Jennifer Kunes1, Theodore Quan2, Rajiv Iyer3, Adam N Fano1, Hiroko Matsumoto1,4, Mark Erickson5, Richard McCarthy6, Douglas Brockmeyer7, Richard C E Anderson8, Michael G Vitale1,9. 1. Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA. 2. Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA. teddyquan@gwu.edu. 3. Department of Neurosurgery, Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, UT, 84113, USA. 4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA. 5. Department of Orthopaedics, Children's Hospital Colorado, Aurora, CO, 80045, USA. 6. Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA. 7. Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84113, USA. 8. New York University, Hassenfeld Children's Hospital at NYU Langone, New York, NY, 10016, USA. 9. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA.
Abstract
PURPOSE: In patients with early onset scoliosis (EOS) and intraspinal anomalies, surgery may be necessary for both the tethered spinal cord (TSC) and spinal deformity. The purpose of this study was to determine if there is a difference in complications when TSC release and surgery for spinal deformity correction (SDC) are performed separately compared simultaneously. METHODS: EOS patients with TSC who underwent detethering and SDC surgeries were identified through a multicenter registry. Patients were stratified into two groups. The simultaneous cohort consisted of patients receiving both detethering and SDC surgeries in a single anesthetic event on the same day, and the staged cohort consisted of patients undergoing detethering and SDC on two separate occasions. Postoperative complications up to 180 days for either surgery were assessed. RESULTS: Twenty five (65.8%) patients were staged and 13 (34.2%) underwent a simultaneous approach. Percent curve correction following SDC surgery did not significantly differ between the groups (p = 0.36). Within 90 days postoperatively, 16 complications in 11 patients (44.0%) occurred in the staged group, whereas no complications occurred in the simultaneous cohort (p = 0.006). From 90-days to 180-days postoperatively, 4 additional complications in 3 patients (12.0%) occurred in the staged group, with no complications reported in the same timeframe for the simultaneous cohort. CONCLUSION: To our knowledge, this is the largest multicenter comparative study to date, and it suggests that a simultaneous approach can be performed safely for EOS patients undergoing detethering and SDC surgeries, with a potentially lower risk profile than the traditional staged approach to these pathologies. LEVEL OF EVIDENCE: Level III.
PURPOSE: In patients with early onset scoliosis (EOS) and intraspinal anomalies, surgery may be necessary for both the tethered spinal cord (TSC) and spinal deformity. The purpose of this study was to determine if there is a difference in complications when TSC release and surgery for spinal deformity correction (SDC) are performed separately compared simultaneously. METHODS: EOS patients with TSC who underwent detethering and SDC surgeries were identified through a multicenter registry. Patients were stratified into two groups. The simultaneous cohort consisted of patients receiving both detethering and SDC surgeries in a single anesthetic event on the same day, and the staged cohort consisted of patients undergoing detethering and SDC on two separate occasions. Postoperative complications up to 180 days for either surgery were assessed. RESULTS: Twenty five (65.8%) patients were staged and 13 (34.2%) underwent a simultaneous approach. Percent curve correction following SDC surgery did not significantly differ between the groups (p = 0.36). Within 90 days postoperatively, 16 complications in 11 patients (44.0%) occurred in the staged group, whereas no complications occurred in the simultaneous cohort (p = 0.006). From 90-days to 180-days postoperatively, 4 additional complications in 3 patients (12.0%) occurred in the staged group, with no complications reported in the same timeframe for the simultaneous cohort. CONCLUSION: To our knowledge, this is the largest multicenter comparative study to date, and it suggests that a simultaneous approach can be performed safely for EOS patients undergoing detethering and SDC surgeries, with a potentially lower risk profile than the traditional staged approach to these pathologies. LEVEL OF EVIDENCE: Level III.
Authors: John E Tis; Lawrence I Karlin; Behrooz A Akbarnia; Laurel C Blakemore; George H Thompson; Richard E McCarthy; Carlos A Tello; Michael J Mendelow; Edward P Southern Journal: J Pediatr Orthop Date: 2012 Oct-Nov Impact factor: 2.324
Authors: Mustafa Barutçuoğlu; Mehmet Selçuki; Ahmet Sukru Umur; Mesut Mete; Seren Gulsen Gurgen; Deniz Selcuki Journal: Indian J Orthop Date: 2016 Jan-Feb Impact factor: 1.251