Correction of Neuromuscular Scoliosis in Patients With Preexisting Respiratory Failure

Gill, Inder; Eagle, Michelle; Mehta, Jwalant; Gibson, Michael J.; Bushby, Kate; Bullock, R. E.

doi:10.1097/01.brs.0000239215.87174.8f

Cited by 67 publications

(49 citation statements)

References 17 publications

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“…Rawlins et al [9] reviewed patients with restrictive lung disease and FVC less than 40%, age under 18 and vertebral deformity (32 patients). Gill et al [3] prospectively studied patients with progressive scoliosis, myopathy and respiratory failure (8 patients). The findings from our group of patients and the results from these studies are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Severe restrictive lung disease and vertebral surgery in a pediatric population

et al. 2009

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The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) \40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC \40%, age \19 years and diagnosis of scoliosis. The retrospective study of 24 patients with severe restrictive lung disease, who underwent spinal surgery. Variables studied were age and gender, pre-and postoperative spirometry (FVC, FEV1, FEV1/FVC), preoperative, postoperative and late use of non-invasive ventilation (BiPAP) or mechanical ventilation, associated multidisciplinary treatment, type and location of the curve, pre-and postoperative curve values, type of vertebral fusion, intraand postoperative complications, duration of intensive care unit (ICU) stay and length of postoperative hospitalization. Mean age was 13 years (9-19) of which 13 were males and 11 females. Mean follow-up was 32 months (24-45). The etiology was neuromuscular in 17 patients and other etiologies in 7 patients. Mean preoperative FVC was 26%

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Section: Discussionmentioning

confidence: 99%

Severe restrictive lung disease and vertebral surgery in a pediatric population

et al. 2009

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“…Despite the magnitude of this surgery, the successful outcome of an operation for DMD scoliosis has been considered beneficial by most patients and their principal care providers [1,5,7]. The patient's function will be worse because of the progressively deteriorating nature of the disease as well as further progressive scoliosis if surgery is not performed.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary complications in the peri/postoperative period in DMD patients have been reported to be frequent [1,16,18,21]. Higher pulmonary complications have been reported when the FVC is <30% [7,8,10,19].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, many surgeons have recommended scoliosis surgery only for patients who have a FVC of at least 35-40% [7,18,21]. To prevent pulmonary complications and to increase pulmonary function, we recommend preoperative respiratory muscle training using threshold IMT when the patient decides to undergo surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of studies have reported only data on changes in scoliotic curvature and complications. Irreversible changes in cardiac and pulmonary function pose serious risks to anaesthesia and have been relative contraindications to surgery [7,17,18,20,22,23].…”

Section: Introductionmentioning

confidence: 99%

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Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Takaso

Nakazawa

Imura

et al. 2010

International Orthopaedics (SICOT)

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In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

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Scoliosis Surgery in Children With Neuromuscular Disease

Barsdorf¹,

Sproule²,

Kaufmann³

2010

Arch Neurol

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Background: Scoliosis is a frequent complication of pediatric neuromuscular disease (NMD). Scoliosis surgery in children with NMD is thought to carry greater morbidity and mortality. Objectives: To study demographics, comorbidities, outcomes, and hospitalization expenditures among children with NMD undergoing scoliosis surgery. Design: Using the Kids Inpatient Database, a large allpayer US database of hospital discharges among children and adults younger than 20 years, we studied children undergoing scoliosis surgery between January 1, 1997, and December 31, 2003. Continuous variables were compared by t test, and categorical variables were compared by Pearson product moment correlation 2 test. Setting: National database of pediatric hospital discharges. Patients: Children with and without NMD. Main Outcome Measures: Demographics, hospital length of stay, and in-hospital mortality associated with scoliosis surgery. Results: Of 17 780 reported hospitalizations owing to scoliosis surgery, 437 children (2.5%) had NMD. Compared with children undergoing scoliosis surgery for other indications, children with NMD were more likely to be younger (12.4 vs 14.2 years), male (73.5% vs 38.3%), and insured by Medicaid (35.6% vs 20.3%). Comorbidities that were more common among children with NMD included pulmonary complications (lung disease not classified, pulmonary collapse, pulmonary insufficiency, chronic respiratory failure, and ventilator requirement) and cardiovascular complications (cardiomyopathy, hypotension, and tachycardia). Scoliosis surgery in children with NMD was associated with increased hospital length of stay (10.3 vs 7.7 days) and hospitalization expenditures ($80 251 vs $62 154), and higher in-hospital mortality (1.6% vs 0.2%). Conclusion: Children with NMD have increased hospital length of stay and higher in-hospital mortality associated with scoliosis surgery, highlighting the need for further study of measures that could reduce complications and improve outcomes in this population.

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Correction of Neuromuscular Scoliosis in Patients With Preexisting Respiratory Failure

Abstract: Patients with preexisting respiratory failure on nocturnal noninvasive ventilation can be safely operated for deformity correction. This can help to significantly improve their quality of life.

Cited by 67 publications

References 17 publications

Severe restrictive lung disease and vertebral surgery in a pediatric population

Severe restrictive lung disease and vertebral surgery in a pediatric population

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Scoliosis Surgery in Children With Neuromuscular Disease

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