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Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees

Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with...

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Autores principales: Miyagi, Masayuki, Saito, Wataru, Mimura, Yusuke, Nakazawa, Toshiyuki, Imura, Takayuki, Shirasawa, Eiki, Uchida, Kentaro, Ikeda, Shinsuke, Kuroda, Akiyoshi, Inoue, Sho, Yokozeki, Yuji, Tanaka, Yoshihide, Akazawa, Tsutomu, Takaso, Masashi, Inoue, Gen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303956/
https://www.ncbi.nlm.nih.gov/pubmed/37374294
http://dx.doi.org/10.3390/medicina59061090
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author Miyagi, Masayuki
Saito, Wataru
Mimura, Yusuke
Nakazawa, Toshiyuki
Imura, Takayuki
Shirasawa, Eiki
Uchida, Kentaro
Ikeda, Shinsuke
Kuroda, Akiyoshi
Inoue, Sho
Yokozeki, Yuji
Tanaka, Yoshihide
Akazawa, Tsutomu
Takaso, Masashi
Inoue, Gen
author_facet Miyagi, Masayuki
Saito, Wataru
Mimura, Yusuke
Nakazawa, Toshiyuki
Imura, Takayuki
Shirasawa, Eiki
Uchida, Kentaro
Ikeda, Shinsuke
Kuroda, Akiyoshi
Inoue, Sho
Yokozeki, Yuji
Tanaka, Yoshihide
Akazawa, Tsutomu
Takaso, Masashi
Inoue, Gen
author_sort Miyagi, Masayuki
collection PubMed
description Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre- or intraoperative traction would be effective for severe spinal deformities but would be invasive. This study aimed to evaluate the outcomes of PSF-only surgery for patients with severe NMS with a Cobb angle > 100°. Materials and Methods: Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF-only surgery for scoliosis with a Cobb angle > 100° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings, including Cobb angle and pelvic obliquity (PO) in the sitting position pre- and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. Results: The mean duration of surgery was 338 min, intraoperative blood loss was 1440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group were significantly higher than those in the L5 group. Conclusions: Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF surgery without anterior release or any intra-/preoperative traction showed satisfactory outcomes, including acceptable scoliosis correction and improved clinical findings, even in patients with extremely severe NMS. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery.
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spelling pubmed-103039562023-06-29 Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees Miyagi, Masayuki Saito, Wataru Mimura, Yusuke Nakazawa, Toshiyuki Imura, Takayuki Shirasawa, Eiki Uchida, Kentaro Ikeda, Shinsuke Kuroda, Akiyoshi Inoue, Sho Yokozeki, Yuji Tanaka, Yoshihide Akazawa, Tsutomu Takaso, Masashi Inoue, Gen Medicina (Kaunas) Article Background and objectives: Patients with neuromuscular diseases usually have progressive neuromuscular scoliosis (NMS), requiring invasive surgery. Some patients present with severe scoliosis at the time of consultation and are difficult to treat. Posterior spinal fusion (PSF) surgery combined with anterior release and pre- or intraoperative traction would be effective for severe spinal deformities but would be invasive. This study aimed to evaluate the outcomes of PSF-only surgery for patients with severe NMS with a Cobb angle > 100°. Materials and Methods: Thirty NMS patients (13 boys and 17 girls; mean age 13.8 years) who underwent PSF-only surgery for scoliosis with a Cobb angle > 100° were included. We reviewed the lower instrumented vertebra (LIV), duration of surgery, blood loss, perioperative complications, preoperative clinical findings, and radiographic findings, including Cobb angle and pelvic obliquity (PO) in the sitting position pre- and postoperatively. The correction rate and correction loss of the Cobb angle and PO were also calculated. Results: The mean duration of surgery was 338 min, intraoperative blood loss was 1440 mL, preoperative %VC was 34.1%, FEV1.0 (%) was 91.5%, and EF was 66.1%. There were eight cases of perioperative complications. The Cobb angle and PO correction rates were 48.5% and 42.0%, respectively. We divided the patients into two groups: the L5 group, in which the LIV was L5, and the pelvis group, in which the LIV was the pelvis. The duration of surgery and PO correction rate in the pelvis group were significantly higher than those in the L5 group. Conclusions: Patients with severe NMS demonstrated severe preoperative restrictive ventilatory impairments. PSF surgery without anterior release or any intra-/preoperative traction showed satisfactory outcomes, including acceptable scoliosis correction and improved clinical findings, even in patients with extremely severe NMS. Instrumentation and fusion to the pelvis for severe scoliosis in patients with NMS showed good PO correction and low correction loss of Cobb angle and PO, but a longer duration of surgery. MDPI 2023-06-05 /pmc/articles/PMC10303956/ /pubmed/37374294 http://dx.doi.org/10.3390/medicina59061090 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Miyagi, Masayuki
Saito, Wataru
Mimura, Yusuke
Nakazawa, Toshiyuki
Imura, Takayuki
Shirasawa, Eiki
Uchida, Kentaro
Ikeda, Shinsuke
Kuroda, Akiyoshi
Inoue, Sho
Yokozeki, Yuji
Tanaka, Yoshihide
Akazawa, Tsutomu
Takaso, Masashi
Inoue, Gen
Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
title Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
title_full Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
title_fullStr Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
title_full_unstemmed Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
title_short Posterior Spinal Fusion Surgery for Neuromuscular Disease Patients with Severe Scoliosis Whose Cobb Angle Was over 100 Degrees
title_sort posterior spinal fusion surgery for neuromuscular disease patients with severe scoliosis whose cobb angle was over 100 degrees
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10303956/
https://www.ncbi.nlm.nih.gov/pubmed/37374294
http://dx.doi.org/10.3390/medicina59061090
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