Ryan McMahon1, Sara J Morgan2,3, Jaysson T Brooks4, Patrick Cahill5, Ryan Fitzgerald6, Ying Li7, Walter H Truong8,9,10. 1. Medical School, University of Minnesota, Minneapolis, MN, USA. 2. Gillette Children's Specialty Healthcare, 200 University Ave East, Saint Paul, MN, 55101, USA. 3. Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA. 4. Department of Orthopaedic Surgery, Scottish Rite for Children, Dallas, TX, USA. 5. Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 6. Department of Orthopaedic Surgery, Riley Children's Hospital at Indiana University, Indianapolis, IN, USA. 7. Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA. 8. Gillette Children's Specialty Healthcare, 200 University Ave East, Saint Paul, MN, 55101, USA. wtruong@gillettechildrens.com. 9. Pediatric Spine Foundation, Valley Forge, PA, USA. wtruong@gillettechildrens.com. 10. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA. wtruong@gillettechildrens.com.
Abstract
PURPOSE: Operative and postoperative management of early onset scoliosis (EOS) patients with programmable implanted devices has not been well characterized in the literature. The aim of this study was to describe current practices for pediatric spine surgeons who operate on patients with these devices. METHODS: An electronic survey was distributed to 167 pediatric spine surgeons between January and March of 2021. The survey queried participants on operative and postoperative management of patients with the following implanted devices: vagal nerve stimulators, ventriculoperitoneal shunts, intrathecal baclofen pumps, pacemakers, and cochlear implants. Descriptive statistics were used to assess survey data. RESULTS: Fifty-three respondents (31.7% response rate) with a mean 16.5 (SD 12.0) years in practice completed the survey. Depending on the type of device present, surgeons report changing their operative plan anywhere from 28.6 to 60.1% of the time when inserting magnetically controlled growing rods. Most respondents reported performing transcranial motor evoked potentials (80.0-98.0%) and monopolar cautery (70.0-92.9%) across implanted devices. Only 10% (n = 5) of surgeons reported complications related to operative and/or postoperative management of these patients. No complications were related to cautery, neuromonitoring, or surgical placement of MCGRs. CONCLUSIONS: This study demonstrates variation in operative and postoperative management of these patients with various programmable implanted devices. Much of this inconsistency in practice is likely due to decades old case reports, constantly changing device manufacturer recommendations, and/or published simulation studies. Reported heterogeneity in management across surgeons necessitates development of published guidelines regarding proper operative and postoperative management of patients with EOS and implanted devices.
PURPOSE: Operative and postoperative management of early onset scoliosis (EOS) patients with programmable implanted devices has not been well characterized in the literature. The aim of this study was to describe current practices for pediatric spine surgeons who operate on patients with these devices. METHODS: An electronic survey was distributed to 167 pediatric spine surgeons between January and March of 2021. The survey queried participants on operative and postoperative management of patients with the following implanted devices: vagal nerve stimulators, ventriculoperitoneal shunts, intrathecal baclofen pumps, pacemakers, and cochlear implants. Descriptive statistics were used to assess survey data. RESULTS: Fifty-three respondents (31.7% response rate) with a mean 16.5 (SD 12.0) years in practice completed the survey. Depending on the type of device present, surgeons report changing their operative plan anywhere from 28.6 to 60.1% of the time when inserting magnetically controlled growing rods. Most respondents reported performing transcranial motor evoked potentials (80.0-98.0%) and monopolar cautery (70.0-92.9%) across implanted devices. Only 10% (n = 5) of surgeons reported complications related to operative and/or postoperative management of these patients. No complications were related to cautery, neuromonitoring, or surgical placement of MCGRs. CONCLUSIONS: This study demonstrates variation in operative and postoperative management of these patients with various programmable implanted devices. Much of this inconsistency in practice is likely due to decades old case reports, constantly changing device manufacturer recommendations, and/or published simulation studies. Reported heterogeneity in management across surgeons necessitates development of published guidelines regarding proper operative and postoperative management of patients with EOS and implanted devices.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Behrooz A Akbarnia; Jeff B Pawelek; Kenneth M C Cheung; Gokhan Demirkiran; Hazem Elsebaie; John B Emans; Charles E Johnston; Gregory M Mundis; Hilali Noordeen; David L Skaggs; Paul D Sponseller; George H Thompson; Burt Yaszay; Muharrem Yazici Journal: Spine Deform Date: 2014-10-27
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