and at final follow-up were collected. Data regarding complications and unplanned reoperations were also extracted. The mean values of these parameters were calculated, or pooled meta-analysis was performed if available. Ten articles were included in this systematic review, with a total of 116 patients and a follow-up period between 23 and 61 months. The mean preoperative Cobb angle and kyphosis angle were 60.1° and 38.0°, respectively, and improved to 35.4° and 26.1° postoperatively. At final follow-up, the Cobb and kyphosis angles were maintained at 36.9° and 36.0°, respectively. The average preoperative T1-T12 and T1-S1 lengths were 180.6 mm and 293.6 mm, respectively, and increased to 198.3 mm and 320.3 mm postoperatively. T1-T12 and T1-S1 lengths were 212.3 mm and 339.3 mm at final follow-up, respectively. The overall rate of patients with complications was 48% (95% confidence interval [CI], 0.38-0.58) and unplanned reoperation 44% (95% CI, 0.33-0.55) after sensitivity analysis. The current evidence from different countries with a minimum of a 2-year follow-up suggests that magnetically controlled growing rods are an effective technique to treat pediatric scoliosis and promote spine growth. However, nearly half of patients still developed complications or required unplanned reoperations.
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Affiliation(s)
- Ai-Min Wu
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
- Department of Orthopaedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Kenneth Man Chee Cheung
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
| | - Jia-Liang Lin
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Hai-Ming Jin
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Dong Chen
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Xiang-Yang Wang
- Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Jie Zhao
- Department of Orthopaedics, Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai, China
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR
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Du JY, Poe-Kochert C, Thompson GH, Son-Hing JP, Hardesty CK, Mistovich RJ. Risk Factors for Early Infection in Pediatric Spinal Deformity Surgery: A Multivariate Analysis. Spine Deform 2019; 7:410-416. [PMID: 31053311 DOI: 10.1016/j.jspd.2018.09.011] [Citation(s) in RCA: 9] [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: 04/30/2018] [Revised: 09/11/2018] [Accepted: 09/15/2018] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES To identify risk factors for early deep surgical site infections (SSIs; within three months of index procedure) following pediatric spinal deformity surgery. BACKGROUND Deep surgical site infections (SSIs) following pediatric spinal deformity surgery are a source of significant morbidity. We sought to identify independent risk factors for early infection following primary, definitive single-stage pediatric posterior spinal fusion and instrumentation (PSFI). METHODS A total of 616 consecutive patients (2001-2016) from an institutional prospectively maintained Pediatric Orthopaedic Spine database were identified that met inclusion criteria of definitive single-stage PSFI. Early deep SSI was defined as infection within three months of index procedure requiring surgical intervention. A multivariate analysis of demographics, comorbidities, and perioperative factors was performed and independent risk factors were identified. RESULTS Eleven patients (1.6%) developed an early deep SSI. Independent risk factors for SSI identified were nonidiopathic (neuromuscular, syndromic, and congenital) etiologies of scoliosis (adjusted odds ratio [aOR]: 8.384, 95% confidence interval [CI]: 1.784-39.386, p = .007) and amount of intraoperative crystalloids (aOR: 1.547 per additional liter of fluid, 95% CI: 1.057-2.263, p = .025). Mean crystalloid administered in the SSI group was 3.3 ± 1.2 L versus 2.4 ± 1.0 L in the noninfected group (p = .019). On univariate analysis, there was no significant difference in weight of patients between cohorts (p = .869) or surgery time (p = .089). There was also no significant difference in infection rates from redosing of antibiotics intraoperatively after 3 hours of surgery (p = .231). CONCLUSIONS Nonidiopathic scoliosis and amount of intraoperative crystalloids were independently associated with early postoperative SSI. Further investigation into intraoperative fluid management may identify modifiable risk factors for early postoperative SSI in primary pediatric spinal deformity posterior spinal fusion patients. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Jerry Y Du
- Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA.
| | - Connie Poe-Kochert
- Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
| | - George H Thompson
- Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
| | - Jochen P Son-Hing
- Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
| | - Christina K Hardesty
- Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
| | - R Justin Mistovich
- Division of Pediatric Orthopaedics, Rainbow Babies & Children's Hospitals/University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
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Hardesty CK, Huang RP, El-Hawary R, Samdani A, Hermida PB, Bas T, Balioğlu MB, Gurd D, Pawelek J, McCarthy R, Zhu F, Luhmann S. Early-Onset Scoliosis: Updated Treatment Techniques and Results. Spine Deform 2019; 6:467-472. [PMID: 29886921 DOI: 10.1016/j.jspd.2017.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 08/09/2017] [Revised: 12/22/2017] [Accepted: 12/25/2017] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN This is a review of the current literature on early-onset scoliosis (EOS) techniques and treatment written by the Growing Spine Committee of the Scoliosis Research Society. OBJECTIVES The Growing Spine Committee of the Scoliosis Research Society sought to update the information available on the definition and treatment of EOS, including new information about existing techniques. SUMMARY OF BACKGROUND DATA EOS represents a diverse, heterogeneous, and clinically challenging group of spinal disorders occurring in children under the age of 10. Our understanding of EOS has changed dramatically in the last 15 years, and management of EOS has changed even more rapidly in the last five years. METHODS The Growing Spine Committee of the Scoliosis Research Society has embarked upon a review of the most current literature on EOS techniques and treatment. RESULTS This white paper provides recent updates on current techniques, including a summary of new modalities, indications, contraindications, and clinical results. CONCLUSIONS Although treatment of EOS is still challenging and complicated, the evolution of options and knowledge presents hope for better understanding and management in the future. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Christina K Hardesty
- Rainbow Babies and Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, RBC 6081, Cleveland, OH 44106, USA.
| | - Robert P Huang
- Studer Family Children's Hospital Scoliosis and Pediatric Orthopaedic Surgery, 4541 N. Davis Highway, Suite A, Pensacola, FL 32503, USA
| | - Ron El-Hawary
- IWK Heath Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Amer Samdani
- Shriners Hospitals for Children, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - Paloma Bas Hermida
- Hospital Universitario y Politecnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Teresa Bas
- Hospital Universitario y Politecnico La Fe, Avinguda de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Mehmet Bülent Balioğlu
- Department of Orthopaedics, Istinye University Liv Hospital, Asik Veysel mah. Suleyman Demirel Cad. No:1 34510, Esenyurt, Istanbul, Turkey
| | - David Gurd
- San Diego Diego Spine Foundation, 6190 Cornerstone Ct East, Ste 212, San Diego, CA 92121, USA
| | - Jeff Pawelek
- Cleveland Clinic Children's Hospital, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Richard McCarthy
- Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA
| | - Feng Zhu
- Chinese University of Hong Kong, Sino Building, Chung Chi Rd, Sha Tin, Hong Kong, China
| | - Scott Luhmann
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
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Tsirikos AI, Loughenbury PR. Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes. World J Orthop 2018; 9:138-148. [PMID: 30254970 PMCID: PMC6153132 DOI: 10.5312/wjo.v9.i9.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/09/2018] [Revised: 03/16/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.
METHODS This study was a prospective single surgeon series. Patients were treated with single rod hybrid constructs and had a minimum 2-year follow-up. Indications included complex underlying co-morbidities, conversion of growing rods to definitive fusion, and moderate adolescent idiopathic primarily thoracic scoliosis with severe eczema and low body mass index (BMI).
RESULTS We included 99 consecutive patients. Mean age at surgery was 12.8 years (SD 3.5 years). Mean scoliosis correction was 62% (SD 15%) from 73° (SD 22°) to 28° (SD 15°). Mean surgical time was 153 min (SD 34 min), and blood loss was 530 mL (SD 327 mL); 20% BV (SD 13%). Mean clinical and radiological follow-up was 3.2 years (range: 2-12) post-operatively. Complications included rod failure, which occurred in three of our complex patients with severe syndromic or congenital kyphoscoliosis (3%). Only one of these three patients required revision surgery to address a non-union. Our revision rate was 2% (including a distal junctional kyphosis in a Marfan’s syndrome patient).
CONCLUSION The single rod technique has achieved satisfactory deformity correction and a low rate of complications in patients with specific indications and severe underlying medical conditions. In these children with significant co-morbidities, where the risks of scoliosis surgery are significantly increased, this technique has achieved low operative time, blood loss, and associated surgical morbidity.
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Affiliation(s)
- Athanasios I Tsirikos
- Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
| | - Peter R Loughenbury
- Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh EH9 1LF, United Kingdom
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Pourtaheri S, Miller F, Dabney K, Shah SA, Dubowy S, Holmes L. Deep Wound Infections After Pediatric Scoliosis Surgery. Spine Deform 2015; 3:533-540. [PMID: 27927555 DOI: 10.1016/j.jspd.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 08/06/2014] [Revised: 03/31/2015] [Accepted: 04/09/2015] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective clinical and radiographic review. OBJECTIVE The purpose of this study was to evaluate the characteristics of deep wound infection, as well as the potential factors that correlate to surgical site infection (SSI) in spine deformity surgery. SUMMARY OF BACKGROUND DATA Preventing SSIs in pediatric spinal deformity surgery is a crucial task. Recent data have shown that antibiotic-loaded allograft and properly timed preoperative antibiotic administration decrease SSIs. However, there remain controversies over the appropriate preoperative antibiotic selection. METHODS We reviewed 851 spinal deformity surgeries that took place at a single institution from 2006 to 2010. In particular, preoperative and postoperative characteristics of the deep wound infections were evaluated. RESULTS Twenty-four patients had SSIs. The mean age at surgery in the infected cohort was 14 years, mean length of surgery was 8 hours, and median estimated blood loss was 2,482 mL (%EBV: 66%). Approximately 67% of the infected patients had bowel/bladder incontinence, and 71% had prolonged intravenous access perioperatively. According to culture results, the most effective antibiotic to treat the infections was vancomycin. Preoperative antibiotics were administered within 30 minutes of incision (hospital protocol) in only 12.5% (p = .001) and within 1 hour of incision in 54% of the cases. The wound status within 3 days of surgery is as follows: 38% intact, 29% significant wound drainage, and 33% wound dehiscence. Methicillin-resistant Staphylococcus aureus (MRSA) and oxacillin-resistant Staphylococcus epidermidis were associated with intact wounds, whereas gram-negative pathogens were seen in dehisced or draining wounds (p < .001). CONCLUSIONS The authors showed that their cohort of patients with infection had a high rate of draining wounds, MRSA infections, administration of antibiotics more than 1 hour ahead of incision, and prolonged need for intravenous access after surgery. Efforts to mitigate these associations by using vancomycin prophylactically, doing meticulous wound closure to prevent drainage or dehiscence, and delivering antibiotics at an optimal time ahead of incision may lead to a decrease in infection rates in pediatric spinal surgery. Future prospective studies will be needed to validate this.
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Affiliation(s)
- Sina Pourtaheri
- Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA
| | - Freeman Miller
- Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA.
| | - Kirk Dabney
- Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA
| | - Suken A Shah
- Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA
| | - Susan Dubowy
- Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA
| | - Laurens Holmes
- Department of Orthopaedics, Nemours/Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899, USA
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