Surgical Treatment of Scoliosis Associated with Myelomeningocele

Stella, G.; Ascani, E.; Cervellati, S.; Bettini, N.; Scarsi, Mirko; Vicini, M.; Magillo, Paolo; Carbone, M.

doi:10.1055/s-2008-1071247

Cited by 35 publications

(23 citation statements)

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“…11,13,23,31 Contradictory documentation of the benefits of 1-stage versus multistage procedures exists. 3,10,19,21,30,34,35 In the current study, the overall complication rate corresponds to the lower rate of earlier reports, despite a selected patient population with the highest risk factors. There were no perioperative deaths or neurological complications.…”

Section: Discussionsupporting

confidence: 75%

One-stage major spine deformity correction surgery: comparison between groups with and without additional neurosurgical intervention, with more than 24 months of follow-up

Murans

Gustavsson²,

Saraste

2010

SPI

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Object Early-onset, nonidiopathic spine deformities are frequently caused by intraspinal anomalies necessitating both neurosurgical and orthopedic intervention. The clinical tradition at most treatment units is to perform neurosurgical and orthopedic procedures separately. Sometimes the deformity correction surgery is also done in stages, which leads to several periods of hospitalization, increased use of health care resources, and a long rehabilitation time for the patient. The purpose of this project was to perform an outcome survey for major spine surgery in high-risk patients, and to analyze whether an additional neurosurgical intervention during the same session increased the risk of complications. Methods A consecutive series of 81 patients with major rigid spine deformities treated by the same orthopedic surgeon was analyzed. In 24 of 81 cases there were additional intraspinal pathological entities indicating a neurosurgical procedure. All cases were divided into 2 groups: one with anterior-posterior surgery and also neurosurgery, and the other with anterior-posterior surgery but without neurosurgery. The result variables for the group comparisons were as follows: clinical and radiographic outcome, operating time, length of intensive care and hospital stay, relative blood loss, and occurrence of complications or adverse events. Groups were similar in terms of sex, size of spinal curve, and surgical procedures, but different in terms of diagnosis (there were more patients with myelomeningocele in the group treated with both anterior-posterior surgery and neurosurgery) and patient age (the group with both anterior-posterior surgery and neurosurgery was younger). Results An additional neurosurgical procedure combined with fusion surgery did not increase the complication rate or use of resources compared with fusion surgery alone, except in the length of operating time. The mean correction of the spinal curve was 56.7%, and the mean correction of the pelvic obliquity was 74.7%. The loss of correction was 3° on average. A more than 10° progression was seen in 9 cases. There were no deaths, and there were no neurological complications or surgery-related deterioration of ambulatory function. There were 10 complications that altered the planned postoperative course, including 5 infections. Conclusions One-stage major spine surgery, even when neurosurgery is included, is safe and does not increase the risk of complications. The increase in hospital and ICU stays is marginal.

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Section: Discussionsupporting

confidence: 75%

One-stage major spine deformity correction surgery: comparison between groups with and without additional neurosurgical intervention, with more than 24 months of follow-up

Murans

Gustavsson²,

Saraste

2010

SPI

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“…The correction and fusion were higher in patients receiving combined anterior and posterior fusion. The nonunion rate was 46% in the posterior only fusion group [20] compared with 14% to 23% in the combined anterior and posterior group [4,20,27]. No study provided comparative data on complications, including infection, comparing different surgical approaches.…”

Section: Resultsmentioning

confidence: 99%

“…Stella et al [27] reviewed, at an average of 8 years' followup, the surgical treatment of 14 patients with scoliosis and spina bifida. Although the numbers are small, the conclusion of the authors was that combined anterior and posterior surgery with fusion to the sacrum provided the best results.…”

Section: Scoliosismentioning

confidence: 99%

“…Although the numbers are small, the conclusion of the authors was that combined anterior and posterior surgery with fusion to the sacrum provided the best results. Stella et al [27] evaluated 29 patients with spina bifida who were treated using spinal fusion techniques, seven by posterior arthrodesis, three by anterior arthrodesis, and 19 by the combined anterior and posterior approach. The correction of deformity was highest in the combined anterior and posterior instrumentation and fusion group with 14% nonunion.…”

Section: Scoliosismentioning

confidence: 99%

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Hip and Spine Surgery is of Questionable Value in Spina Bifida: An Evidence-based Review

Wright

2011

Clinical Orthopaedics &Amp; Related Research

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“…4,12,[14][15][16]21 Some patient cohorts are at an increased risk for SSIs after spinal fusion; SSI rates for patients with spinal dysraphism range from 8% to 41.7%, and for those with cerebral palsy range from 6.1% to 15.2%. 1,2,6,9,17,19,20 Surgical site infections impart a tremendous burden on the health and well-being of patients and their families and bear a significant cost to the health care system 8 and to the individual health care provider as future reimbursement practices in the US health care system incorporate pay-for-performance measures and attempt to link patient outcomes to provider payments.Considerable variation exists in infection prevention practices for spine surgery by the center and by the sur-Object. Quality improvement methods are being implemented in various areas of medicine.…”

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confidence: 99%

A standardized protocol to reduce pediatric spine surgery infection: a quality improvement initiative

Ryan¹,

Sen²,

Staggers³

et al. 2014

PED

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Object Quality improvement methods are being implemented in various areas of medicine. In an effort to reduce the complex (instrumented) spine infection rate in pediatric patients, a standardized protocol was developed and implemented at an institution with a high case volume of instrumented spine fusion procedures in the pediatric age group. Methods Members of the Texas Children's Hospital Spine Study Group developed the protocol incrementally by using the current literature and prior institutional experience until consensus was obtained. The protocol was prospectively applied to all children undergoing complex spine surgery starting August 21, 2012. Acute infections were defined as positive wound cultures within 12 weeks of surgery, defined in alignment with current hospital infection control criteria. Procedures and infections were measured before and after protocol implementation. This protocol received full review and approval of the Baylor College of Medicine institutional review board. Results Nine spine surgeons performed 267 procedures between August 21, 2012, and September 30, 2013. The minimum follow-up was 12 weeks. The annual institutional infection rate prior to the protocol (2007–2011) ranged from 3.4% to 8.9%, with an average of 5.8%. After introducing the protocol, the infection rate decreased to 2.2% (6 infections of 267 cases) (p = 0.0362; absolute risk reduction 3.6%; relative risk 0.41 [95% CI 0.18–0.94]). Overall compliance with data form completion was 63.7%. In 4 of the 6 cases of infection, noncompliance with completion of the data collection form was documented; moreover, 2 of the 4 spine surgeons whose patients experienced infections had the lowest compliance rates in the study group. Conclusions The standardized protocol for complex spine surgery significantly reduced surgical site infection at the authors' institution. The overall compliance with entry into the protocol was good. Identification of factors associated with post–spine surgery wound infection will allow further protocol refinement in the future.

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Surgical Treatment of Scoliosis Associated with Myelomeningocele

Cited by 35 publications

References 0 publications

One-stage major spine deformity correction surgery: comparison between groups with and without additional neurosurgical intervention, with more than 24 months of follow-up

One-stage major spine deformity correction surgery: comparison between groups with and without additional neurosurgical intervention, with more than 24 months of follow-up

Hip and Spine Surgery is of Questionable Value in Spina Bifida: An Evidence-based Review

A standardized protocol to reduce pediatric spine surgery infection: a quality improvement initiative

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