Posterior Spinal Fusion in Children With Flaccid Neuromuscular Scoliosis

Mills, Bryan; Bach, John R.; Zhao, Chen; Saporito, Lou; Sabharwal, Sanjeev

doi:10.1097/bpo.0b013e318287058f

Cited by 22 publications

(4 citation statements)

References 30 publications

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“…Eighteen other centers reported 284 CNVS dependent patients with DMD including many who were never hospitalized [ 56 60 61 ]. CNVS is also an alternative to tracheotomy in the perioperative management of children with flaccid neuromuscular scoliosis [ 62 ]. Since patients dependent on CTMV often die from complications related to the tracheostomy tubes, CTMV users with DMD are rarely reported to survive 40 years.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

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This review article describes definitive noninvasive respiratory management of respiratory muscle dysfunction to eliminate need to resort to tracheotomy. In 2010 clinicians from 22 centers in 18 countries reported 1,623 spinal muscular atrophy type 1 (SMA1), Duchenne muscular dystrophy (DMD), and amyotrophic lateral sclerosis users of noninvasive ventilatory support (NVS) of whom 760 required it continuously (CNVS). The CNVS sustained their lives by over 3,000 patient-years without resort to indwelling tracheostomy tubes. These centers have now extubated at least 74 consecutive ventilator unweanable patients with DMD, over 95% of CNVS-dependent patients with SMA1, and hundreds of others with advanced neuromuscular disorders (NMDs) without resort to tracheotomy. Two centers reported a 99% success rate at extubating 258 ventilator unweanable patients without resort to tracheotomy. Patients with myopathic or lower motor neuron disorders can be managed noninvasively by up to CNVS, indefinitely, despite having little or no measurable vital capacity, with the use of physical medicine respiratory muscle aids. Ventilator-dependent patients can be decannulated of their tracheostomy tubes.

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Section: Discussionmentioning

confidence: 99%

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Bach

2017

Ann Rehabil Med

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“…Lung developmental defects, impaired neurologic command over added lung restrictive syndromes and postoperative intensive care with lung infection risks can partially explain our findings [ 6 ]. Preoperative breathing hyper insufflation strategies could be worthwhile as they demonstrated interest in spinal fusions in children with neuromuscular flaccid scoliosis [ 31 ]. As preoperative primary care visits led to lower costs and shorter hospitalizations in complex scoliosis surgeries, we support the idea of efficient preoperative rehabilitation programs before spinal fusions.…”

Section: Discussionmentioning

confidence: 99%

Impact of spinal fusion on severity health status in scoliotic adolescents with polyhandicap

Bessaguet,

Rousseau,

Gautheron

et al. 2024

PLoS ONE

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Background Scoliosis constitutes a prevalent comorbidity in adolescents with polyhandicap and frequently leads to other severe impairments, impacting abilities and requiring complex caregiving strategies. Therefore, spinal fusion surgeries are commonly performed to alleviate pain and provide more comfort. However, spine stabilization has not previously been proven to improve the severity health status of adolescents with polyhandicap according to specific clinical scales. Objective This study describes and compares the severity health status of adolescents with polyhandicap before and after they underwent spinal fusion. Methods A monocentric retrospective observational study was conducted in the university hospital centre of Saint-Etienne, France. We included between 2009 to 2020, 30 scoliotic adolescents with polyhandicap who underwent spinal fusion performed with the same surgical technique and the same surgeon. The main outcome was the variation in the Polyhandicap Severity Scale (PSS) score after surgery. Secondary outcomes were variations in PSS subscores, quality of life scores, fronto-sagittal X-ray parameters, and measures of surgical complication rates and lengths of stay. Results Among 30 adolescents, 27 PSS analyses were performed. We found a significant improvement between pre- and postoperative PSS scores, mainly for pain and respiratory, digestive, and skin disabilities. These improvements were accompanied by significant reductions in pelvic obliquity, in frontal and sagittal curves. The mean hospital length of stay was 45 days. During postoperative period, patients received a personalized postoperative rehabilitation procedure with spasticity and pain treatments, physiotherapy, and verticalization (wheelchair sitting and positioning devices such as contoured seat intended to increase postural stability). The mortality rate was estimated at 7%. At least 1 complication per patient occurred. Conclusions We show that spinal fusion surgeries confer a significant improvement in the severity health status in scoliotic adolescents with polyhandicap.

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“…Patients with neuromuscular scoliosis often suffer from preexisting respiratory diseases such as muscle weakness (e.g., Duchenne's muscular dystrophy) or restrictive disorders, most often caused by chest deformities, which leads to a risk of postoperative respiratory failure [61,62]. Facial dysmorphism in some syndromes is associated with difficult airways.…”

Section: Airway and Breathingmentioning

confidence: 99%

Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review

Hudec

Prokopová

Kosinová

et al. 2023

JCM

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Scoliosis is the most frequent spinal deformity in children. It is defined as a spine deviation of more than 10° in the frontal plane. Neuromuscular scoliosis is associated with a heterogeneous spectrum of muscular or neurological symptoms. Anesthesia and surgery for neuromuscular scoliosis have a higher risk of perioperative complications than for idiopathic scoliosis. However, patients and their relatives report improved quality of life after the surgery. The challenges for the anesthetic team result from the specifics of the anesthesia, the scoliosis surgery itself, or factors associated with neuromuscular disorders. This article includes details of preanesthetic evaluation, intraoperative management, and postoperative care in the intensive care unit from an anesthetic view. In summary, adequate care for patients who have neuromuscular scoliosis requires interdisciplinary cooperation. This comprehensive review covers information about the perioperative management of neuromuscular scoliosis for all healthcare providers who take care of these patients during the perioperative period, with an emphasis on anesthesia management.

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Posterior Spinal Fusion in Children With Flaccid Neuromuscular Scoliosis

Abstract: Level IV-case series.

Cited by 22 publications

References 30 publications

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Noninvasive Respiratory Management of Patients With Neuromuscular Disease

Impact of spinal fusion on severity health status in scoliotic adolescents with polyhandicap

Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review

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