Short-term surgical complications of spinal fusion in myelomeningocele

Araujo, Alex Oliveira de; Gomes, Cícero Ricardo; Fava, Daniela; Borigato, Eliana Valverde Magro; Duarte, Lenamaris Mendes Rocha; Oliveira, Rafael Garcia de

doi:10.1007/s43390-021-00304-8

Spine Deform

2021

DOI: 10.1007/s43390-021-00304-8

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Short-term surgical complications of spinal fusion in myelomeningocele

Alex Oliveira de Araujo

Cícero Ricardo Gomes

Daniela Fava

et al.

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Cited by 4 publications

(2 citation statements)

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“…[1][2][3] Infection rates as high as 33% and complication rates up to 60% have been reported in specific CMC subpopulations undergoing spinal fusion. 2,[4][5][6][7][8][9][10][11][12][13] These complication rates have decreased over the last 2 decades in response to implementing protocols specific to high-risk patients. 3,[14][15][16][17] However, risk-identification programs in this population are still lacking.…”

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confidence: 99%

“…Complication rates are significantly higher for CMC undergoing spinal fusion than they are for adolescents with idiopathic scoliosis 1–3. Infection rates as high as 33% and complication rates up to 60% have been reported in specific CMC subpopulations undergoing spinal fusion 2,4–13. These complication rates have decreased over the last 2 decades in response to implementing protocols specific to high-risk patients 3,14–17.…”

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confidence: 99%

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Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA

Cohen¹,

Berry

Nina

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Children with medical complexity are at increased risk of low bone mineral density (BMD) and complications after spinal fusion compared with idiopathic scoliosis patients. Our aim was to compare treatments and outcomes of children with medical complexity undergoing spinal fusion in those who had dual-energy x-ray absorptiometry (DXA) scans versus those who did not in an effort to standardize the workup of these patients before undergoing spinal surgery. Methods: We conducted a retrospective review of patients with low BMD who underwent spinal fusion at a tertiary care pediatric hospital between 2004 and 2016. We consulted with a pediatric endocrinologist to create standard definitions for low BMD to classify each subject. Regardless of DXA status, all patients were given a clinical diagnosis of osteoporosis [at least 2 long bone or 1 vertebral pathologic fracture(s)], osteopenia (stated on radiograph or by the physician), or clinically low bone density belonging to neither category. The last classification was used for patients whose clinicians had documented low bone density not meeting the criteria for osteoporosis or osteopenia. Fifty-nine patients met the criteria, and 314 were excluded for insufficient follow-up and/or not meeting a diagnosis definition. BMD Z-scores compare bone density ascertained by DXA to an age-matched and sex-matched average. Patients who had a DXA scan were also given a DXA diagnosis of low bone density (≤−2 SD), slightly low bone density (−1.0 to −1.9 SD), or neither (>−1.0 SD) based on the lowest BMD Z-score recorded. Results: Fifty-nine patients were analyzed. Fifty-four percent had at least 1 DXA scan preoperatively. Eighty-one percent of DXA patients received some form of treatment compared with 52% of non-DXA patients (P=0.03). Conclusions: Patients referred for DXA scans were more likely to be treated for low BMD, although there is no standardized system in place to determine which patients should get scans. Our research highlights the need to implement clinical protocols to optimize bone health preoperatively. Level of Evidence: Level II—retrospective prognostic study.

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mentioning

confidence: 99%

mentioning

confidence: 99%

Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA

Cohen¹,

Berry

Nina

et al. 2022

Journal of Pediatric Orthopaedics

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Negative pressure wound therapy in cases of spinal surgery and exposed dura: a case-based review

Sergeenko¹,

Korostelev

Shikhaleva

et al. 2021

Childs Nerv Syst

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Growing rods in meningomyelocele lead to increased risk for complications in comparison with fusion; a retrospective study of 30 patients treated for at the University Hospital of Uppsala

Kontakis,

Pazarlis,

Karlsson

et al. 2023

Eur Spine J

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Purpose To compare the complication rates of two different types of posterior instrumentation in patients with MMC, namely, definitive fusion and fusionless surgery (growing rods). Methods Single-center retrospective study of 30 MMC patients that underwent posterior instrumentation for deformity (scoliosis and/or kyphosis) treatment from 2008 until 2020. The patients were grouped based on whether they received definitive fusion or a growth-accommodating system, whether they had a complication that led to early surgery, osteotomy or non-osteotomy. Number of major operations, Cobb angle correction and perioperative blood loss were the outcomes. Results 18 patients received a growing system and 12 were fused at index surgery. The growing system group underwent a mean of 2.38 (± 1.03) surgeries versus 1.91 (± 2.27) in the fusion group, p = 0.01. If an early revision was necessitated due to a complication, then the number of major surgeries per patient was 3.37 (± 2.44) versus 1.77 (± 0.97) in the group that did not undergo an early revision, p = 0.01. Four patients developed a superficial and six a deep wound infection, while loosening/breakage occurred in 10 patients. The Cobb angle was improved from a mean of 69 to 22 degrees postoperatively. Osteotomy did not lead to an increase in perioperative blood loss or number of major operations. Conclusion Growing systems had more major operations in comparison with fusion surgery and early revision surgery led to higher numbers of major operations per patient; these differences were statistically significant. Definitive fusion at index surgery might be the better option in some MMC patients with a high-risk profile.

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Short-term surgical complications of spinal fusion in myelomeningocele

Cited by 4 publications

References 19 publications

Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA

Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA

Negative pressure wound therapy in cases of spinal surgery and exposed dura: a case-based review

Growing rods in meningomyelocele lead to increased risk for complications in comparison with fusion; a retrospective study of 30 patients treated for at the University Hospital of Uppsala

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