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Pediatric posterior spinal fusion

Karen Thomson, Sophie R Pestieau, Janish J Patel, Heather Gordish-Dressman, Ariana Mirzada, Zeev N Kain, Matthew E Oetgen
BACKGROUND: The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children's National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS). METHODS: A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population...
October 3, 2016: Anesthesia and Analgesia
Brianne Bordes, David Martin, Brian Schloss, Allan Beebe, Walter Samora, Jan Klamar, David Stukus, Joseph D Tobias
When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss...
July 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Mathew D Schur, Gideon W Blumstein, Derek A Seehausen, Patrick A Ross, Lindsay M Andras, David L Skaggs
BACKGROUND: Intraoperative hypothermia may be associated with increased blood loss due to the effects of temperature on clotting but this has not been evaluated in the setting of pediatric posterior spinal fusion (PSF). The purpose of this study was to determine if a correlation exists between intraoperative hypothermia and estimated blood loss (EBL) or transfusion requirements in pediatric patients undergoing PSF. METHODS: A retrospective review of consecutive patients undergoing PSF for scoliosis at a single institution between 6/2004 and 3/2012 was performed...
September 3, 2016: Journal of Pediatric Orthopedics
Charles E Mackel, Patrick J Cahill, Marie Roguski, Amer F Samdani, Patrick A Sugrue, Noriaki Kawakami, Peter F Sturm, Joshua M Pahys, Randal R Betz, Ron El-Hawary, Steven W Hwang
OBJECTIVE The authors performed a study to identify clinical characteristics of pediatric patients diagnosed with Chiari I malformation and scoliosis associated with a need for spinal fusion after posterior fossa decompression when managing the scoliotic curve. METHODS The authors conducted a multicenter retrospective review of 44 patients, aged 18 years or younger, diagnosed with Chiari I malformation and scoliosis who underwent posterior fossa decompression from 2000 to 2010. The outcome of interest was the need for spinal fusion after decompression...
September 2, 2016: Journal of Neurosurgery. Pediatrics
Rebecca E Rosenberg, Stacey Trzcinski, Mindy Cohen, Mark Erickson, Thomas Errico, Lisa McLeod
STUDY DESIGN: Comparative effectiveness database study. OBJECTIVE: To describe variation in use of adjuvant therapies for managing postoperative pain in in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic (AIS) and determine association between use of these therapies and patient outcomes. SUMMARY OF BACKGROUND DATA: Variation in postoperative pain management for children undergoing PSF for AIS likely impacts outcomes...
August 31, 2016: Spine
Marina Perelló, David Artés, Cristina Pascuets, Elisabeth Esteban, Ana Maria Ey
STUDY DESIGN: Randomized, double-blind, placebo-controlled study, with a six-month follow-up period. OBJECTIVES: To test the hypothesis that a 72-hour dose of subanesthetic ketamine in this surgical procedure reduces postoperative morphine use; To assess if there are fewer adverse effects, if postoperative recovery is faster, if there is less peri-incisional hyperalgesia or if there is lower incidence of persistent postsurgical pain. SUMMARY OF BACKGROUND DATA: Tissue injury and high opioid requirements following posterior spinal fusion surgery produce central sensitization, which can in turn be associated with hyperalgesia and chronic pain...
July 7, 2016: Spine
Yingsong Wang, Noriaki Kawakami, Taichi Tsuji, Tetsuya Ohara, Yoshitaka Suzuki, Toshiki Saito, Ayato Nohara, Ryoji Tauchi, Kazuki Kawakami
STUDY DESIGN: A retrospective study. OBJECTIVE: To investigate whether PJK or obvious proximal junctional angle (PJA) changes in the sagittal plane develops following short fusion in children younger than 10 years of age with congenital scoliosis, and to investigate the possible risk factors. SUMMARY OF BACKGROUND DATA: Proximal junctional kyphosis (PJK) following long spinal fusion in adolescents and adults is a serious postoperative complication...
June 20, 2016: Clinical Spine Surgery
Kavelin Rumalla, Chester K Yarbrough, Andrew J Pugely, Linda Koester, Ian G Dorward
OBJECTIVE The objective of this study was to determine if the recent changes in technology, surgical techniques, and surgical literature have influenced practice trends in spinal fusion surgery for pediatric neuromuscular scoliosis (NMS). In this study the authors analyzed recent trends in the surgical management of NMS and investigated the effect of various patient and surgical factors on in-hospital complications, outcomes, and costs, using the Nationwide Inpatient Sample (NIS) database. METHODS The NIS was queried from 2002 to 2011 using International Classification of Diseases, Ninth Edition, Clinical Modification codes to identify pediatric cases (age < 18 years) of spinal fusion for NMS...
May 20, 2016: Journal of Neurosurgery. Spine
M Alysse Jacklen, Jason A Campagna, Joseph D Tobias
Various factors may be responsible for blood pressure alterations during perioperative care. When these physiologic alterations require treatment, several therapeutic options are available. Clevidipine is an ultrashort-acting, intravenous L-type calcium channel antagonist of the dihydropyridine class. Anecdotal experience has demonstrated its efficacy in various clinical scenarios in the pediatric population. We report apparent resistance to the vasodilatory effects of clevidipine in a 13-year-old girl who presented for anesthetic care during posterior spinal fusion for neuromuscular scoliosis whose chronic medication regimen included aripiprazole and methylphenidate for the treatment of depression and attention-deficit/hyperactivity disorder...
2014: Journal of Experimental Pharmacology
Seth H Richman, Andrew J Razzano, Melanie A Morscher, Patrick M Riley
STUDY DESIGN: Case report. OBJECTIVE: To report a case of progressive pain and paraparesis secondary to metallosis four years after a pediatric posterior spinal fusion (PSF). SUMMARY OF BACKGROUND DATA: Metallosis as a late complication of pediatric spinal surgery is rarely reported. Myelographic computed tomography (CT) can be helpful in establishing the diagnosis. The use of serum chromium levels as a means of definitive diagnosis has been suggested, but has only been reported retrospectively...
May 11, 2016: Spine
Jean-Marc Mac-Thiong, Jahangir Asghar, Stefan Parent, Harry L Shufflebarger, Amer Samdani, Hubert Labelle
Anterior release and fusion is sometimes required in pediatric patients with thoracic scoliosis. Typically, a formal anterior approach is performed through open thoracotomy or video-assisted thoracoscopic surgery. The authors recently developed a technique for anterior release and fusion in thoracic scoliosis referred to as "posterior convex release and interbody fusion" (PCRIF). This technique is performed via the posterior-only approach typically used for posterior instrumentation and fusion and thus avoids a formal anterior approach...
September 2016: Journal of Neurosurgery. Spine
Austin E Sanders, Lindsay M Andras, Paul D Choi, Vernon T Tolo, David L Skaggs
STUDY DESIGN: Prospective study of consecutive patients. OBJECTIVE: The purpose of the study was to evaluate the incidence, risk factors, and time to resolution of lateral femoral cutaneous nerve palsy (LFCNP) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: No prior studies have prospectively evaluated the prevalence of LFCNP exclusively in the treatment of AIS. METHODS: Between June 2014 and May 2015, patients undergoing PSF for AIS were examined preoperatively, postoperatively, and at follow-up clinic visits until the resolution of the LFCNP...
October 1, 2016: Spine
Tyler Christman, Ying Li
CONTEXT: Pediatric patients who undergo spinal surgery are frequently involved in sporting activities. Return to play is often an important postoperative concern for the patient and family. EVIDENCE ACQUISITION: A PubMed search was conducted for articles in the English language on return to play after treatment of pediatric acute disc herniation, degenerative disc disease, spondylolysis, spondylolisthesis, and scoliosis from 1980 to 2015. Reference lists were reviewed for additional pertinent articles...
July 2016: Sports Health
Xuesong Wang, Gang Sun, Ruifu Sun, Chenglei Ba, Xiaojin Gong, Weibo Liu, Rui Zhai
STUDY DESIGN: A prospective, randomized, controlled clinical study. OBJECTIVE: To determine the efficacy of bipolar sealer device in reducing perioperative blood loss and transfusions in degenerative lumbar scoliosis patients undergoing primary posterior spinal fusion. BACKGROUND: It has recently been used successfully in pediatric spine surgery, particularly in idiopathic and neuromuscular deformities. However, there is a dearth of literature on prospective study of the efficacy of bipolar sealer device in reducing perioperative blood loss and transfusions in patients undergoing degenerative lumbar scoliosis surgery...
March 2016: Clinical Spine Surgery
Shenglin Wang, Ming Yan, Peter G Passias, Chao Wang
STUDY DESIGN: Retrospective case series of atlantoaxial rotatory fixed dislocation (AARFD). OBJECTIVE: To describe clinical features and the surgical treatment of AARFD. SUMMARY OF BACKGROUND DATA: The classification and treatment strategy for atlantoaxial rotatory fixation (AARF) were previously described and remained controversial. AARF concomitant with atlantoaxial dislocation has different clinical features and treatment strategy with the most AARF...
June 2016: Spine
Phillip S Adams, Antonio Cassara
Polyuria related to pharmacologic α2-adrenoreceptor agonism has been well described in vitro and in animal models and is thought to be the result of functional antagonism of arginine vasopressin. Despite its widespread use as a sedative and anesthetic adjunct, very few reports of dexmedetomidine-related polyuria in humans exist in the literature. We present the first description of a pediatric patient manifesting polyuria and hypernatremia in association with dexmedetomidine infusion for posterior spinal fusion...
April 2016: Journal of Anesthesia
Zhengfeng Zhang, Honggang Wang, Wenjie Zheng
STUDY DESIGN: A retrospective study. OBJECTIVE: The goal of this retrospective study was to describe the uncommon presentation of neurological deficits in patients with congenital kyphosis of the upper thoracic spine (T1-T4). SUMMARY OF BACKGROUND DATA: Congenital kyphosis is an uncommon deformity but can potentially lead to spinal cord compression and paraplegia, particularly in type I (failure of formation) deformities. Few reports have described compressive myelopathy associated with congenital kyphosis of the upper thoracic spine...
November 12, 2015: Journal of Spinal Disorders & Techniques
Bryce A Basques, Adam M Lukasiewicz, Andre M Samuel, Matthew L Webb, Daniel D Bohl, Brian G Smith, Jonathan N Grauer
BACKGROUND: Quality improvement in orthopaedic surgery has received increasing attention; however, there is insufficient information available about the perioperative safety of many common pediatric orthopaedic procedures. This study aimed to characterize the incidence of adverse events in a national pediatric patient sample to understand the risk profiles of common pediatric orthopaedic procedures, and to identify patients and operations that are associated with increased rates of adverse outcomes...
November 10, 2015: Journal of Pediatric Orthopedics
Ben A Strickland, Christina Sayama, Valentina Briceño, Sandi K Lam, Thomas G Luerssen, Andrew Jea
OBJECT In a previous study, the authors reported on their experience with the use of sublaminar polyester bands as part of segmental spinal constructs. However, the risk of neurological complications with sublaminar passage of instrumentation, such as spinal cord injury, limits the use of this technique. The present study reports the novel use of subtransverse process polyester bands in posterior instrumented spinal fusions of the thoracic and lumbar spines and sacrum or ilium in 4 patients. METHODS The authors retrospectively reviewed the demographic and procedural data of patients who had undergone posterior instrumented fusion using subtransverse process polyester bands...
October 30, 2015: Journal of Neurosurgery. Pediatrics
Dmitri van Popta, John Stephenson, Rajat Verma
BACKGROUND CONTEXT: Corrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature. PURPOSE: This study aimed to identify predictors of gain in SH following corrective surgery for AIS. We present a unique model to predict postoperative height prior to intervention, which could contribute to the preoperative counseling and consenting process...
February 2016: Spine Journal: Official Journal of the North American Spine Society
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