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P89. Increased complications in pediatric patients with non-idiopathic scoliosis undergoing spinal instrumentation for neuromuscular scoliosis compared to syndromic and congenital scoliosis
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231
anterior lumbar interbody fusion around PSO with rod change (n=9), and rod change with 4-rod constructs (n=17). RESULTS: Preoperative lumbar lordosis was corrected (69.48) from 3.6˚ to -65.88 while sagittal vertical axis (SVA) was corrected (185.7 mm) from 176.9 mm to -8.8 mm. Pseudarthrosis occurred (42/79, 53%) around PSO site on the average of 21 months after the surgery, so that revision surgery was performed. There were no statistically significant differences among the other risk factors except the surgical methods for the three groups. Repseudarthrosis occurred in 4 of 42 (9.5%) cases in patients who received rod change using the 2-rod constructs method around PSO site at 15, 18, 24 and 35 months postoperatively, and there was no re-pseudarthrosis in the other two groups (P=0.042). CONCLUSIONS: Our study showed that anterior lumbar interbody fusion around PSO and 4-rod constructs are preferable to rod change with 2-rod constructs. Therefore, our research can provide an effective guideline for revision surgery for pseudarthrosis that occurs after long PSF with PSO. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
20.1% SS/CS, p=0.02). Intraoperatively, NM patients experienced more blood loss (EBL/weight 18.6§17.8 ml/kg NM vs 13.4§12.6 ml/kg SS/CS, p=0.03) and required more postoperative blood products (128.8§261.6 ml NM vs 58.6§163.8 ml SS/CS, p=0.04). Postoperatively, there were more mortalities in NM patients (2 NM vs 0 SS/CS at 30 days, p=0.295 and 4 NM vs 0 SS/CS at 1 year, p=0.137), but the difference was not significant. NM patients had more SSIs (12 NM vs 1 SS/CS, p=0.03), readmission at 30 days (21 NM vs 5 SS/CS, p = 0.05), and return to OR in 90 days (19 NM vs 4 SS/CS, p=0.05). NM patients had a non-significant increase in revision surgery in 1 year (21 NM vs 7 SS/CS, p = 0.10) and ER visits in 90 days (31 NM vs 9 SS/CS, p=0.06). CONCLUSIONS: Non-idiopathic patients with NM scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.513 https://doi.org/10.1016/j.spinee.2019.05.514 P89. Increased complications in pediatric patients with non-idiopathic scoliosis undergoing spinal instrumentation for neuromuscular scoliosis compared to syndromic and congenital scoliosis Lorenzo Deveza, MD, PhD1, John Heydemann, MD2, Benny Dahl, MD, PhD3; 1 Houston, TX, US; 2 Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, US; 3 Texas Children’s Hospital, Houston, Texas, US BACKGROUND CONTEXT: Non-idiopathic scoliosis encompasses a group of diagnoses including neuromuscular, syndromic and congenital scoliosis. It is known that those with neuromuscular scoliosis have increased complications in comparison to those with idiopathic scoliosis. However, patients diagnosed with syndromic or congenital scoliosis do not share the same characteristics and are often treated similarly to those with neuromuscular scoliosis. The clinical differences between pediatric patients with neuromuscular scoliosis and syndromic/congenital scoliosis are not well described. PURPOSE: To assess differences in pediatric non-idiopathic scoliosis patients with neuromuscular scoliosis (NM) vs syndromic and congenital scoliosis (SS/CS). STUDY DESIGN/SETTING: Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE: All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic scoliosis at a single institution from 2012-2016. OUTCOME MEASURES: Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS: This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic scoliosis. Neuromuscular scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students’ t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS: NM patients were older than those with SS/CS (13.3§3.5 NM vs 11.7§3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p < 0.001), technology dependence (38.0% NM vs 20.0% SS/CS p=0.01), and seizure disorder (37.2% NM vs 8.6% SS/CS, p <0.001). On the other hand, SS/CS patients were more likely to have cardiac disease (11.6% NM vs
P90. The surgical strategy of treatment lumbosacral hemivertebra: comparative analysis of under 10 years old and older than 10 years old groups with five years follow up Zhiyue Shi, MD1, Yingsong Wang, MD1, Jing-Ming Xie, MD1, Quan Li, MD2, Ni Bi, MD1, Qiuan Lu, MD2, Ying Zhang, MD1, Zhi Zhao, MD1, Tao Li, MD1; 1 Department of Orthopedics, 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China; 2 Kunming, China BACKGROUND CONTEXT: The lumbosacral hemivertebra usually leads to the early rapid progress of spinal deformity, shift and large compensatory curve. Compensatory curve of lumbosacral deformities in the early stage of less than 10 years old is often more flexible, while the compensatory curve in children older than 10 usually turns into a structural curve and surgical treatment of deformity in different age is not entirely the same. However, the timing and strategy of lumbosacral hemivertebral surgery in different ages are still controversial. PURPOSE: To analyze and compare the surgical strategies and long-term outcomes of lumbosacral hemivertebra deformities in different age groups. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Eighteen patients with lumbosacral hemivertebra deformity were retrospectively reviewed between 2004 and 2013. OUTCOME MEASURES: Clinical and imaging data were collected for statistical analysis. METHODS: Patients received a minimum 5-year follow-up and assigned into two groups: Group A (N=8, mean age 6.6 years old) patients who were under 10 years old and underwent hemivertebral resection and short segment fixation, Group B (N=10, mean age 14.3 years old) patients who were older than 10 years old and underwent hemivertebral resection, long segment fixation including compensatory curve. RESULTS: Mean follow-up was 6.2 years. In group B all patients were treated with long segment and iliac screw fixation while no iliac screw fixation in group A. The Cobb angle of coronal main curve in group A improved from 31.3˚ to 9.3˚ post-op, and to 9.5˚ at final follow-up. The Cobb angle of coronal main curve in group B improved from 51.5˚ to 15.5˚ post-op, and to 16.3˚at final follow-up.The Cobb angle of compensatory cranial curve in group A was 23.5˚ before operation, 13.7˚after operation, 16.2˚ at final follow-up, while in group B 40.5˚ before operation, 13.3˚ after operation, 13.8˚ at final follow-up. CSVL in group A improved from 1.5cm before operation to 0.7 cm at final follow-up and in group B improved from 2.1 cm to 0.9 cm. Fixed fusion segments were 2.1 in group A and 5.6 in group B. The mean operative time and blood loss in Group A was 189 minutes and 380 ml, respectively, and in group B 265 minutes and 750 ml, respectively. The mean operative time and blood loss in group B were statistically significant more than group A.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S195−S231
anterior lumbar interbody fusion around PSO with rod change (n=9), and rod change with 4-rod constructs (n=17). RESULTS: Preoperative lumbar lordosis was corrected (69.48) from 3.6˚ to -65.88 while sagittal vertical axis (SVA) was corrected (185.7 mm) from 176.9 mm to -8.8 mm. Pseudarthrosis occurred (42/79, 53%) around PSO site on the average of 21 months after the surgery, so that revision surgery was performed. There were no statistically significant differences among the other risk factors except the surgical methods for the three groups. Repseudarthrosis occurred in 4 of 42 (9.5%) cases in patients who received rod change using the 2-rod constructs method around PSO site at 15, 18, 24 and 35 months postoperatively, and there was no re-pseudarthrosis in the other two groups (P=0.042). CONCLUSIONS: Our study showed that anterior lumbar interbody fusion around PSO and 4-rod constructs are preferable to rod change with 2-rod constructs. Therefore, our research can provide an effective guideline for revision surgery for pseudarthrosis that occurs after long PSF with PSO. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
20.1% SS/CS, p=0.02). Intraoperatively, NM patients experienced more blood loss (EBL/weight 18.6§17.8 ml/kg NM vs 13.4§12.6 ml/kg SS/CS, p=0.03) and required more postoperative blood products (128.8§261.6 ml NM vs 58.6§163.8 ml SS/CS, p=0.04). Postoperatively, there were more mortalities in NM patients (2 NM vs 0 SS/CS at 30 days, p=0.295 and 4 NM vs 0 SS/CS at 1 year, p=0.137), but the difference was not significant. NM patients had more SSIs (12 NM vs 1 SS/CS, p=0.03), readmission at 30 days (21 NM vs 5 SS/CS, p = 0.05), and return to OR in 90 days (19 NM vs 4 SS/CS, p=0.05). NM patients had a non-significant increase in revision surgery in 1 year (21 NM vs 7 SS/CS, p = 0.10) and ER visits in 90 days (31 NM vs 9 SS/CS, p=0.06). CONCLUSIONS: Non-idiopathic patients with NM scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.513 https://doi.org/10.1016/j.spinee.2019.05.514 P89. Increased complications in pediatric patients with non-idiopathic scoliosis undergoing spinal instrumentation for neuromuscular scoliosis compared to syndromic and congenital scoliosis Lorenzo Deveza, MD, PhD1, John Heydemann, MD2, Benny Dahl, MD, PhD3; 1 Houston, TX, US; 2 Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, US; 3 Texas Children’s Hospital, Houston, Texas, US BACKGROUND CONTEXT: Non-idiopathic scoliosis encompasses a group of diagnoses including neuromuscular, syndromic and congenital scoliosis. It is known that those with neuromuscular scoliosis have increased complications in comparison to those with idiopathic scoliosis. However, patients diagnosed with syndromic or congenital scoliosis do not share the same characteristics and are often treated similarly to those with neuromuscular scoliosis. The clinical differences between pediatric patients with neuromuscular scoliosis and syndromic/congenital scoliosis are not well described. PURPOSE: To assess differences in pediatric non-idiopathic scoliosis patients with neuromuscular scoliosis (NM) vs syndromic and congenital scoliosis (SS/CS). STUDY DESIGN/SETTING: Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE: All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic scoliosis at a single institution from 2012-2016. OUTCOME MEASURES: Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS: This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic scoliosis. Neuromuscular scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students’ t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS: NM patients were older than those with SS/CS (13.3§3.5 NM vs 11.7§3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p < 0.001), technology dependence (38.0% NM vs 20.0% SS/CS p=0.01), and seizure disorder (37.2% NM vs 8.6% SS/CS, p <0.001). On the other hand, SS/CS patients were more likely to have cardiac disease (11.6% NM vs
P90. The surgical strategy of treatment lumbosacral hemivertebra: comparative analysis of under 10 years old and older than 10 years old groups with five years follow up Zhiyue Shi, MD1, Yingsong Wang, MD1, Jing-Ming Xie, MD1, Quan Li, MD2, Ni Bi, MD1, Qiuan Lu, MD2, Ying Zhang, MD1, Zhi Zhao, MD1, Tao Li, MD1; 1 Department of Orthopedics, 2nd Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China; 2 Kunming, China BACKGROUND CONTEXT: The lumbosacral hemivertebra usually leads to the early rapid progress of spinal deformity, shift and large compensatory curve. Compensatory curve of lumbosacral deformities in the early stage of less than 10 years old is often more flexible, while the compensatory curve in children older than 10 usually turns into a structural curve and surgical treatment of deformity in different age is not entirely the same. However, the timing and strategy of lumbosacral hemivertebral surgery in different ages are still controversial. PURPOSE: To analyze and compare the surgical strategies and long-term outcomes of lumbosacral hemivertebra deformities in different age groups. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Eighteen patients with lumbosacral hemivertebra deformity were retrospectively reviewed between 2004 and 2013. OUTCOME MEASURES: Clinical and imaging data were collected for statistical analysis. METHODS: Patients received a minimum 5-year follow-up and assigned into two groups: Group A (N=8, mean age 6.6 years old) patients who were under 10 years old and underwent hemivertebral resection and short segment fixation, Group B (N=10, mean age 14.3 years old) patients who were older than 10 years old and underwent hemivertebral resection, long segment fixation including compensatory curve. RESULTS: Mean follow-up was 6.2 years. In group B all patients were treated with long segment and iliac screw fixation while no iliac screw fixation in group A. The Cobb angle of coronal main curve in group A improved from 31.3˚ to 9.3˚ post-op, and to 9.5˚ at final follow-up. The Cobb angle of coronal main curve in group B improved from 51.5˚ to 15.5˚ post-op, and to 16.3˚at final follow-up.The Cobb angle of compensatory cranial curve in group A was 23.5˚ before operation, 13.7˚after operation, 16.2˚ at final follow-up, while in group B 40.5˚ before operation, 13.3˚ after operation, 13.8˚ at final follow-up. CSVL in group A improved from 1.5cm before operation to 0.7 cm at final follow-up and in group B improved from 2.1 cm to 0.9 cm. Fixed fusion segments were 2.1 in group A and 5.6 in group B. The mean operative time and blood loss in Group A was 189 minutes and 380 ml, respectively, and in group B 265 minutes and 750 ml, respectively. The mean operative time and blood loss in group B were statistically significant more than group A.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.