Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular scoliosis: a preliminary report

Oyoun, Nariman Abol; Stuecker, Ralf

doi:10.1016/j.spinee.2013.07.484

Cited by 30 publications

(29 citation statements)

References 28 publications

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“…2) [6,7,9–15,18–169]. The pooled average SSI rate was calculated to be 1.9% (median, 3.3%; range, 0.1%–22.6%) based on 196 different study cohorts (some studies had more than one cohort).…”

Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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Background: Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs.Methods: PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations.Results: Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%–22.6%) and 1.0% (median, 2.0%; range, 0.02%–10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%–100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%–100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%–2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%–100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI.Conclusions: Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.

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Section: Resultsmentioning

confidence: 99%

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Patel¹,

Khoury²,

Girgenti

et al. 2017

Surgical Infections

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“…In Abol and Stuecker 28 series, 20 children with neuromuscular scoliosis underwent percutaneous rib-to-pelvis Vertical Expandable Prosthetic Titanium Rib implantation. Nineteen patients suffered complications in the form of proximal cradle migration (5), implant breakage (5), deep wound infection (3), and dislodged iliac hooks (2).…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery for Neuromuscular Scoliosis

Miladi

Gaumé

Khouri

et al. 2018

Spine

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Study Design.A retrospective review.Objective.To report the results of an alternative technique using a minimally invasive fusionless surgery. The originality is based on the progressive correction of the deformities with proximal and distal fixation and on the reliability of the pelvic fixation using iliosacral screws on osteoporotic bones.Summary of Background Data.Spinal deformities are common in neuromuscular diseases. Conventional treatment involves bracing, followed by spinal instrumented fusion. Growing rod techniques are increasingly advocated but have a high rate of complications.Methods.The technique relies on a bilateral double rod sliding construct anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. Hundred patients with neuromuscular scoliosis underwent the same fusionless surgery extended from T1 to the pelvis. The average age at initial surgery was 11 + 6 years. Diagnoses included cerebral palsy (61), spinal muscular atrophy (22), muscular dystrophy (10), and other neurological etiologies (7). Cobb angle and pelvic obliquity were measured before and after initial surgery, and at final follow-up. Complications were reviewed.Results.At latest follow-up 3 + 9 years (range 2 yr–6 + 3 yr), the mean Cobb angle improved from 89° to 35° which corresponds to 61% correction. Mean pelvic obliquity improved from 29° to 5°, which corresponds to 83% correction. Mean T1-S1 length increased from 30.02 to 37.28 cm. Mean preoperative hyper kyphosis was reduced from 68.44° to 33.29°. Complications occurred in 26 patients including mechanical complications (12) and wound infections (16). No arthrodesis was required at last follow-up.Conclusion.This original fusionless technique is safe and effective, preserving spinal and thoracic growth. It provides a significant correction of spinal deformities and pelvic obliquity with a reduced complications rate. The strength and stability of this modular construct over time allow the avoidance of final arthrodesis.Level of Evidence: 4

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“… 3 , 6 - 8 In the same way, scoliosis development inversely correlates with ambulatory abilities, with high rates of scoliosis seen in nonambulatory patients with poor trunk control. 3 , 5 6 7 8 9 …”

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confidence: 99%

“…It is well known that the spinal deformity in this population represents a notable burden for patients and their caregivers. 7 , 9 , 10 This abnormality leads to a loss of spine height, causing difficulties in sitting, eating, and urination because of an increase in the chest and abdominal pressures. 10 , 11 In addition, patients could experience breathing difficulty because of reduced chest wall compliance and uneven lung expansion producing an ineffective length-tension relationship of the respiratory muscles with a subsequent decline in pulmonary function.…”

mentioning

confidence: 99%

“…Currently, the primary treatment target has been centered on limiting spinal curve progression, improving respiratory system development, preventing bedsores, and releasing the upper limbs from the duty of supporting the trunk. 3 , 5 , 9 However, in patients with early-onset scoliosis (EOS), fusion in situ and hemiepiphysiodesis have failed to manage the thoracic deformity, restricting spine and lung growth. 9 , 15 In 2003, Campbell et al 16 developed the rib-based growing system (RBGS), a novel surgical approach to control spinal deformity, allowing vertebral column growth and lung parenchymal development in EOS.…”

mentioning

confidence: 99%

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Evaluating the Efficacy of Rib-to-pelvis Growth-friendly Surgery for the Treatment of Non-ambulatory Early-Onset Scoliosis Myelomeningocele Patients

Ramírez¹,

Olivella²,

Fitzgerald³

et al. 2022

JAAOS Glob Res Rev

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Introduction: Early-onset scoliosis (EOS) is a well-known orthopaedic manifestation in patients with myelomeningocele. The rib-based growing system (RBGS) has been proposed as an alternative for these individuals because of the poor outcomes with traditional surgical techniques. We aimed to describe the effect of RBGS in patients with nonambulatory EOS myelomeningocele. Methods: We retrospectively reviewed the Pediatric Spine Study Group Multicenter Database for all patients with nonambulatory EOS myelomeningocele treated with RBGS from 2004 to 2019. Demographics, surgical data, radiographic findings, and postoperative complications were obtained. The quality-of-life parameters were assessed postoperatively using the Early-onset Scoliosis Questionnaire-24. Results: Thirty patients (18 women; 60%) were patients with nonambulatory EOS myelomeningocele treated with RBGS. The mean age at the initial surgery was 5.3 years. The thoracic (T1-T12) spine height showed a significant increase from initial surgery to the most recent follow-up (P , 0.001). Spine (T1-S1) height was also significantly increased (P , 0.001). The postoperative complication rate was 87%. The Early-onset Scoliosis Questionnaire-24 demonstrates significant improvements in the quality-of-life scores (P = 0.037). Conclusion:This study demonstrated that RBGS could improve the reported quality-of-life scores in patients with nonambulatory EOS myelomeningocele when assessed with an EOS-oriented tool. Moreover, we confirmed the ability of RBGS to hold or even correct spinal deformity. Myelomeningocele is a saclike structure containing cerebrospinal fluid and neural tissue that occurs in approximately one in 1,000 live births due to a failure of the neural tube to close during the fourth week of gestation. 1 Throughout history, scoliosis has been reported as

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Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular scoliosis: a preliminary report

Cited by 30 publications

References 28 publications

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

Minimally Invasive Surgery for Neuromuscular Scoliosis

Evaluating the Efficacy of Rib-to-pelvis Growth-friendly Surgery for the Treatment of Non-ambulatory Early-Onset Scoliosis Myelomeningocele Patients

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