Pediatric Spinal Deformity Surgery Research Articles

The incidence and risk factors for short-term morbidity and mortality in pediatric deformity spinal surgery: an analysis of the NSQIP pediatric database.

Retrospective review of a prospective cohort. To determine the incidence and risk factors for 30-day morbidity and mortality after pediatric deformity spinal surgery. Pediatric deformity spinal surgery is generally considered a safe and effective treatment option. The rising costs associated with spinal surgery and related perioperative complications have received national attention. Few studies with standardized definitions and data collection methods exist. A large, multicenter clinical registry specifically designed to collect pediatric surgical outcomes was queried for all patients undergoing spinal deformity surgery in 2012. Current Procedural Terminology codes were used to select patients undergoing anterior, posterior, and combined fusions. Detailed patient and case characteristics were analyzed. Thirty-day morbidity and mortality rates were calculated. Univariate and multivariate logistic regression analyses were used to identify patient characteristics, comorbidities, and operative variables predictive of complication. In total, 2005 pediatric patients undergoing deformity spinal fusion were included. The rate of 30-day complications was 10.0%; with a mortality rate of 0.15% (3 patients), a morbidity rate of 8.4%, reoperation rate of 3.74%, and readmission rate of 3.94%. The morbidity rate was highest in the neuromuscular group (13.09%) and lowest in the idiopathic cohort (5.69%), P < 0.01). Compared with posterior fusions, anterior fusions and those extending to the pelvis were associated with higher complication rates (P < 0.01). Risk factors for complication included hepatobiliary disease (P = 0.03), cognitive impairment (P = 0.02), elevated American Society of Anesthesiologists class (P < 0.01), and prolonged operative time (P < 0.01). The overall rate of 30-day morbidity after pediatric spinal deformity surgery was 10%. Multiple patient comorbidities and surgical duration and invasiveness were associated with an increased complication risk. These data may aid in the informed consent process, facilitate patient risk assessment, and allow quality comparisons between surgeons and institutions. 2.

The Efficacy of Amicar Versus Tranexamic Acid in Pediatric Spinal Deformity Surgery: A Prospective, Randomized, Double-Blinded Pilot Study

Study DesignSingle-center, prospective, randomized, double-blinded trial. ObjectivesTo compare blood loss, allogenic transfusion requirements, and coagulation parameters between pediatric spinal deformity patients receiving aminocaproic acid (Amicar) or tranexamic acid (TXA) during posterior spinal fusion. Summary of Background DataAmicar and TXA have been shown to decrease blood loss in pediatric spinal deformity cases compared with controls. The difference in efficacy between these medications in this population has not been reported. MethodsEnrolled patients were randomized to receive either Amicar or TXA during scoliosis surgery. Baseline demographic and deformity comparisons were collected. Intraoperative comparisons included estimated and calculated blood loss, number of levels instrumented, number of osteotomies, operative time, and allogenic transfusion requirements. Preoperative and postoperative hemoglobin, platelets, prothrombin time, partial prothrombin time (PTT), international normalized ratio (INR), and fibrinogen were recorded. ResultsA total of 47 patients were enrolled with data available for review (N = 25, Amicar; N = 22, TXA). No difference in cohorts was found in demographics, preoperative hemoglobin, platelets, prothrombin time, PTT, INR, initial Cobb angle, average number of: levels fused, patients with osteotomies and osteotomies, operative time, and final Cobb angles. Estimated blood loss was significantly less (about 221 mL) than the calculated blood loss in both groups (p = .003). Estimated blood loss (1,088 vs. 726 mL; p = .055) and calculated blood loss (1,366 vs. 903 mL; p = .13) trended higher in the Amicar group. Although no difference in allogenic transfusion rates (20% vs. 14%) was observed, average volumes transfused were significantly higher in the Amicar cohort (1,014 vs. 461 mL; p = .03). The TXA cohort demonstrated a statistically significant smaller change in INR, a lower PTT, and greater fibrinogen levels postoperatively. ConclusionsCompared with Amicar, TXA use was associated with a lower allogenic transfusion requirement, less alteration in postoperative clotting studies, and a trend toward lower blood loss in pediatric posterior spinal fusion patients.

Neuromonitoring changes in pediatric spinal deformity surgery: a single-institution experience

Intraoperative monitoring of the spinal cord has become the standard of care during surgery for pediatric spinal deformity correction. The use of both somatosensory and motor evoked potentials has dramatically increased the sensitivity and specificity of detecting intraoperative neurophysiological changes to the spinal cord, which assists in the intraoperative decision-making process. The authors report on a large, single-center experience with neuromonitoring changes and outline the surgical management of patients who experience significant neuromonitoring changes during spinal deformity correction surgery. The authors conducted a retrospective review of all cases involving pediatric patients who underwent spinal deformity correction surgery at Shriners Hospital for Children, Philadelphia, between January 2007 and March 2010. Five hundred nineteen consecutive cases were reviewed in which neuromonitoring was used, with 47 cases being identified as having significant changes in somatosensory evoked potentials, motor evoked potentials, or both. These cases were reviewed for patient demographic data and surgical characteristics. The incidence of significant neuromonitoring changes was 9.1% (47 of 519 cases), including 6 cases of abnormal Stagnara wake-up tests, of which 4 had corroborated postoperative neurological deficits (8.5% of 47 cases, 0.8% of 519). In response to neuromonitoring changes, wake-up tests were performed in 37 (79%) of 47 cases, hardware was adjusted in 15 (32%), anesthesiology interventions were reported in 5 (11%), hardware was removed in 5 (11%), the patient was successfully repositioned in 3 (6%), and the procedure was aborted in 13 (28%). In 1 of the 4 patients with new postoperative deficits, the deficit had fully resolved by the last follow-up; the other 3 patients had persistent neurological impairment as of the most recent follow-up examination. The authors observed a sensitivity of 100% for intraoperative neuromonitoring. Due to the profound risks associated with spinal deformity surgery, intraoperative neurophysiological monitoring is an integral tool to warn of impending spinal cord injury. Intraoperative neuromonitoring appears to provide a safe and useful warning mechanism to minimize spinal cord injury that may arise during scoliosis correction surgery in pediatric patients.

Bipolar Sealer Device Reduces Blood Loss and Transfusion Requirements in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Reducing perioperative blood loss and transfusion requirements is important in the operative treatment of idiopathic scoliosis. This can be achieved with special frames, cell saver systems, pharmacologic aspects, and other techniques. Recently there has been interest in bipolar sealer devices as an adjunct to traditional monopolar electrocautery. However, there is limited information on this device in pediatric spinal deformity surgery. We reviewed our experience with this device in a setting of a standard institutional operative carepath. Perioperative blood loss and transfusion requirements of 50 consecutive patients with adolescent idiopathic scoliosis undergoing a posterior spinal fusion and segmental spinal instrumentation and who had a bipolar sealer device used during their surgery was compared with a control group of the 50 preceding consecutive patients who did not. Anesthesia, surgical technique, use of intraoperative epsilon aminocaproic acid (Amicar), postoperative protocol, and indications for transfusions (hemoglobin≤7.0 g/dL) were identical in both groups. The preoperative demographics for the patients in both groups were statistically the same. The bipolar sealer group demonstrated a significant reduction in intraoperative estimated blood loss, total perioperative blood loss, volume of blood products transfused, and overall transfusion rate when compared with the control group. When subgroups consisting of only hybrid or all-pedicle screw constructs were considered individually, these findings remained consistent. There were no complications associated with the use of this device. Using the bipolar sealer device is a significant adjunct in decreasing perioperative blood loss and transfusion requirements in patients undergoing surgery for adolescent idiopathic scoliosis. Level III-retrospective comparative study.

Prevalence of Intraoperative Tissue Bacterial Contamination in Posterior Pediatric Spinal Deformity Surgery

Retrospective case control study. To determine prevalence and risk factors for intraoperative bacterial contamination in posterior spinal deformity surgery. The prevalence of deep surgical site infection in pediatric spinal deformity surgery varies from 1% to 14%. Little evidence exists about the incidence and role of intraoperative bacterial contamination. A total of 114 cases of pediatric posterior instrumented deformity surgery were retrospectively identified. All patients received preoperative and every 4-hour intraoperative antibiotics and 3M Ioban 2 Antimicrobial Incise Drape. Preoperative photographs of patients' backs were used to correlate presence of back acne with contaminant bacteria. Laboratory cultures were obtained from paraspinal muscle debrided before closure. Of the 114 cultures obtained, 26 (23%) were positive in 21% of idiopathic, 37% of neuromuscular (P = 0.02), and 14% of congenital patients. Contaminant bacteria included Propionibacterium acnes (69%), Staphylococcus (23%), Coryneform (4%), and Clostridium (4%). P. acnes was seen only in children 11 years or older (P = 0.02) and only with back acne (P < 0.0001). Eight of 19 (42%) patients with pelvic fusion had positive cultures (P = 0.04) and all 8 were neuromuscular patients. Eighty-one percent of culture-positive patients were older than 11 years (P = 0.01). Three of 114 (2.7%) patients developed an early deep surgical site infection, all with positive cultures (P = 0.01). Neuromuscular patients fused to the pelvis, children older than 11 years, and surgery duration greater than 6 hours were associated with positive cultures. Back acne is a preventable risk factor for P. acnes seeding. Intraoperative bacterial contamination indicates a need to consider the type of surgery and patient age to determine prophylactic antibiotics and other modalities to prevent infection.

Validity of Estimates of Intraoperative Blood Loss in Pediatric Spinal Deformity Surgery

IntroductionIntraoperative blood loss is a significant concern in pediatric spinal deformity surgery, and numerous reports exist in the literature regarding this issue. Multiple interventions are used to minimize intraoperative blood loss and subsequent need for blood product replacement during and after these procedures. However, a basic question remains regarding the overall accuracy of intraoperative blood loss measurements used to generate these studies. Materials and MethodsWe performed an institutional review board–approved study that compared estimated blood loss (EBL) by the anesthesia provider and surgeon after the completion of surgery for pediatric spinal deformity by a single surgeon. We used the estimate by the anesthesia provider that was to be part of the anesthesia record. The surgeon's estimate was generated based on a formula employing the volume of blood products processed by a Cell-Saver device and available for reinfusion. ResultsWe collected data from 51 patients. The mean EBL (surgeon) was 795.84 mL and mean EBL (anesthesia) was 669.30 mL. The mean percent estimated blood volume loss (%EBVL) (surgeon) was 22.9% and mean %EBVL (anesthesia) was 19.8%. Student t-test analysis demonstrated statistical significance between both sets of values (EBL, p = .010; %EBVL, p = .010). ConclusionsThere was a statistically significant difference in EBL values for this patient sample between the anesthesiologist and orthopedic surgeon; the surgeon's estimates were significantly higher. This difference may be important in interpreting existing studies regarding interventions used to minimize surgical blood loss. In addition, this lack of agreement highlights the need for authors to be more accurate and consistent regarding the source of blood loss data in future clinical studies.

Outcome of Revision Surgery in Pediatric Spine Deformity Patients

Study DesignRetrospective case series. ObjectivesTo report the complications and outcomes of pediatric revision spine surgery and review the surgical indications and treatment methods. Background SummaryRecent reports have shown the necessity of revision spine surgery for pediatric deformities. Many reports have shown the result of revision surgery for pediatric spinal deformity. Materials and MethodsWe conducted a retrospective review of 638 patients with pediatric spinal deformity who were treated with surgery from 1996 to 2007. We identified 50 patients who underwent revision spinal fusion surgery with a minimum of 3 years of follow-up. ResultsMean follow-up was 4 years (range, 3-8.3 years). The diagnosis at index surgery was idiopathic scoliosis in 18 patients, congenital scoliosis in 13, neuromuscular scoliosis in 13, tumor and spinal arteriovenous malformation in 4, burst fracture in thoracic spine in 1, and Scheuermann kyphosis in 1. The primary surgeries were 1 hemi epiphysiodesis, 3 anterior spinal fusions, 4 posterior decompressions, 8 combined anterior and posterior spinal fusions, and 34 posterior spinal fusions. A total of 16 patients had pseudarthrosis, 12 decompensation, 11 progressive kyphosis, 8 crankshaft phenomenon, 2 infections, and 1 junctional degeneration. All 50 reoperations included spinal instrumentation and fusion. The revision surgeries were 2 anterior spinal fusions, 14 posterior fusions, and 34 combined anterior and posterior spinal fusions. Spine arthrodesis was obtained in 98% of patients (49 of 50) and complications occurred in 14% of patients (7 of 50). The Scoliosis Research Society Patient Questionnaire outcomes at the latest follow-up were as follows: total 3.95, function 3.88, pain 3.83, self-image 3.98, and mental health 4.04. ConclusionPseudarthrosis was the most common indication for revision surgery, and bony union was achieved in 98% with revision surgery. Despite the complications, pediatric revision spine surgery can achieve successful outcomes.

Intraoperative Neuromonitoring Applications and Issues in Pediatric Spinal Deformity Surgery

Intraoperative neuromonitoring for deformity surgery in the very young or in neurologically abnormal patients may present special challenges for the surgeon and intraoperative monitoring team. Circumstances where monitoring may not be achievable, indications for monitoring in exceptional procedures, and safety considerations with monitoring itself are described for some less common pediatric spinal deformities. Strategies for responding to adverse intraoperative neuromonitoring changes are reviewed. Awareness of these issues is useful for planning spinal deformity surgery in the young.

Surgical site infection after pediatric spinal deformity surgery.

The incidence of surgical site infection (SSI) after spinal deformity surgery for adolescent idiopathic scoliosis ranges from 0.5-6.7%. The risk of infection following spinal fusion in patients with neuromuscular scoliosis is greater, with reported rates of 6.1-15.2% for cerebral palsy and 8-41.7% for myelodysplasia. SSIs result in increased patient morbidity, multiple operations, prolonged hospital stays, and significant financial costs. Recent literature has focused on elucidating the most common organisms involved in SSIs, as well as identifying modifiable risk factors and prevention strategies that may decrease the rates of infection. These include malnutrition, positive urine cultures, antibiotic prophylaxis, surgical site antisepsis, antibiotic-loaded allograft, local application of antibiotics, and irrigation solutions. Acute and delayed SSIs are managed differently. Removal of instrumentation is required for effective treatment of delayed SSIs. This review article examines the current literature on the prevention and management of SSIs after pediatric spinal deformity surgery.

Idiopathic intracranial hypertension following spinal deformity surgery in children

Idiopathic intracranial hypertension (IIH) after pediatric spinal deformity surgery has not been previously reported. The authors conducted a retrospective analysis of more than 1500 pediatric spinal surgeries performed between 1992 and 2011. From their analysis, they report on 3 adolescent patients who underwent uncomplicated segmental spinal instrumentation for pediatric spinal deformity correction and subsequently developed features of IIH. The common variables in these 3 patients were adolescent age, spinal deformity, being overweight, symptom onset within 2 weeks postoperatively, significant estimated blood loss, and intraoperative use of ε-aminocaproic acid (antifibrinolytic) injection. The authors postulate that the development of IIH could be the result of venous outflow obstruction due to derangement of the epidural venous plexus during surgery. The use of ε-aminocaproic acid could potentially have the risk of causing IIH, probably mediated through hyperfibrinogenemia, although there have not been published cases in the neurosurgical, orthopedic, cardiac, or general surgical literature. Idiopathic intracranial hypertension after spinal deformity correction is a condition that should be recognized by neurosurgeons and orthopedic surgeons, because appropriate intervention with early medical therapy can lead to a satisfactory clinical outcome.

Blood management in pediatric spinal deformity surgery: review of a 2‐year experience

Pediatric scoliosis surgery is associated with considerable blood loss and allogenic transfusions. Transfusions contribute to morbidities and cost. A perioperative pediatric blood management program was implemented at our institution. Patients received preoperative evaluation, cell salvage, topical hemostasis, antifibrinolytics, and hypotensive anesthesia. The study was a 2-year retrospective cohort review of the program's population from September 2007 through August 2009. A total of 110 scoliosis surgeries were performed with only 34 and 12% of the patients requiring preoperative oral iron and erythropoietin, respectively. Neuromuscular scoliosis patients had more repaired segments and a larger transfusion rate than idiopathic scoliosis patients (36% vs. 1.7%, p = 0.001). Transfused patients had more blood loss relative to their blood volume (p = 0.001) and blood loss was associated with higher Cobb angles (p = 0.04). Logistic regression revealed that blood loss (p = 0.001), number of segments fused (p = 0.004), and lower patient weight (p = 0.007) are associated with increased odds for transfusion. Twelve patients (10.9%) were identified with low von Willebrand activity with a trend toward higher blood losses (p = 0.07) with lower activity levels. Transfusion requirements in scoliosis patients are dependent on blood loss as determined by Cobb angles and number of segments fused relative to the patients' blood volume as determined by weight. Implementation of a blood management protocol resulted in a low transfusion rate and unexpectedly led to the preoperative diagnosis of a number of patients with low levels of von Willebrand activity.

The Role of Posterior Spinal Osteotomies in Pediatric Spinal Deformity Surgery

The primary goals of spinal deformity surgery are to prevent the progression of further deformity and to improve sagittal and coronal balance. Although increasingly powerful instrumentation has greatly facilitated these treatment goals, osteotomy of the spine is sometimes necessary to address more significant deformity. This review provides a detailed overview of posterior spinal osteotomies, which have gained increased attention as an adjunct to the treatment of complex pediatric spine deformity. The indications, operative technique, and advantages and disadvantages of the Smith-Petersen, pedicle subtraction and vertebral column resection osteotomies will be discussed, as well as operative considerations generally applicable to spinal deformity surgery involving correction with osteotomies.

Validity and Reliability of Intraoperative Monitoring in Pediatric Spinal Deformity Surgery

This was a 23-year retrospective study of 3436 consecutive pediatric orthopedic spinal surgery patients between 1995 and 2008. To demonstrate the effectiveness of multimodality electrophysiologic monitoring in reducing the incidence of iatrogenic neurologic deficit in a pediatric spinal surgery population. The elective nature of many pediatric spinal surgery procedures continues to drive the need for minimizing risk to each individual patient. Electrophysiologic monitoring has been proposed as an effective means of decreasing permanent neurologic injury in this population. A total of 3436 consecutive monitored pediatric spinal procedures at a single institution between January 1985 and September 2008 were reviewed. Monitoring included somatosensory-evoked potentials, descending neurogenic-evoked potentials, transcranial electric motor-evoked potentials, and various nerve root monitoring techniques. Patients were divided into 10 diagnostic categories. True-positive and false-negative monitoring outcomes were analyzed for each category. Neurologic deficits were classified as transient or permanent. Seven of 10 diagnostic groups demonstrated true positive findings resulting in surgical intervention. Seventy-four (2.2%) potential neurologic deficits were identified in 3436 pediatric surgical cases. Seven patients (0.2%) had false-negative monitoring outcomes. These patients awoke with neurologic deficits undetected by neuromonitoring. Intervention reduced permanent neurologic deficits to 6 (0.17%) patients. Monitoring data were able to detect permanent neurologic status in 99.6% of this population. The ratio of intraoperative events to total monitored cases was 1 event every 42 surgical cases and 1 permanent neurologic deficit every 573 cases. The combined use of somatosensory-evoked potentials, transcranial electric motor-evoked potentials, descending neurogenic-evoked potentials, and electromyography monitoring allowed accurate detection of permanent neurologic status in 99.6% of 3436 patients and reduced the total number of permanent neurologic injuries to 6.

Low Profile Pelvic Fixation With the Sacral Alar Iliac Technique in the Pediatric Population Improves Results at Two-Year Minimum Follow-up

Retrospective review. Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. We compared the new sacral alar iliac (SAI) fixation technique (with a starting point in the sacral ala and in-line anchors deep under the midline muscle flap) with other methods of screw fixation. Iliac anchors have been shown to provide the best form of pelvic fixation. A trajectory from the posterior sacral surface to the iliac wings has recently been described. To our knowledge, no clinical series has compared this method of pelvic fixation in children to others. Of 32 consecutive pediatric patients who underwent SAI fixation, 2 died and 26 returned for follow-up (>2 years). Mean age at surgery was 14 years. Average screw size was 67 mm long and 7 to 9 mm in diameter. Clinical examinations, radiographs, and computed tomography scans were analyzed. Outcomes included pain over the implants, screw placement, implant prominence, radiographic lucency, need for revision, and infection. SAI patients were compared with 27 previous patients who had pelvic fixation via other screw techniques. For SAI fixation, correction of pelvic obliquity and Cobb angles were 20° ± 11° (70%) and 42° ± 25° (67%), respectively. For other pelvic fixation methods, those values were 10° ± 9° (50%), and 46° ± 16° (60%), respectively. Compared with other screws, SAI screws provided significantly better pelvic obliquity correction (P = 0.002) but no difference in Cobb correction. There were 2 lucencies adjacent to screws in both groups. Computed tomography scans of 18 SAI patients showed no intrapelvic protrusion, but 1 screw extended laterally (<5 mm). One early SAI patient required revision with larger screws, which relieved pain; there was 1 revision in the comparison group. SAI patients had no deep infections, implant prominence, late skin breakdown, or anchor migration; traditional patients had 3 deep infections (P = 0.09) and 3 instances of implant prominence, skin breakdown, or anchor migration. SAI pelvic fixation produces better correction of pelvic obliquity than do previous techniques. Radiographic and clinical anchor stability is satisfactory at 2-year follow-up.

Infection After Spinal Fusion for Pediatric Spinal Deformity

A retrospective, consecutive case study of 1571 pediatric patients who underwent spinal deformity surgery and had minimum 2-year follow-up. To identify (1) the rate of infection after pediatric spinal deformity surgery; (2) the number of surgeries required to treat a postoperative infection after a pediatric spinal deformity surgery; (3) the percentage of patients with a postoperative infection after pediatric spinal deformity surgery who require implant removal to quantify the effect of removal on the deformity; and (4) the microbiology of postoperative infections after pediatric spinal deformity surgery. Several previous reports have discussed the rates of infection after spinal surgery for pediatric spinal deformity. No previous reports have quantified the rate and magnitude of deformity progression after infection in pediatric spinal deformity surgery. A retrospective review was performed of the medical records and radiographs of all children undergoing surgery for spinal deformity at the Shriners Hospital for Children in Chicago from January 1, 1975, to June 1, 2005. The rate of infection varied based on underlying diagnosis: idiopathic scoliosis 0.5%, myelomeningocele 19.2%, myopathies 4.3%, and cerebral palsy 11.2%. On average, 2 surgeries were required to eradicate the infection. Approximately half of the patients required removal of the instrumentation to treat their infection. Forty-four percent of patients who developed an infection had significant progression of their deformity, with an average increase in deformity magnitude of 27 degrees. Implant removal predisposed patients to progression of deformity. The 3 most common organisms in order were Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa. Infection after spinal deformity in idiopathic scoliosis is rare but is relatively common in neuromuscular conditions. Eradication of infection can be expected, but implant removal is often required. Should implants be totally removed, significant progression of the deformity is possible.

Intraoperative Neuromonitoring in Pediatric Spinal Deformity Surgery

Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Spinal deformity surgery is performed to arrest the progression of and correct coronal and sagittal plane deformities including scoliosis and kyphosis. It is also undertaken to improve cosmesis and decrease the pain that can be associated with certain types of spinal deformity. Iatrogenic spinal cord injury remains the most feared complication of corrective spine surgery. Intraoperative neuromonitoring may be the single innovation that has had the greatest impact in lowering neurological complication rates over the last 2 decades. It is currently recommended in pediatric spinal deformity surgery whenever cord-level spinal instrumentation is planned and reliable signals can be anticipated. This article will briefly discuss common types of pediatric spinal deformity and corrective spine surgery. The use of intraoperative neuromonitoring in pediatric spine surgery will also be reviewed. As our abilities to correct more complex spinal deformities continue to improve, the importance of more advanced methods to decrease the risk of intraoperative neurological complications will also continue to increase.

Intraoperative Neuromonitoring in Pediatric Spinal Deformity Surgery

Orthopaedic Nursing: November 2009 - Volume 28 - Issue 6 - p 293-294 doi: 10.1097/NOR.0b013e3181c37a99

42. Low Profile Pelvic Fixation Using S2 ALAR Iliac (S2AI) Fixation in the Pediatric Population Improves Results at 2-Year Minimum Follow-Up

BACKGROUND CONTEXT: Anchor stability and prominence are problems with pelvic fixation in pediatric spinal deformity surgery. A new method of iliac fixation with a starting point in the S2 ala offers in-line anchors that are deep under the midline muscle flap.

P7. The Treatment of Postoperative Infection in Pediatric Spinal Deformity Surgery

BACKGROUND CONTEXT: Infection after spinal deformity surgery in children is a relatively rare event. Most treatment algorithms include surgical irrigation, debridement and occasionally hardware removal. However, the success of repeat debridements is not well defined in this group of patients. Furthermore, the frequency and of hardware removal and the effect this has on the deformity has also been poorly reported. We have reviewed the 30 year experience at one institution. Our series represents the largest series of post-operative infections in pediatric spinal deformity patients published or presented to date.

Developing Outcome Measures for Pediatric Deformity Surgery

: Review article regarding the development of outcome measures for pediatric spinal deformity. : To discuss the role of patient-based outcomes and process measures in pediatric spinal deformity patients. : A number of health-related quality of life (HRQOL) questionnaires assess, from patients' perspectives, the effectiveness of spinal deformity correction. The SRS instrument is the most prominent HRQOL tool used in North American adolescent scoliosis studies today. However, these patient-based outcomes and perceptions do not necessarily correlate with process measurements, particularly in the area of increase spinal deformity correction being achieved with newer, more powerful, pedicle screw instrumentation. Furthermore, spinal deformity presenting during infancy or early childhood poses a particular challenge for developing useful evidence-based outcomes tools. : The rationale for patient-based outcome development in pediatric spinal deformity is discussed, along with its important association with process measures. : Newer HRQOL tools are under development that may better recognize and differentiate changes in adolescent patients' appearances before and after surgery. For early-onset spinal deformity patients, newer process measures for periodic outcome assessment, such as volume measurement of lung parenchyma and spine/chest cage measurement, are being developed. : Ultimately, both patient and process measures are necessary to fully evaluate the results of pediatric spinal deformity surgery.