期刊论文详细信息
European spine journal
Factors associated with surgical approach and outcomes in cerebral palsy scoliosis
article
Taylor Jackson1  Burt Yaszay1  Paul D. Sponseller2  Peter O. Newton3  Suken A. Shah4  Firoz Miyanji5  Patrick J. Cahill1 
[1] Division of Orthopedics, The Children’s Hospital of Philadelphia;Johns Hopkins University;Rady Children’s Hospital;Nemours/Alfred I duPont Hospital for Children;British Columbia Children’s Hospital
关键词: Cerebral palsy;    Neuromuscular scoliosis;    Posterior spinal fusion;    Anterior spinal fusion;    Staged fusion;   
DOI  :  10.1007/s00586-018-5745-3
来源: Springer
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【 摘 要 】

Neuromuscular scoliosis is often treated with posterior spinal fusion, with or without anterior release, and either a same-day or staged, 2-day procedure. We retrospectively reviewed 222 patients from a prospectively collected, multi-center database of patients with cerebral palsy scoliosis with 2-year follow-up. Baseline characteristics, perioperative, radiographic, and HRQoL measures were compared in six sub-analyses: (1) staged versus same-day surgeries, (2) posterior-only fusion (PSF) versus anterior–posterior spinal fusion (APSF), (3) same-day versus staged PSF, (4) staged versus same-day APSF, (5) same-day PSF versus same-day APSF, (6) staged PSF versus staged APSF. Staged patients had larger curves and more pelvic obliquity, longer anesthesia and surgical times, longer hospital and ICU stays (p < 0.001), and more days intubated (p = 0.021). The staged PSF group had larger curves (p = 0.006), longer anesthesia (p = 0.020) and surgeries (p = 0.007), hospital (p = 0.009) and ICU stays (p = 0.028) compared to same-day PSF. The staged APSF group had longer hospital (p < 0.001) and ICU stays (p = 0.004) and anesthesia and surgeries (p < 0.001). Same-day APSF was associated with larger curves (p < 0.002), longer anesthesia (p = 0.012) and surgeries (p = 0.042), greater residual curves (p = 0.035), and greater absolute correction (p = 0.007) compared to same-day PSF. The staged APSF group had longer anesthesia times (p < 0.001) compared to the staged PSF group. No sub-analysis revealed significant differences in baseline characteristics, complications, or HRQoL. Staged and circumferential approaches tend to be used for greater deformity, but were not associated with superior deformity correction, and were associated with longer operative time, hospital stays, ICU stays, and days intubated. However, for the most severe deformity, other patient factors may play more important roles in treatment decisions given that patients treated with a staged PSF or an APSF, whether staged or not, were similar at baseline. III. These slides can be retrieved under Electronic Supplementary Material.

【 授权许可】

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