Perioperative Considerations in Patients with Rett Syndrome as Compared to Those with Cerebral Palsy.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2024-11-06 DOI:10.1097/BRS.0000000000005210

Vishal Sarwahi, Effat Rahman, Katherine Eigo, Jesse Galina, Sayyida Hasan, Andrew Ko, Yungtai Lo, Terry Amaral, Aleksandra Djukic, Maria Santiago, James Schneider

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引用次数: 0

Abstract

Study design: Retrospective cohort study.

Objective: This study aimed to compare perioperative outcomes of Rett syndrome and Cerebral palsy patients undergoing posterior spinal fusion for neuromuscular scoliosis.

Summary of background data: Surgical correction in the treatment of scoliosis for patients with Rett syndrome (RS) has been shown to increase survival rate. Cerebral palsy (CP) patients, like RS patients, are often nonverbal, nonambulatory, with frequent surgical complications.

Methods: Retrospective review of 36 RS and 80 CP patients undergoing PSF from 2005-2023. Data and x-ray measurements were collected pre- and post-operatively. Sub-analysis was performed comparing non-ambulatory patients (GMFCS IV-V). Wilcoxon-Rank Sum, Fisher's Exact, and Chi-square tests were utilized.

Results: The primary outcome measure, complication rates, was similar between the groups (P=0.09). Preoperative Cobb angle, levels fused, fixation points, and LOS were similar (P>0.05). EBL was significantly higher in CP patients as was rate of transfusion (P=0.001) and surgical time (P=0.001). Postoperative Cobb angle (P=0.002) was significantly higher for CP patients. There was no significant difference between CP and RS patients in both preoperative (P=0.383) and postoperative (P=0.051) coronal decompensation. Nonambulatory status was associated with increased odds of having a postoperative complication (OR=6.17, 95% C.I. 1.36 - 28.04). Sub-analysis of non-ambulatory RS and CP patients revealed significantly higher postoperative Cobb (P=0.008), EBL (P=0.019) and surgical time (P=0.017) in CP patients compared to RS patients. There were no significant differences in preoperative Cobb, levels fused, fixation points, hospital stay, or complication rate (P>0.05).

Conclusion: RS patients are shown to have better outcomes to CP patients in terms of surgical, perioperative, and radiographic variables. Ambulatory status was identified as an independent risk factor for complications.

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与脑瘫患者相比，雷特综合征患者的围手术期注意事项。

研究设计回顾性队列研究：本研究旨在比较接受脊柱后路融合术治疗神经肌肉性脊柱侧凸的雷特综合征和脑瘫患者的围手术期结果：对雷特综合征（Rett Syndrome，RS）患者进行脊柱侧弯手术矫正可提高存活率。脑性瘫痪（CP）患者与RS患者一样，通常不说话、不行动，手术并发症频繁：方法：回顾性分析 2005-2023 年间接受 PSF 手术的 36 名 RS 患者和 80 名 CP 患者。方法：对 2005-2023 年间接受 PSF 手术的 36 名 RS 患者和 80 名 CP 患者进行回顾性回顾，收集术前和术后数据及 X 光测量结果。对非行动不便的患者（GMFCS IV-V）进行子分析比较。采用了 Wilcoxon-Rank Sum、费雪精确检验和卡方检验：主要结果指标--并发症发生率--在两组间相似（P=0.09）。术前Cobb角、融合水平、固定点和LOS相似（P>0.05）。CP患者的EBL明显更高，输血率（P=0.001）和手术时间（P=0.001）也明显更高。CP 患者的术后 Cobb 角（P=0.002）明显更高。CP 和 RS 患者在术前（P=0.383）和术后（P=0.051）冠状面失代偿方面没有明显差异。非行动不便与术后并发症几率增加有关（OR=6.17，95% C.I. 1.36 - 28.04）。对无法行走的RS和CP患者进行的子分析显示，CP患者的术后Cobb（P=0.008）、EBL（P=0.019）和手术时间（P=0.017）明显高于RS患者。在术前Cobb、融合水平、固定点、住院时间和并发症发生率等方面没有明显差异（P>0.05）：结论：就手术、围手术期和放射学变量而言，RS 患者的疗效优于 CP 患者。不卧床状态被认为是并发症的独立风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.