Intraoperative traction in neuromuscular scoliosis surgery improves major curve correction when fusing to L5

Object Appreciation of the optimal management of skeletally mature patients with spinal deformities requires understanding of the natural history of the disease relative to expected outcomes of surgical intervention. Appropriate outcome measures are necessary to define the surgical treatment. Unfortunately, the literature lacks prospective randomized data. The majority of published series report outcomes of a particular surgical approach, procedure, or surgeon. The purpose of the current study was to systematically review the present spine deformity literature and assess the available data on clinical and radiographic outcome measurements. Methods A systematic review of MEDLINE and PubMed databases was performed to identify articles published from 1950 to the present using the following key words: “adult scoliosis surgery,” “adult spine deformity surgery,” “outcomes,” and “complications.” Exclusion criteria included follow-up shorter than 2 years and mean patient age younger than 18 years. Data on major curve (coronal scoliosis or lumbar lordosis Cobb angle as reported), major curve correction, Oswestry Disability Index (ODI) scores, Scoliosis Research Society (SRS) instrument scores, complications, and pseudarthroses were recorded. Results Forty-nine articles were obtained and included in this review; 3299 patient data points were analyzed. The mean age was 47.7 years, and the mean follow-up period was 3.6 years. The average major curve correction was 26.6° (for 2188 patients); for 2129 patients, it was possible to calculate average curve reduction as a percentage (40.7%). The mean total ODI was 41.2 (for 1289 patients), and the mean postoperative reduction in ODI was 15.7 (for 911 patients). The mean SRS-30 equivalent score was 97.1 (for 1700 patients) with a mean postoperative decrease of 23.1 (for 999 patients). There were 897 reported complications for 2175 patients (41.2%) and 319 pseudarthroses for 2469 patients (12.9%). Conclusions Surgery for adult scoliosis is associated with improvement in radiographic and clinical outcomes at a minimum 2-year follow-up. Perioperative morbidity includes an approximately 13% risk of pseudarthrosis and a greater than 40% incidence of perioperative adverse events. Incidence of perioperative complications is substantial and must be considered when deciding optimal disease management. Although the quality of published studies in this area has improved, particularly in the last few years, the current review highlights the lack of routine use of standardized outcomes measures and assessment in the adult scoliosis literature.

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Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz306 ◽

2019 ◽

Vol 19 (2) ◽

pp. E163-E164 ◽

Cited By ~ 1

Author(s):

Thomas J Buell ◽

Avery L Buchholz ◽

Marcus D Mazur ◽

Jeffrey P Mullin ◽

Ching-Jen Chen ◽

...

Keyword(s):

Functional Outcomes ◽

Adult Scoliosis ◽

Scoliosis Surgery ◽

Major Curve ◽

Coronal Imbalance ◽

Medical Publication ◽

Alignment Correction ◽

Iliac Screw ◽

Coronal Malalignment ◽

The Impact

Abstract Restoration of spinal alignment and balance is a major goal of adult scoliosis surgery. In the past, sagittal alignment has been emphasized and was shown to have the greatest impact on functional outcomes. However, recent evidence suggests the impact of coronal imbalance on pain and functional outcomes has likely been underestimated.1,2 In addition, iatrogenic coronal imbalance may be common and frequently results from inadequate correction of the lumbosacral fractional curve.2,3 The “kickstand rod” is a recently described technique to achieve and maintain significant coronal-plane correction.4 Also, of secondary benefit, the kickstand rod may function as an accessory supplemental rod to offload stress and bolster primary instrumentation. This may reduce occurrence of rod fracture (RF) or pseudarthrosis (PA).5 Briefly, this technique involves positioning the kickstand rod on the side of coronal imbalance (along the major curve concavity or fractional curve convexity in our video demonstration). The kickstand rod spans the thoracolumbar junction proximally to the pelvis distally and is secured with an additional iliac screw placed just superior to the primary iliac screw. By using the iliac wing as a base, powerful distraction forces can reduce the major curve to achieve more normal coronal balance. This operative video illustrates the technical nuances of utilizing the kickstand rod technique for correction of severe lumbar scoliosis and coronal malalignment in a 60-yr-old male patient. Alignment correction was achieved and maintained without evidence of RF/PA after nearly 6 mo postoperatively. The patient gave informed consent for surgery and to use imaging for medical publication.

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Does nutrition consultation in the year leading up to neuromuscular scoliosis surgery result in significant weight gain, or just a larger magnitude curve?

Spine Deformity ◽

10.1007/s43390-021-00401-8 ◽

2021 ◽

Author(s):

Ariana T. Meltzer-Bruhn ◽

Matthew R. Landrum ◽

David A. Spiegel ◽

Patrick J. Cahill ◽

Jason B. Anari ◽

...

Keyword(s):

Weight Gain ◽

Neuromuscular Scoliosis ◽

Scoliosis Surgery ◽

Significant Weight Gain

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Mycoplasma hominis deep wound infection after neuromuscular scoliosis surgery: the use of real-time polymerase chain reaction (PCR)

European Spine Journal ◽

10.1007/s00586-005-0055-y ◽

2006 ◽

Vol 15 (S5) ◽

pp. 599-603 ◽

Cited By ~ 11

Author(s):

Matthijs R. Krijnen ◽

Thecla Hekker ◽

Johan Algra ◽

Paul I. J. M. Wuisman ◽

Barend J. Van Royen

Keyword(s):

Polymerase Chain Reaction ◽

Wound Infection ◽

Real Time ◽

Mycoplasma Hominis ◽

Neuromuscular Scoliosis ◽

Scoliosis Surgery ◽

Chain Reaction ◽

Deep Wound Infection ◽

Deep Wound ◽

Polymerase Chain

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Funcionalidad y calidad de vida luego de la cirugía de escoliosis neuromuscular. [Functionality and quality of life after neuromuscular scoliosis surgery.]

Revista de la Asociación Argentina de Ortopedia y Traumatología ◽

10.15417/issn.1852-7434.2018.83.2.804 ◽

2018 ◽

Vol 83 (2) ◽

pp. 101

Author(s):

Patricia Carolina Curbelo Nova ◽

Claudio Silveri ◽

Alejandro Cuneo ◽

Rodrigo Olivera

Keyword(s):

Quality Of Life ◽

Social Life ◽

Case Series ◽

Neuromuscular Scoliosis ◽

Scoliosis Surgery ◽

Retrospective Case ◽

Calidad De Vida ◽

Case Series Study ◽

Degree Of Satisfaction

ObjetivoEl objetivo de nuestro trabajo es estudiar las complicaciones de la cirugía en las escoliosis neuromusculares operadas en nuestro centro, así como la funcionalidad y calidad de vida de los pacientes luego del tratamiento quirúrgico.MétodosSe realizó un estudio retrospectivo, tipo serie de casos. Se revisó la historia clínica y se entrevistó a paciente y cuidador principal. Se valoró los resultados luego de la cirugía en cuanto a las complicaciones, funcionabilidad, calidad de vida y grado de satisfacción de los cuidadores.ResultadosObtuvimos un 26,7% de complicaciones, debidas a infección y alteraciones hemodinámicas. En cuanto a la funcionabilidad y calidad de vida de estos pacientes obtuvimos resultados positivos, siendo más significativos en cuanto a la capacidad de estar sentado y las actividades de la vida diaria.ConclusionesLa cirugía de los pacientes con escoliosis neuromuscular mejora la capacidad y el equilibrio de estar sentado, favoreciendo con esto la capacidad digestiva, respiratoria y de vida social del paciente. Si bien se trata de cirugías con altos indices de complicaciones muestra indices elevados de satisfacción por parte de los cuidadores. Abstract Introduction: The objective of this study was to evaluate surgical complications in patients with scoliosis operated on in our Center, as well as their functionality and quality of life after surgical treatment. Methods: A retrospective case series study was carried out. Medical history was reviewed and the patient and primary caregiver were interviewed. Results after surgery were assessed for complications, function, quality of life and caregivers´ degree of satisfaction. Results: Complication rate was 26.7%, due to infection and hemodynamic alterations. Positive results were obtained regarding function and quality of life of these patients, being more significant in terms of the ability to be seated and activities of daily living. Conclusions: Surgery of patients with neuromuscular scoliosis improves the capacity and balance of sitting, favoring digestive, respiratory and social life capacity. Although rate of complications is high, satisfaction rates on the part of the caregivers are elevated.

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Influence of curve morphology and location on the efficacy of rigid conservative treatment in patients with adolescent idiopathic scoliosis

The Bone & Joint Journal ◽

10.1302/0301-620x.103b2.bjj-2020-1113.r2 ◽

2021 ◽

Vol 103-B (2) ◽

pp. 373-381

Author(s):

Patrick Strube ◽

Maria Gunold ◽

Tanja Müller ◽

Mario Leimert ◽

André Sachse ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Conservative Treatment ◽

Idiopathic Scoliosis ◽

Treatment Failure ◽

Univariate Analysis ◽

Curve Progression ◽

Curve Correction ◽

Major Curve ◽

Apical Rotation ◽

Curve Magnitude

Aims The aim of the present study was to answer the question whether curve morphology and location have an influence on rigid conservative treatment in patients with adolescent idiopathic scoliosis (AIS). Methods We retrospectively analyzed AIS in 127 patients with single and double curves who had been treated with a Chêneau brace and physiotherapeutic specific exercises (B-PSE). The inclusion criteria were the presence of structural major curves ≥ 20° and < 50° (Risser stage 0 to 2) at the time when B-PSE was initiated. The patients were divided into two groups according to the outcome of treatment: failure (curve progression to ≥ 45° or surgery) and success (curve progression < 45° and no surgery). The main curve type (MCT), curve magnitude, and length (overall, above and below the apex), apical rotation, initial curve correction, flexibility, and derotation by the brace were compared between the two groups. Results In univariate analysis treatment failure depended significantly on: 1) MCT (p = 0.008); 2) the apical rotation of the major curve before (p = 0.007) and during brace treatment (p < 0.001); 3) the initial and in-brace Cobb angles of the major (p = 0.001 and p < 0.001, respectively) and minor curves (p = 0.015 and p = 0.002); 4) major curve flexibility (p = 0.005) and the in-brace curve correction rates (major p = 0.008, minor p = 0.034); and 5) the length of the major curve (LoC) above (p < 0.001) and below (p = 0.002) the apex. Furthermore, MCT (p = 0.043, p = 0.129, and p = 0.017 in MCT comparisons), LoC (upper length p = 0.003, lower length p = 0.005), and in-brace Cobb angles (major p = 0.002, minor p = 0.027) were significant in binary logistic regression analysis. Conclusion Curve size, location, and morphology were found to influence the outcome of rigid conservative treatment of AIS. These findings may improve future brace design and patient selection for conservative treatment. Cite this article: Bone Joint J 2021;103-B(2):373–381.

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Efficacy of Routine Intraoperative Cranio-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves Measuring Between 50° and 90°

Global Spine Journal ◽

10.1177/21925682211052969 ◽

2021 ◽

pp. 219256822110529

Author(s):

Jacob R. Carl ◽

Gurpal Pannu ◽

Evan Cherng-Yeh Chua ◽

Adam Bacon ◽

Blythe Durbin-Johnson ◽

...

Keyword(s):

Surgical Treatment ◽

Adolescent Idiopathic Scoliosis ◽

Blood Loss ◽

Idiopathic Scoliosis ◽

Revision Surgery ◽

Operative Time ◽

Curve Correction ◽

Major Curve ◽

Estimated Blood Loss ◽

Retrospective Comparative Study

Study Design Retrospective Comparative Study, Level III. Objective In patients with scoliosis >90°, cranio-femoral traction (CFT) has been shown to obtain comparable curve correction with decreased operative time and blood loss. Routine intraoperative CFT use in the treatment of AIS <90° has not been established definitively. This study investigates the effectiveness of intraoperative CFT in the treatment of AIS between 50° and 90°, comparing the magnitude of curve correction, blood loss, operative time, and traction-related complications with and without CFT. Methods 73 patients with curves less than 90° were identified, 36 without and 37 with cranio-femoral traction. Neuromuscular scoliosis and revision surgery were excluded. Age, preoperative Cobb angles, bending angles, and curve types were recorded. Surgical characteristics were analyzed including number of levels fused, estimated blood loss, operative time, major curve correction (%), and degree of postoperative kyphosis. Results Patients with traction had significantly higher preoperative major curves but no difference in age or flexibility. Lenke 1 curves had significantly shorter operative time and improvement in curve correction with traction. Among subjects with 5 to 8 levels fused, subjects with traction had significantly less EBL. Operative time was significantly shorter for subjects with 5-8 levels and 9-11 levels fused. Curves measuring 50°-75° showed improved correction with traction. Conclusion Intraoperative traction resulted in shorter intraoperative time and greater correction of major curves during surgical treatment of adolescent idiopathic scoliosis less than 90°. Strong considerations should be given to use of intraoperative CFT for moderate AIS.

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Fatal Cerebral Swelling Associated with Scoliosis Surgery in Two Patients with Neuromuscular Scoliosis and Congenital Hydrocephalus

JBJS Case Connector ◽

10.2106/jbjs.cc.k.00087 ◽

2012 ◽

Vol 2 (2) ◽

pp. e23

Author(s):

Meghan A. Kirksey ◽

Paul S. Issack ◽

Chris R. Edmonds ◽

Mark M. Souweidane ◽

Andrew Lee ◽

...

Keyword(s):

Neuromuscular Scoliosis ◽

Congenital Hydrocephalus ◽

Scoliosis Surgery

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The correlations between the anchor density and the curve correction of adolescent idiopathic scoliosis surgery

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2844-1 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Yu-Cheng Yeh ◽

Chi-Chien Niu ◽

Lih-Huei Chen ◽

Wen-Jer Chen ◽

Po-Liang Lai

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Thoracic Kyphosis ◽

Three Dimensional ◽

High Density ◽

Scoliosis Surgery ◽

Low Density ◽

Curve Correction ◽

Kyphosis Correction ◽

Positive Correlations

Abstract Background The optimal anchor density in adolescent idiopathic scoliosis (AIS) surgery to achieve good curve correction remains unclear. The purpose of the study is to analyze the correlations between three-dimensional curve correction and anchor density in the pedicle screw-based posterior fusion of AIS. Methods One hundred and twenty-seven AIS patients receiving primary posterior fusion with pedicle screw instrumentation were retrospectively reviewed. Anchor density (AD) was defined as the screws number per fused spinal segment. The correlations between three-dimensional curve correction radiographic parameters and anchor density were analyzed with subgroup analysis based on different curve types, curve magnitudes, and curve flexibilities. The differences of curve correction parameters between the low-density (AD ≤1.4), middle-density (1.4 < AD ≤1.7) and high-density (AD > 1.7) groups were also calculated. Independent t-test, analysis of variance (ANOVA), and Pearson’s correlation coefficient were used for statistical analysis. Results There were no correlations between the anchor density and the coronal curve correction or apical vertebral rotation (AVR) correction. In the sagittal plane, mild positive correlations existed between anchor density and thoracic kyphosis correction in all patients (r = 0.27, p = 0.002). Subgroup analysis revealed similar mild positive correlations in Lenke 1 (r = 0.31, p = 0.02), Lenke 1–3 (r = 0.27, p = 0.01), small curves (40°-60°, r = 0.38, p < 0.001), and flexible curves (flexibility > 40%, r = 0.34, p = 0.01). There were no differences between low-density (mean 1.31), middle-density (mean 1.55), and high-density (mean 1.83) in terms of coronal or axial curve correction parameters. Low-density group has longer fused level (mean difference 2.14, p = 0.001) and smaller thoracic kyphosis correction (mean difference 9.25°, p = 0.004) than high-density group. Conclusion In our study, the anchor density was not related to coronal or axial curve corrections. Mild positive correlations with anchor density were found in thoracic kyphosis correction, especially in patients with smaller and flexible curves. Low anchor density with longer fusion level achieves similar curve corrections with middle or high anchor density in adolescent idiopathic scoliosis surgery.

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Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis

BioMed Research International ◽

10.1155/2015/481945 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Vishal Sarwahi ◽

Terry Amaral ◽

Stephen Wendolowski ◽

Rachel Gecelter ◽

Melanie Gambassi ◽

...

Keyword(s):

Minimally Invasive ◽

Operative Time ◽

Standard Procedure ◽

Pedicle Screws ◽

Neuromuscular Scoliosis ◽

Long Term Results ◽

Scoliosis Surgery ◽

Short Term ◽

Pelvic Fixation

Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

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