The hospital stay was reduced from 10.9 to 6.2 days after introduction of a multimodal patient school that was held 10 days prior to admission, with mobilization on the day of surgery with a strictly followed treatment plan supervised by therapists and taking into account the patient's own assessment, as well an early plan for discharge based on fixed established criteria. This concept is a very successful tool to achieve high quality standard of treatment paired with a reduction of hospital stay.
Peri- and intraoperative treatment algorithms have a significant influence on postoperative recovery and patient outcome after lumbar spinal surgery. Recent studies show that intraoperative blood loss and blood transfusion can be significantly reduced by optimizing patient positioning and dorsoventral combined warming measures to maintain body temperature. These measures are supplemented by the use of local infiltration of anesthesia and vasoconstrictive drugs at the start and high-dose administration of tranexamic acid in the early stages of the operation. Use of an epidural catheter significantly reduces postoperative, systemic analgesia use and allows rapid mobilization to be initiated. Immobilizing drain and corset treatments can be limited to complex cases. These treatment measures promote patient satisfaction, lead to high-quality, evidence-based care, and contribute to a shorter hospital stay and convalescence of the patient.
Introduction:
Scoliosis could develop at the childhood age and progress beyond skeletal maturity. An early spinal fusion arrests growth of the spine and thorax, risking the development of secondary thoracic insufficiency syndrome. Vertical expandable prosthetic titanium rib (VEPTR) is a fusionless technique aiming to correct the deformity with preservation of growth potential.
Aim:
To show our experience and results regarding the use of VEPTR in children with scoliosis in regard to coronal profiles(length and deformity angle), spinal growth, and the complications we faced during the follow-up of two years after the index procedure.
Methods:
A retrospective analysis of prospectively collected data of a case series. Forty child with scoliosis of different etiologies. Their primary diagnoses were neuromuscular scoliosis in 13, Juvenile idiopathic scoliosis in12, Congenital Scoliosis in 8, syndromatic patients 5 and 2 with Arthrogryposis. All 40 patients received percutaneous rib-to-pelvis or rib to vertebra or rib to rib VEPTR implantation between January 2016 and January 2018. None of them needed blood transfusion. They underwent 56 primary implantation, 16(40%) bilateral system and 24(60%) unilateral followed by lengthening procedure in a period of 4-6 months. The patients were assessed based on mechanical measures, that is, the radiographic improvement of their scoliosis, spinal height, and sagittal and coronal correction, which are measured and compared preoperatively, immediately postoperatively and at two years follow up, complication encountered during this period are also counted.
Results:
The average initial correction in Cobb angle immediately after the index surgery was 14.4° (5°-26°) and the average final correction of Cobb which is measured after the last expansion procedure (Cobb angle of the major curve measured after last expansion minus initial preoperative Cobb angle of the major curve) was 7.3° (12%). The average of preoperative coronal T1-S1 length was 25.6 cm with an average initial correction achieved immediately after implantation of VEPTR of2.8 cm (1.2-5.1cm) which is 10.9%, and the average coronal length gain at 2 years follow up was 5.7 cm (3.7-9.8cm) that is 22.2%. Complication occurred in 18 of our patients (45%).
Conclusion:
Early results of VEPTR for childhood scoliosis are encouraging. Follow-up till skeletal maturity will best determine future indications.
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