Comparison of combined anterior–posterior approach versus posterior-only approach in neuromuscular scoliosis: a systematic review and meta-analysis

Shao, Zewei; Xia, Fang; Lv, Qingyu; Hu, Zhichao; Shao, Shi-Yun; Hu, Yuanbo; Wu, Ai-Min; Wang, Xiangyang

doi:10.1007/s00586-018-5702-1

Cited by 11 publications

(12 citation statements)

References 30 publications

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“…The posterior approach advantages included less operative time and blood loss, shorter hospital stay, and fewer complications. 17 In our series, only 1 case required combined anterior-posterior correction. All the other cases were operated posteriorly with significant curve correction, good clinical results, and a relatively low rate of complications.…”

Section: Discussionmentioning

confidence: 63%

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Scoliosis in RETT Syndrome

Menachem¹,

Hershkovich²,

Ackshota³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Objective: The objective of this study was to discuss the treatment challenges in scoliosis patients with Rett syndrome (RTT) in a national referral centre for RTT. We describe structural characteristics of curves, age of onset, genetic mutation, ambulation status, and treatment through RTT progression. Based on this unique experience, we aimed to suggest guidelines for scoliosis treatment in RTT patients.Summary of Background Data: RTT is a neurodevelopmental disorder associated with a mutation in the methyl-CpG binding protein 2 (MECP2) gene, primarily in females with significant features of growth failure, gastrointestinal and pulmonary dysfunction, ataxia, seizures, and intellectual disability. Scoliosis is the most common orthopedic manifestation of RTT and is present in 64%-75% of patients. No clear guidelines for scoliosis treatment in RTT are available, and typically patients are treated according to guidelines of another neuromuscular scoliosis.Methods: Clinical and radiographic data were gathered, including MECP2 mutation type, scoliosis characteristics, preoperative treatment, surgical treatment, functional status, and postoperative follow-up.Results: Our cohort included 102 patients with RTT. They were 36 who presented with scoliosis; 18 were treated surgically. C-curve was found in 17 patients and S-type in 19. Scoliosis treatment onset was 8.76 years in the C-type group and 13.88 years in the S-type group. The average curve at the time of surgery was 52.42 degrees. The average time until surgery was 2.44 years. Seventeen patients underwent posterior spinal fusion, and 1 patient underwent posterior spinal fusion+anterior spinal fusion with an average correction of 40 degrees. The most common mutation was R255X nucleotide (30% of cases). The most severe curves had mutations R168X and R270X nucleotides.Conclusions: We advise early monitoring for patients with RTT and scoliosis due to early and rapid progression. Common mutations found were R255X, R168X, R270X, and T158M. We recommend surgical treatment in every curve above 45 degrees, independently of age.

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Section: Discussionmentioning

confidence: 63%

“…However, the anterior approach had advantages in correcting pelvic obliquity and decreasing the loss of angle between postoperation and follow-up. The posterior approach advantages included less operative time and blood loss, shorter hospital stay, and fewer complications 17…”

Section: Discussionmentioning

confidence: 99%

Scoliosis in RETT Syndrome

Menachem¹,

Hershkovich²,

Ackshota³

et al. 2022

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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“…The overall confidence in the results of the 28 reviews was rated as “low” in 2 SRs 9 , 10 and “critically low” in the rest 11 - 36 ( Table 3 ). Critical appraisal of each SR is found in Table S2 in the supplemental material.…”

Section: Resultsmentioning

confidence: 99%

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Dettori

Skelly

Brodt

2020

Global Spine Journal

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Study Design: A systematic cross-sectional survey of systematic reviews (SRs). Objective: To evaluate the methodological quality of spine surgery SRs published in 2018 using the updated AMSTAR 2 critical appraisal instrument. Methods: We identified the PubMed indexed journals devoted to spine surgery research in 2018. All SRs of spine surgical interventions from those journals were critically appraised for quality independently by 2 reviewers using the AMSTAR 2 instrument. We calculated the percentage of SRs achieving a positive response for each AMSTAR 2 domain item and assessed the levels of confidence in the results of each SR. Results: We identified 28 SRs from 4 journals that met our criteria for inclusion. Only 49.5% of the AMSTAR 2 domain items satisfied the AMSTAR 2 criteria. Critical domain items were satisfied less often (39.1%) compared with noncritical domain items (57.3%). Domain items most poorly reported include accounting for individual study risk of bias when interpreting results (14%), list and justification of excluded articles (18%), and an a priori establishment of methods prior to the review or registered protocol (18%). The overall confidence in the results was rated “low” in 2 SRs and “critically low” in 26. Conclusions: The credibility of a SR and its value to clinicians and policy makers are dependent on its methodological quality. This appraisal found significant methodological limitations in several critical domains, such that the confidence in the findings of these reviews is “critically low.”

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“…Anterior-only and/or combined fusions are largely invasive procedures, as compared to posterior-only fusions, and have been shown to be associated with significant morbidity in adults 11,12 and pediatric patients. 13,14 It is likely that the invasiveness of the approach may guide the choice of an ICU admission in these patients. We also noted that performing spinal fusions on all types of nonidiopathic scoliosis was also associated with higher odds of ICU admission, and it is probable that the higher comorbidity burden seen in congenital/neuromuscular/syndromic scoliotic types may be playing a role.…”

Section: Discussionmentioning

confidence: 99%

Intensive Care Unit Admission Following Surgery for Pediatric Spinal Deformity: An Analysis of the ACS-NSQIP Pediatric Spinal Fusion Procedure Targeted Dataset

Malik

Kim

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort. Objective: To understand which patient and surgical factors are predictive of an increased odds of undergoing an admission and a prolonged stay >2 days in an intensive care unit (ICU) following corrective surgery for pediatric deformity. Methods: The 2016 American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric Spinal Fusion Procedure Targeted database records, merged with original 2016 ACS-NSQIP Pediatric file variables, were used for this study. Univariate and multivariate analyses were used to identify independent risk factors associated with admission, as well as a prolonged length of stay in the ICU following surgery. Results: A total of 1398 (39.5%) patients required an ICU admission following the procedure—out of whom 416 (29.8%) stayed for more than 2 days. Following adjusted analysis, patient and surgical factors independently associated with an ICU admission were black/African American versus white race, anterior fusion, combined fusion, nonidiopathic scoliosis, preoperative ventilator dependence, asthma, having structural pulmonary abnormality, developmental delay, having a neuromuscular disorder, requiring nutritional support and a total operative time >270 minutes. The only significant factors associated with a prolonged length of ICU stay >2 days were preoperative ventilator dependence, nutritional support requirement, and undergoing anterior or combined fusion. Conclusions: This study is the first of its kind to identify significant patient- and procedure-level factors associated with an ICU admission, and also explores predictors for a prolonged stay in the ICU. Surgeons can use this data to preoperatively counsel families and ensure postoperative course of care is appropriately planned ahead of time.

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Comparison of combined anterior–posterior approach versus posterior-only approach in neuromuscular scoliosis: a systematic review and meta-analysis

Abstract: Level II. These slides can be retrieved under Electronic Supplementary Material.

Cited by 11 publications

References 30 publications

Scoliosis in RETT Syndrome

Scoliosis in RETT Syndrome

Critically Low Confidence in the Results Produced by Spine Surgery Systematic Reviews: An AMSTAR-2 Evaluation From 4 Spine Journals

Intensive Care Unit Admission Following Surgery for Pediatric Spinal Deformity: An Analysis of the ACS-NSQIP Pediatric Spinal Fusion Procedure Targeted Dataset

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