What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-05-05 DOI:10.1097/BRS.0000000000005380

Brandon Yoshida, Jacquelyn N Valenzuela-Moss, Tyler A Tetreault, Tishya A L Wren, Tiffany Phan, Gerard K Williams, Lindsay M Andras, Michael J Heffernan

{"title":"What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis.","authors":"Brandon Yoshida, Jacquelyn N Valenzuela-Moss, Tyler A Tetreault, Tishya A L Wren, Tiffany Phan, Gerard K Williams, Lindsay M Andras, Michael J Heffernan","doi":"10.1097/BRS.0000000000005380","DOIUrl":null,"url":null,"abstract":"Study design: Retrospective study.Objective: Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS).Summary of background data: Despite previous attempts to determine the impact of curve magnitude on outcomes after posterior spinal fusion (PSF) in NMS, equipoise remains regarding optimal surgical timing.Methods: Patients aged 7-21 years with NMS and fusion to the pelvis at a single tertiary hospital were retrospectively reviewed. Patient demographics, surgical parameters, complications, and radiographic measurements were collected. Clinical and radiographic outcomes were compared between patients with pre-operative curves≥80° and <80°.Results: 337 patients met inclusion criteria with a mean curve of 83.1°±26.5°. Patients with curves≥80° had greater blood loss (994±607 vs 764±535 mL, P=0.0003), transfusion requirement (795±647 vs 478±482 mL, P<0.0001), surgical time (418±117 vs 338±117 min, P<0.0001), anesthesia time (552±123 vs 472±122 min, P<0.0001), and ICU stay (3±2 vs 2±1 d, P=0.009) compared to patients with curves<80°. Continued intubation was 2.4 times more likely (OR 2.4; 95% CI [1.5, 3.9], P=0.0002) and the odds of utilizing adjunctive surgical techniques (i.e. intraoperative halo traction, temporary rods, and/or staged procedures) were 4 times more likely for patients with curves≥80° (OR 4.1; 95% CI [2.5, 6.6], P<0.0001). The use of spinal osteotomies was more likely among patients with larger curves (OR 4.6; 95% CI [2.8, 7.2], P<0.0001). Residual curve magnitude (44.7°±20.5° vs 22.6°±13.6°, P<0.0001) and pelvic obliquity (10.2°±12 .6° vs 4.8°±8.7°, P<0.0001) were higher in the≥80° group. Those with curves ≥80° were 3 times more likely to experience a change in neuromonitoring signals during surgery (OR 3.07; 95%CI:[1.40, 6.73], P=0.003).Conclusion: Curve magnitude≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005380","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Study design: Retrospective study.

Objective: Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS).

Summary of background data: Despite previous attempts to determine the impact of curve magnitude on outcomes after posterior spinal fusion (PSF) in NMS, equipoise remains regarding optimal surgical timing.

Methods: Patients aged 7-21 years with NMS and fusion to the pelvis at a single tertiary hospital were retrospectively reviewed. Patient demographics, surgical parameters, complications, and radiographic measurements were collected. Clinical and radiographic outcomes were compared between patients with pre-operative curves≥80° and <80°.

Results: 337 patients met inclusion criteria with a mean curve of 83.1°±26.5°. Patients with curves≥80° had greater blood loss (994±607 vs 764±535 mL, P=0.0003), transfusion requirement (795±647 vs 478±482 mL, P<0.0001), surgical time (418±117 vs 338±117 min, P<0.0001), anesthesia time (552±123 vs 472±122 min, P<0.0001), and ICU stay (3±2 vs 2±1 d, P=0.009) compared to patients with curves<80°. Continued intubation was 2.4 times more likely (OR 2.4; 95% CI [1.5, 3.9], P=0.0002) and the odds of utilizing adjunctive surgical techniques (i.e. intraoperative halo traction, temporary rods, and/or staged procedures) were 4 times more likely for patients with curves≥80° (OR 4.1; 95% CI [2.5, 6.6], P<0.0001). The use of spinal osteotomies was more likely among patients with larger curves (OR 4.6; 95% CI [2.8, 7.2], P<0.0001). Residual curve magnitude (44.7°±20.5° vs 22.6°±13.6°, P<0.0001) and pelvic obliquity (10.2°±12 .6° vs 4.8°±8.7°, P<0.0001) were higher in the≥80° group. Those with curves ≥80° were 3 times more likely to experience a change in neuromonitoring signals during surgery (OR 3.07; 95%CI:[1.40, 6.73], P=0.003).

Conclusion: Curve magnitude≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.

查看原文本刊更多论文

当你等待时会发生什么？神经肌肉性脊柱侧凸的大弯曲需要更多的资源来减少矫治。

研究设计：回顾性研究。目的：评估曲线大小对神经肌肉性脊柱侧凸（NMS）手术治疗过程中手术复杂性、资源利用和结果的影响。背景资料总结：尽管之前尝试确定曲线大小对NMS后路脊柱融合术（PSF）后结果的影响，但关于最佳手术时间的平衡仍然存在。方法：回顾性分析某三甲医院7 ~ 21岁行NMS合并骨盆融合的患者。收集患者人口统计资料、手术参数、并发症和放射学测量数据。比较术前曲线≥80°患者的临床和影像学结果。结果：337例患者符合纳入标准，平均曲线为83.1°±26.5°。曲线≥80°的患者出血量更大（994±607 vs 764±535 mL， P=0.0003），输血需水量更大（795±647 vs 478±482 mL）。结论：曲线≥80°的患者残留曲线更大，尽管增加了手术复杂性，提高了NMS管理的资源利用率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

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.