Dataset Information

Pelvic fixation in surgical correction of neuromuscular scoliosis.

ABSTRACT:

Background

Surgical correction of neuromuscular scoliosis can be associated with high complication rates, including such associated with pelvic fixation. Up to now it is debated whether and when to include the pelvis into the fusion construct. Therefore, we aimed to illuminate when pelvic fixation is beneficial in surgical correction of neuromuscular scoliosis.

Methods

A prospective cohort of 49 patients (mean age 13 ± 3 y, 63% females, follow up 56 months, range 24-215) who underwent correction of neuromuscular scoliosis including S1/the ileum (n = 18) or without (n = 31) pelvic fixation were included. The outcome was measured with analysis of radiological parameters, clinical improvement and complication/revision rates. Subgroup analysis was performed to find if non-ambulatory patients with gross motor function classification system (GMFCS) levels >III, with larger scoliotic curves (>60°) and moderate pelvic obliquities up to 35° benefit from pelvic fixation.

Results

There was no significant difference in complications when comparing patients with (9 out of 18 patients, 50%) or without (9 out of 31 patients, 29%) fixation to the pelvis (p = .219). Wheelchair bound patients (GMFCS >III) with cobb angles greater than 60° and pelvic obliquity less than 35° (n = 20) revealed no differences in amount of clinical improvement of ambulation with (n = 9) or without (n = 11) pelvic fixation (p: n.s.). And even complication or revision rates where not different in those two groups.

Conclusion

Pelvic fixation does not seem obligatory in wheelchair bound patients per definition. Even with pelvic obliquities up to 35° and large scoliotic curves >60°, avoiding pelvic fixation does not result in higher revision rate or worse clinical outcomes.

SUBMITTER: Farshad M

PROVIDER: S-EPMC9126953 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Pelvic fixation in surgical correction of neuromuscular scoliosis.

Farshad Mazda M Weber Sabrina S Spirig José Miguel JM Betz Michael M Haupt Samuel S

North American Spine Society journal 20220511

<h4>Background</h4>Surgical correction of neuromuscular scoliosis can be associated with high complication rates, including such associated with pelvic fixation. Up to now it is debated whether and when to include the pelvis into the fusion construct. Therefore, we aimed to illuminate when pelvic fixation is beneficial in surgical correction of neuromuscular scoliosis.<h4>Methods</h4>A prospective cohort of 49 patients (mean age 13 ± 3 y, 63% females, follow up 56 months, range 24-215) who under ...[more]

PMID: 35619626

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Project description:BackgroundManagement of neuromuscular scoliosis (NMS) is challenging, with both surgical and conservative options involving risks. This study aimed to evaluate multimorbidity in patients with NMS and how this influences multidisciplinary team (MDT) decisions as well as postoperative outcomes.MethodsA retrospective cohort study of patients referred for assessment by the scoliosis MDT in the 8-year period between 2013 and 2021 from a single tertiary centre.Results84 patients with NMS were referred for assessment to the MDT. The most common underlying cause of NMS was cerebral palsy (51%). The MDT recommended surgery for 60 patients and 24 were conservatively managed. There were no significant differences in age, sex, body mass index or baseline Cobb angle between the two groups. Patients recommended surgery had fewer comorbidities (2.3 vs 3.5, p<0.05) and greater Cobb angle progression in the 18 months prior to MDT decision (22° vs 8°, p<0.05). No single comorbidity significantly influenced the MDT decision. Of the 48 patients that proceeded with surgery, immediate postoperative complications were documented in 54.1%, with no mortality. The most common complications were postoperative anaemia and respiratory infections. Multivariate logistic regression identified the use of non-invasive ventilation, forced vital capacity <70% of predicted and full-time wheelchair use as significant predictors of immediate postoperative complications. Improved posture was the most common long-term outcome (41.7%) and 81.3% of patients reported no complications at 12 months following their surgery.ConclusionsMultimorbidity in children with NMS influences scoliosis MDT decisions, alongside factors such as scoliosis curve progression. Immediate postoperative complications were common but longer term outcomes were favourable for most patients. Further research aiming to better inform shared decision-making, improve surgical selection and ultimately enhance the quality of life for patients with NMS is required.

Project description:BackgroundThe management of hemodynamically unstable pelvic ring injuries necessitates surgical intervention, often involving procedures such as external fixation and percutaneous screw placement. Given the infrequent performance of these procedures, regular training is imperative to ensure readiness for emergencies. Our pre- post simulation study aimed to adapt and validate a realistic simulation model for stabilizing unstable pelvic ring injuries, facilitating participants' knowledge retention and procedural confidence enhancement.MethodsA standardized simulator of an unstable pelvic ring utilizing synthetic pelvic bones featuring complete disruption of the symphysis and sacroiliac joint was developed. Trauma surgeons of a level one academic hospital were invited to perform external fixation and emergency sacroiliac screw application under C-arm guidance. Prior to and following the simulation session, participants completed a subjective questionnaire assessing their confidence in emergency interventions on a 10-point Likert scale (10-LS). Objective parameters, such as intraoperative imaging quality, reduction accuracy, and the positioning of screws, wires, and external fixators, were also evaluated as secondary outcome measures.ResultsFifteen trauma surgeons (10 residents, 5 consultants) participated in the simulation over the course of one day. The mean total operation time was 20.34 ± 6.06 min, without significant differences between consultants and residents (p = 0.604). The confidence for emergency SI-Screw placement increased significantly after the simulator (10-LS: Before = 3.8 ± 3.08 vs. After = 5.67 ± 2.35; p = 0.002) as well as after external fixation (10-LS: Before = 3.93 ± 2.79 vs. After = 6.07 ± 2.52; p = 0.002). In addition, confidence in (intraoperative) pelvic imaging increased significantly (10-LS: Before = 4.60 ± 3.0 vs. After = 6.53 ± 2.39; p = 0.011). Overall, the model was rated as a realistic simulation of clinical practice (10-LS = 7.87 ± 1.13).ConclusionsOur unstable pelvis fracture model is a tool to practice emergency interventions such as external fixation and percutaneous techniques. Participants benefitted from this in terms of technical instrumentation as well as intraoperative imaging. Further studies are required to validate the objective benefits and improvements that participants undergo through frequent training.

Dataset Information

Pelvic fixation in surgical correction of neuromuscular scoliosis.

Background

Methods

Results

Conclusion

Publications

Pelvic fixation in surgical correction of neuromuscular scoliosis.

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