Bone mineral density evaluation among patients with neuromuscular scoliosis secondary to cerebral palsy

Rezende, Rodrigo; Cardoso, Igor Machado; Leonel, Rayana Bomfim; Perim, Larissa Grobério Lopes; Oliveira, Tarcísio Guimarães Silva; Júnior, Charbel Jacob; Júnior, José Lucas Batista; Lourenço, Rafael Burgomeister

doi:10.1016/j.rboe.2014.12.003

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Risk factors for pseudarthrosis include an increased number of vertebral levels involved in the instrumented fusion, smoking, thoracolumbar kyphosis >20°, and fusion to the sacrum [ 92 ]. Paediatric patients most at risk of pseudarthrosis include patients with neuromuscular conditions, osteoporosis, nutritional deficiency or metabolic bone diseases [ 92 , 93 ]. Amongst patients with neuromuscular scoliosis, patients with myelodysplasia are at significantly increased risk of pseudarthrosis, associated with greater risk of surgical site infection, implant loosening, fusion to sacrum, and high correction loss [ 94 , 95 ].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

Paediatric Spinal Deformity Surgery: Complications and Their Management

Roberts

2022

Healthcare

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Surgical correction of paediatric spinal deformity is associated with risks, adverse events, and complications that must be preoperatively discussed with patients and their families to inform treatment decisions, expectations, and long-term outcomes. The incidence of complications varies in relation to the underlying aetiology of spinal deformity and surgical procedure. Intraoperative complications include bleeding, neurological injury, and those related to positioning. Postoperative complications include persistent pain, surgical site infection, venous thromboembolism, pulmonary complications, superior mesenteric artery syndrome, and also pseudarthrosis and implant failure, proximal junctional kyphosis, crankshaft phenomenon, and adding-on deformity, which may necessitate revision surgery. Interventions included in enhanced recovery after surgery protocols may reduce the incidence of complications. Complications must be diagnosed, investigated and managed expeditiously to prevent further deterioration and to ensure optimal outcomes. This review summarises the complications associated with paediatric spinal deformity surgery and their management.

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Section: Postoperative Complicationsmentioning

confidence: 99%

Paediatric Spinal Deformity Surgery: Complications and Their Management

Roberts

2022

Healthcare

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“…1 Surgical intervention 2,3 is usually indicated for curves greater than 40°, aimed at preventing progression of the curvature, improving sitting posture, facilitating hygiene and improving the patient's quality of life. [3][4][5][6] The approach to postoperative patient management requires caution, as this patient profile has a high potential for complications, with risk rates ranging from 18% to 75%. A recent study showed that 94% of patients with neuromuscular scoliosis had some type of mild complication, such as constipation, in the immediate postoperative period, while a small proportion had more severe complications, with the development of systemic inflammatory response syndrome in 16% of patients, and surgical site infection in 12%.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Patients Undergoing Correction of Neuromuscular Scoliosis With a Controlled Hospital Protocol – Preliminar Outcomes

et al. 2021

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Objectives: To identify the main hospital outcomes of patients undergoing surgical correction of neuromuscular scoliosis and to assess complication rates and achievement of mobility goals after the use of a managed protocol. Methods: This is a longitudinal, retrospective study, with data obtained six months after the application of a protocol in 103 patients of both sexes submitted to surgical correction of neuromuscular scoliosis, at a tertiary level hospital in São Paulo, between June and December 2018 (pre-protocol) and between May and September 2019 (post-protocol). Data from patients who had previously undergone other orthopedic spine surgeries were excluded. In addition to the data for epidemiological characterization of the underlying diseases, the clinical characteristics and complications were analyzed. Results: Of the 103 patients evaluated, there was a predominance of females (53.4%) and a mean age of 14.9 years. The most frequent diagnosis was cerebral palsy, the mean angle of curvature was 75°, and the most frequently observed comorbidities were lung diseases (25%). The protocol was partially adhered to by professionals and after its implementation, there was a significant decrease in pain and the systemic inflammatory response syndrome (SIRS), prevention of immobility and a low rate of infection. Conclusions: The use of a protocol focused on patients undergoing correction of neuromuscular scoliosis led to reduced complications of SIRS and reduced pain; kept the surgical site infection rate low, and prevented short-term immobility. Level of evidence III; Retrospective study.

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“…CMC are at increased risk of having low BMD, leading to pathologic fractures and surgical complications. [20][21][22][23][24][25] BMD in children with cerebral palsy and Rett syndrome decreases in relation to expected values with age. 20,24 Low BMD is a risk factor for instrumentation failure and proximal junctional kyphosis in adult spinal fusion.…”

mentioning

confidence: 99%

“…CMC are at increased risk of having low BMD, leading to pathologic fractures and surgical complications 20–25. BMD in children with cerebral palsy and Rett syndrome decreases in relation to expected values with age 20,24.…”

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confidence: 99%

Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA

Cohen¹,

Berry

Nina

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Children with medical complexity are at increased risk of low bone mineral density (BMD) and complications after spinal fusion compared with idiopathic scoliosis patients. Our aim was to compare treatments and outcomes of children with medical complexity undergoing spinal fusion in those who had dual-energy x-ray absorptiometry (DXA) scans versus those who did not in an effort to standardize the workup of these patients before undergoing spinal surgery. Methods: We conducted a retrospective review of patients with low BMD who underwent spinal fusion at a tertiary care pediatric hospital between 2004 and 2016. We consulted with a pediatric endocrinologist to create standard definitions for low BMD to classify each subject. Regardless of DXA status, all patients were given a clinical diagnosis of osteoporosis [at least 2 long bone or 1 vertebral pathologic fracture(s)], osteopenia (stated on radiograph or by the physician), or clinically low bone density belonging to neither category. The last classification was used for patients whose clinicians had documented low bone density not meeting the criteria for osteoporosis or osteopenia. Fifty-nine patients met the criteria, and 314 were excluded for insufficient follow-up and/or not meeting a diagnosis definition. BMD Z-scores compare bone density ascertained by DXA to an age-matched and sex-matched average. Patients who had a DXA scan were also given a DXA diagnosis of low bone density (≤−2 SD), slightly low bone density (−1.0 to −1.9 SD), or neither (>−1.0 SD) based on the lowest BMD Z-score recorded. Results: Fifty-nine patients were analyzed. Fifty-four percent had at least 1 DXA scan preoperatively. Eighty-one percent of DXA patients received some form of treatment compared with 52% of non-DXA patients (P=0.03). Conclusions: Patients referred for DXA scans were more likely to be treated for low BMD, although there is no standardized system in place to determine which patients should get scans. Our research highlights the need to implement clinical protocols to optimize bone health preoperatively. Level of Evidence: Level II—retrospective prognostic study.

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Bone mineral density evaluation among patients with neuromuscular scoliosis secondary to cerebral palsy

Cited by 5 publications

References 15 publications

Paediatric Spinal Deformity Surgery: Complications and Their Management

Paediatric Spinal Deformity Surgery: Complications and Their Management

Clinical Outcomes of Patients Undergoing Correction of Neuromuscular Scoliosis With a Controlled Hospital Protocol – Preliminar Outcomes

Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA

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