Correction Of Scoliosis In Children Research Articles

Use of neuronavigation technologies for severe forms of scoliosis in children

Background. The method of choice for surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Its use is associated with inherent difficulties and risks, often associated with malposition of supporting elements, as well as the risk of complications. The incidence of neurological complications during surgical correction of scoliosis can reach 7%. High risks, including irreversible complications, of surgical correction of scoliosis dictate the need to introduce modern safety methods, including O-arm navigation and intraoperative neuromonitoring (IONM). Aim. Increasing the effectiveness and safety of surgical correction of scoliosis in children using O-arm navigation and IONM. Materials and methods. 136 patients operated on for scoliosis were observed. The patients were divided into 2 groups: group 1 included patients operated on using the “free-hand” technology (a total of 609 screws were analyzed in 30 patients); group 2 included patients operated on using O-arm navigation and IONM (524 screws in 25 patients). The average Cobb angle of deformation was 66.9±28.1° in group I and 82.4±25.8° in group 2. Malpositions were assessed using the classification of G. Rao et al. (2002), and an analysis of neurological complications was also carried out in 69 patients in group 1, and in 67 patients in group 2. Results. In group 1, the overall incidence of malpositions was 27.3% (166 out of 609 screws). In group 2, it was 10.5% (55 out of 524 screws). In group 1, the frequency of grade 1 malpositions was 3.9% (24 out of 609), grade 2 – 11.8% (72 out of 609), grade 3 – 11.5% (70 out of 609). In 2: grade 1 occurred in 4.2% of cases (22 out of 524), grade 2 – 3.4% (18 out of 524), and grade 3 – 2.9% (15 out of 524). The frequency of medial malpositions in the first group was 7.6% (46 out of 609), in the second group – 2.7% (14 out of 524). Lateral malpositions in the group 1 were 11.7% (71 out of 609), in the group 2 – 4.4% (24 out of 524). Anterior malpositions in group 1 – 8.05% (49 out of 609), in group 2 – 3.2% (17 out of 524). In group 1 there were 3 cases of neurological complications – 4.3%, in group 2 – in 1 case – 1.4%. Conclusion. O-arm navigation and IONM made it possible to reduce the frequency of malpositions, and there was also a tendency to reduce the number of neurological complications in the group of patients where IONM and O-arm navigation were used.

Ensuring the safety of surgical correction of scoliosis in children using neuromonitoring and O-arm navigation

Severe multiplanar spinal deformities of various etiologies are accompanied by disorders of the organ systems, causing early disability and reduced life expectancy of patients, which, in turn, dictates the need for surgical correction. The method of choice for the surgical correction of scoliosis is the technology of three-dimensional polysegmental fixation according to Cotrel–Dubousset. Despite the advantages of this spinal stabilization technology, it has its own specific difficulties and risks of various complications, most often associated with malposition of the supporting elements. To reduce the number of complications associated with the surgical correction of scoliosis, methods have been developed, including intraoperative neuromonitoring and O-arm navigation, the effectiveness of which will be discussed in this article.

Surgical Correction of Scoliosis in Children with Severe Congenital Heart Disease and Palliated Single Ventricle Physiology.

Case series. In this study we focus on this group, and describe the largest cohort to date of single ventricle patients undergoing surgical correction of scoliosis at a single institution. Outcomes of spinal surgery for patients with congenital heart disease (CHD) have evolved and most affected patients have uncomplicated procedures. The risk of perioperative complications remains highest in patients with single ventricle ("Fontan") physiology. We reviewed patients with single ventricle CHD and operative scoliosis repair over a 25-year span. Patients who had undergone a Fontan, bidirectional Glenn, and/or Kawashima procedure before operative scoliosis repair were included. Patients were excluded if they lacked preoperative cardiac care and/or sufficient medical history at our institution. Twenty-three patients were included. The average age at surgery was 13.6 years (range, 5-23). Seventy percent of the cohort was female (16/23). The majority of patients underwent a Fontan before scoliosis surgery (20/23, 87%). Patients without intraoperative tranexamic acid (TXA) had a 67% complication rate (8/12) versus 36% (4/11) in those with intraoperative TXA (P = 0.29). There was a significant difference in estimated blood loss by weight (cc/kg) between non-TXA and TXA patients (P = 0.016). Twelve patients experienced complications (52%), all of which occurred postoperatively. There were no deaths, cerebrovascular events, adverse perioperative cardiac or hemodynamic complications, or wound infections. Using the Clavien-Dindo-Sink classification for postoperative complications, four patients had serious adverse events, including one permanent neurologic deficit. Spinal surgery for scoliosis has been performed in selected patients with single ventricle physiology at a single institution without mortality for 25 years. Operative blood loss may be reduced by routine use of TXA. Complications occur most commonly in the postoperative period, and can include pleural effusion.Level of Evidence: 4.

Surgical correction of scoliosis in children with spastic quadriplegia: benefits, adverse effects, and patient selection.

Study Rationale Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. Objectives The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. Materials and Methods A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. Results A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9−70.9%), mortality (range, 2.8−19%), respiratory/pulmonary complications (range, 26.9−57.1%), and infection (range, 2.5−56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. Conclusion Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.

CORRECTION OF IDIOPATHIC SCOLIOSIS UNDER 3D-CT NAVIGATION IN CHILDREN

Objective. To analyze results of surgical correction of thoracic idiopathic scoliosis in children using the system of active optical 3D-CT navigation and preoperative CT images with anatomical landmark-based registration. Material and Methods. Eighteen patients aged 15 to 17 years (14 girls and 4 boys) with thoracic idiopathic scoliosis were operated on. The Cobb angle of the primary curvature ranged from 55 to 90 degrees. The surgery was performed through a posterior approach with simultaneous halo-tibial traction using multi-anchoring metal device with pedicle screws. Canals for screw insertion were formed under 3D-CT navigation control in accordance with preoperative planning. Results. The extension of fixation for thoracic type of deformity varied between 10 and 13 vertebrae (from T2 to L4). The number of pedicle screws per patient ranged from 19 to 26 (average 24 screws). Thus, 429 screws were placed in 18 patients: 305 in thoracic spine and 124 in the lumbar spine. Postoperative correction of the coronal plane deformity ranged from 92 % to 99 %, and derotational correction of the apical vertebra - from 72 % to 94 %. Conclusion. Intraoperative optical 3D-CT navigation with the processing of preoperative CT images and registration based on anatomical landmarks ensures the accuracy of pedicle screws placement, which allows using this type of correction devices even for severe thoracic deformities. Hir. Pozvonoc. 2012;(2):30-36.

Surgical correction of scoliosis in children with congenital heart failure (Fontan circulation): case report and literature review

Patients with Fontan circulation represent a significant cardiorespiratory risk during spinal surgery. We report about two patients with severe scoliosis and Fontan circulation and their successful operative treatment. The case report will be compared with the national and international literature.

Anaesthesia for Correction of Scoliosis in Children

Surgical correction of spinal deformities in children presents a challenge to the anaesthetist because of the extensive nature of the surgery, the co-morbidities of the patients and the constraints on anaesthetic techniques of intraoperative neurophysiological monitoring of the spinal cord. Adolescent idiopathic scoliosis is the most common deformity. Patients with scoliosis secondary to neuromuscular conditions are at greatest risk of perioperative problems, particularly excessive blood loss and respiratory failure. The risk of spinal cord damage can be decreased by the use of intraoperative spinal cord monitoring, particularly monitoring of the lower limb compound muscle action potential evoked by transcranial electrical stimulation. Specific anaesthetic techniques are required for this monitoring to be reliable. Because of concerns about spinal cord perfusion there is now less reliance on induced hypotension and haemodilution to reduce blood loss, with emphasis on proper patient positioning, controlled haemodynamics and antifibrinolytic therapy. Effective postoperative pain management requires a multimodal approach.

Evaluation of the efficacy of a forced-air warmer (bair hugger) during spinal surgery in children

To evaluate the efficacy of a forced-air warmer during spinal surgery for correction of scoliosis in children. Prospective randomized study (group allocation based on the availability of the warming device). Children's teaching hospital. 51 ASA physical status I and II children (mean age, 15 years; mean weight, 45 kg) scheduled for posterior spinal fusion with general anesthesia. Study group (warmed; n = 26)--legs covered with the forced-air warmer (Bair Hugger, Augustine Medical, Inc., Eden Prairie, MN) after installation of the patient in prone position--versus control group (n = 25)--400W heat lamp placed over the head during surgery as is usually done in our institution. Rectal temperature was taken every 15 minutes during surgery and during the first 2 hours in the recovery room. Time required for the wake-up test, time to extubation, and blood loss also were noted. Temperature profiles were very different in the 2 groups. In the control group, rectal temperature decreased during the first 180 minutes to a minimum of 34.8 degrees C +/- 0.6 degrees C, followed by a slow rewarming phase. In the warmed group, the lowest temperature (35.6 degrees C +/- 0.5 degrees C) was recorded 45 minutes after placement of the forced-air warmer, followed by an effective warming phase. At the end of surgery, temperature was significantly higher in the warmed group than in the control group (36.5 degrees C +/- 0.8 degrees C vs. 35.4 degrees C +/- 0.9 degrees C). However, time required for the wake-up test, time to extubation, and blood loss did not differ between groups. The forced-air warmer (Bair Hugger) is effective during spinal surgery, although only about 20% of body surface area can be covered.

Pathogenesis of postoperative hyponatraemia following correction of scoliosis in children.

Eight paediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium, renin and aldosterone, and urine volume, sodium and osmolality were measured. These patients had an impaired ability to excrete a sodium-free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h postoperation are considered, the sodium-free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P less than 0.01). To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema, it is recommended that no more than 50 ml/kg sodium-free water be given until urine sodium falls and volume increases.