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Major complications of primary versus revision surgery in patients undergoing corrective surgery for adult spinal deformity using 3-column spinal osteotomies
Podium Presentations / The Spine Journal 16 (2016) S45–S63 Is there a correlation between gross motor function classification system (GMFCS) level and scoliosis in patients with cerebral palsy (CP)? A systematic review Lara E. McMillan, Abdul Gaffar Dudhniwala, Sashin Ahuja; Welsh Centre for Spinal Surgery & Trauma, Trauma and Orthopaedics Directorate, University Hospital of Wales, Cardiff CF14 4XW, UK BACKGROUND CONTEXT: Gross motor function classification system (GMFCS) is now an established standardised assessment tool used to classify cerebral palsy (CP) children to levels I–V according to their gross motor function skills. Studies predating GMFCS have shown scoliosis prevalence to be associated with poor motor function. Prevalence of other secondary musculoskeletal complications is associated with increased GMFCS level. PURPOSE: To determine evidence for correlation between GMFCS level and scoliosis in CP patients. Assess possible benefit of using GMFCS levels to identify those most at-risk of developing scoliosis and its rapid or severe progression. STUDY DESIGN/SETTING: Systematic review. PATIENT SAMPLE: Five original publications. OUTCOME MEASURES: Scoliosis incidence, prevalence and progression. METHODS: Publications sourced using Full text journals, EMBASE, Ovid Medline, JSTOR, SCOPUS and Web of Science search for all years of terms/ subject headings: ‘gross motor function classification system’ or ‘GMFCS’ and ‘scoliosis’. RESULTS: GMFCS level is a determinant of scoliosis amongst CP young adults; higher GMFCS III–V was related to increased scoliosis prevalence. GMFCS IV–V CP children had increased overall scoliosis risk and moderate or severe curves. Scoliosis progression rate and severity increased with GMFCS level and with non-ambulation. CONCLUSIONS: GMFCS IV–V CP children should receive greatest spinesurveillance to monitor scoliosis emergence and progression in order to provide early interventions if necessary, thereby avoiding risks associated with treating high-grade curves. Conversely, monitoring with fewer radiographs could be adopted amongst patients with lower GMFCS as they are less likely to develop scoliosis or experience rapid or severe curve progression thereby reducing radiation exposure and avoiding surveillance clinic visit. CONFLICTS OF INTEREST: None. FUNDING SOURCES: N/A. http://dx.doi.org/10.1016/j.spinee.2016.01.053
Surgical outcome of scoliosis correction in Duchenne muscular dystrophy (DMD) using different instrumentation constructs Hossein Mehdian, A.B. Perez-Romera, L.A. Nasto, A. Kapinas; Queen’s Medical Centre, Spinal Unit, Nottingham, UK BACKGROUND CONTEXT: With the advent of newer instrumentation systems, ie, pedicle screw (PS), there has been a recent trend towards its use in neuromuscular scoliosis and DMD. However sublaminar wire (SW) is still widely used; we therefore compared our results with these two techniques. PURPOSE: This study aims to compare SW and PS fixation in DMD. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: 43 DMD patients. OUTCOME MEASURES: Radiographic and surgical outcomes. METHODS: Between 1993 and 2011, 43 patients with DMD were treated surgically. 20 patients underwent SW fixation (Group A), and 23 patients underwent segmental PS fixation (Group B); instrumentation was extended from T2 to pelvis in both groups. RESULTS: In Group A (mean age 14.6 years, follow-up 7.6 years) the mean pre-operative, post-operative and final follow-up Cobb angles were 52.7°, 18.3° and 24.5° respectively. The mean surgical time was 300 minutes with mean blood loss of 4.1 L. Complications included two cases of infection, and one case of revision instrumentation. In Group B (mean age 13.4 years, follow-up 6 years), the mean pre-operative, post-operative and final followup Cobb angles were 45.8°, 3.6° and 4.7°, respectively. The mean surgical
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time was 184 minutes with mean blood loss of 3.2 L. There was one case of prominent metalwork. CONCLUSIONS: All constructs studied were equally effective. SW was associated with increased operative time, blood loss and instrumentation failure. The PS system showed better results in terms of reduced operative time, blood loss and maintenance of the correction. PS can provide significant correction, less blood loss, infection, and instrumentation failure. Hospitalisation appears to be shorter due to a rapid recovery from surgery. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: University of Nottingham. http://dx.doi.org/10.1016/j.spinee.2016.01.054
Major complications of primary versus revision surgery in patients undergoing corrective surgery for adult spinal deformity using 3-column spinal osteotomies Nasir Quraishi, S. Sabou, K. Salem; Centre for Spinal Studies and Surgery, D Floor, West Block, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK BACKGROUND CONTEXT: Whilst 3-column osteotomies for adult spinal deformity are demanding, revision surgeries encompass more challenging techniques. PURPOSE: Our main purpose was to compare the complications of posterior 3-column osteotomies in cases of primary versus revision surgery. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: Patients fitting the inclusion criteria (>18 years, >1 year follow up, 3-column osteotomy for sagittal/coronal imbalance). OUTCOME MEASURES: Complications were stratified into major and minor categories using the classification reported by Glassman. METHODS: A single surgeon series of posterior 3-column osteotomies for adult spinal deformity was retrospectively reviewed. RESULTS: The mean age was 61.1 years (37–77) in the Primary group (N=20) and 60.6 years (47–76) in the Revision (N=15) group. Diagnoses were degenerative scoliosis (18), adolescent idiopathic scoliosis (AIS) (2) in the Primary group and fixed sagittal imbalance with (out) adjacent level disease (12), AIS (1) and kyphoscoliosis (2) in the Revision group. There was no significant difference in blood loss or length of stay between groups. Clinical outcome/radiological correction were also similar with the exception of greater thoracic hypokyphosis in the revision group (p=.04). Complications were major (Primary (6/20 (30%)) vs Revision (5/15 (33%)): Instrumentation/junctional failure (4 vs 2), neurological deficit (0 vs 2), deep infection (2 vs 0)) and minor (Primary (5/20 (25%)) vs Revision (5/15 (33%)): Excessive bleeding (4 vs 4), cardiopulmonary (1 vs 0)). CONCLUSIONS: The 3-column osteotomies can achieve good clinical and radiological outcome in primary and revision surgeries for adult spinal corrective surgery with an acceptable major complication rate in one third of patients. CONFLICTS OF INTEREST: Nil. FUNDING SOURCES: Nil. http://dx.doi.org/10.1016/j.spinee.2016.01.055
Analysis of segmental mobility following a novel posterior apical short-segment correction for adolescent idiopathic scoliosis Colin Nnadi, Pooria Hosseini, L’uboš Rehák, Martin Repko, Michael Grevitt, Ufuk Aydinli, Allen Carl, Jeff Pawelek, Dennis Crandall, Behrooz A. Akbarnia, Pavlos Panteliadis, Chrishan Thakar; Spine Unit, Oxford University Hospitals Foundation NHS Trust, Headley Way, Headington, Oxford, UK BACKGROUND CONTEXT: The consequence of a spinal fusion is an abnormal load on adjacent levels with increased risk of future adjacent segment degeneration.
Surgical outcome of scoliosis correction in Duchenne muscular dystrophy (DMD) using different instrumentation constructs Hossein Mehdian, A.B. Perez-Romera, L.A. Nasto, A. Kapinas; Queen’s Medical Centre, Spinal Unit, Nottingham, UK BACKGROUND CONTEXT: With the advent of newer instrumentation systems, ie, pedicle screw (PS), there has been a recent trend towards its use in neuromuscular scoliosis and DMD. However sublaminar wire (SW) is still widely used; we therefore compared our results with these two techniques. PURPOSE: This study aims to compare SW and PS fixation in DMD. STUDY DESIGN/SETTING: Retrospective case series. PATIENT SAMPLE: 43 DMD patients. OUTCOME MEASURES: Radiographic and surgical outcomes. METHODS: Between 1993 and 2011, 43 patients with DMD were treated surgically. 20 patients underwent SW fixation (Group A), and 23 patients underwent segmental PS fixation (Group B); instrumentation was extended from T2 to pelvis in both groups. RESULTS: In Group A (mean age 14.6 years, follow-up 7.6 years) the mean pre-operative, post-operative and final follow-up Cobb angles were 52.7°, 18.3° and 24.5° respectively. The mean surgical time was 300 minutes with mean blood loss of 4.1 L. Complications included two cases of infection, and one case of revision instrumentation. In Group B (mean age 13.4 years, follow-up 6 years), the mean pre-operative, post-operative and final followup Cobb angles were 45.8°, 3.6° and 4.7°, respectively. The mean surgical
S55
time was 184 minutes with mean blood loss of 3.2 L. There was one case of prominent metalwork. CONCLUSIONS: All constructs studied were equally effective. SW was associated with increased operative time, blood loss and instrumentation failure. The PS system showed better results in terms of reduced operative time, blood loss and maintenance of the correction. PS can provide significant correction, less blood loss, infection, and instrumentation failure. Hospitalisation appears to be shorter due to a rapid recovery from surgery. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: University of Nottingham. http://dx.doi.org/10.1016/j.spinee.2016.01.054
Major complications of primary versus revision surgery in patients undergoing corrective surgery for adult spinal deformity using 3-column spinal osteotomies Nasir Quraishi, S. Sabou, K. Salem; Centre for Spinal Studies and Surgery, D Floor, West Block, Queens Medical Centre, Derby Rd, Nottingham NG7 2UH, UK BACKGROUND CONTEXT: Whilst 3-column osteotomies for adult spinal deformity are demanding, revision surgeries encompass more challenging techniques. PURPOSE: Our main purpose was to compare the complications of posterior 3-column osteotomies in cases of primary versus revision surgery. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: Patients fitting the inclusion criteria (>18 years, >1 year follow up, 3-column osteotomy for sagittal/coronal imbalance). OUTCOME MEASURES: Complications were stratified into major and minor categories using the classification reported by Glassman. METHODS: A single surgeon series of posterior 3-column osteotomies for adult spinal deformity was retrospectively reviewed. RESULTS: The mean age was 61.1 years (37–77) in the Primary group (N=20) and 60.6 years (47–76) in the Revision (N=15) group. Diagnoses were degenerative scoliosis (18), adolescent idiopathic scoliosis (AIS) (2) in the Primary group and fixed sagittal imbalance with (out) adjacent level disease (12), AIS (1) and kyphoscoliosis (2) in the Revision group. There was no significant difference in blood loss or length of stay between groups. Clinical outcome/radiological correction were also similar with the exception of greater thoracic hypokyphosis in the revision group (p=.04). Complications were major (Primary (6/20 (30%)) vs Revision (5/15 (33%)): Instrumentation/junctional failure (4 vs 2), neurological deficit (0 vs 2), deep infection (2 vs 0)) and minor (Primary (5/20 (25%)) vs Revision (5/15 (33%)): Excessive bleeding (4 vs 4), cardiopulmonary (1 vs 0)). CONCLUSIONS: The 3-column osteotomies can achieve good clinical and radiological outcome in primary and revision surgeries for adult spinal corrective surgery with an acceptable major complication rate in one third of patients. CONFLICTS OF INTEREST: Nil. FUNDING SOURCES: Nil. http://dx.doi.org/10.1016/j.spinee.2016.01.055
Analysis of segmental mobility following a novel posterior apical short-segment correction for adolescent idiopathic scoliosis Colin Nnadi, Pooria Hosseini, L’uboš Rehák, Martin Repko, Michael Grevitt, Ufuk Aydinli, Allen Carl, Jeff Pawelek, Dennis Crandall, Behrooz A. Akbarnia, Pavlos Panteliadis, Chrishan Thakar; Spine Unit, Oxford University Hospitals Foundation NHS Trust, Headley Way, Headington, Oxford, UK BACKGROUND CONTEXT: The consequence of a spinal fusion is an abnormal load on adjacent levels with increased risk of future adjacent segment degeneration.