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Who gets staged surgery in severe pediatric and adolescent spine deformity?

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Abstract

Background

There is significant debate regarding the indications of staged surgery for severe adolescent spinal deformity, and the factors associated with the decision to perform staged compared to same-day surgery have not been previously investigated. Thus, the purpose of this study was to determine which factors were most strongly associated with this decision.

Methods

A prospective multicenter registry of adolescent patients with severe spinal deformity was reviewed. Two cohorts were identified: those who underwent a planned staged surgical procedure for deformity correction and those who underwent a same-day procedure. Patients who underwent an unplanned staged procedure secondary to complications during the initial procedure were excluded. Comparisons were made between these cohorts with respect to preoperative patient and radiographic variables to determine which factors were associated with the decision to perform a staged procedure. Surgical data was also compared to evaluate for differences in the intraoperative management of staged versus same-day patients.

Results

Two hundred and twenty-nine patients with severe spinal deformities were identified. Forty patients (17%) underwent a planned staged procedure and 189 patients (80%) underwent a same-day procedure. On univariate analysis of preoperative variables, patients who underwent staged surgery had a significantly younger age at surgery, greater major curve magnitude, greater major curve AVT to CSVL, lesser thoracic spine height, greater radiographic trunk shift, and a greater proportion of patients undergoing revision surgery (as opposed to primary correction) compared to those who underwent a planned single-stage procedure. Multivariate logistic regression of pre-operative variables showed that age < 16 years, maximum cobb angle ≥ 120 degrees, major curve AVT to CSVL of ≥ 3.5 cm, and revision surgery were independently associated with the decision to perform a staged procedure. Intraoperatively, patients in the staged cohort more frequently underwent combined anterior and posterior procedures, grade 4 or higher Schwab osteotomies, and had a greater number of levels fused.

Conclusion

There is substantial variability with respect to the decision to perform surgery for severe adolescent spine deformities in a staged versus same-day fashion. This large analysis of prospectively collected data is the first to describe the factors most strongly associated with the decision to perform a staged procedure and may help guide the surgical decision-making for these patients.

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References

  1. Neal KM, Siegall E (2017) Strategies for surgical management of large, stiff spinal deformities in children. J Am Acad Orthop Surg. https://doi.org/10.5435/JAAOS-D-16-00282

    Article  PubMed  Google Scholar 

  2. Boachie-Adjei O, Yagi M, Nemani VM et al (2015) Incidence and risk factors for major surgical complications in patients with complex spinal deformity: a report from an SRS GOP site. Spine Deform. https://doi.org/10.1016/j.jspd.2014.06.008

    Article  PubMed  Google Scholar 

  3. Lenke LG, Newton PO, Sucato DJ et al (2013) Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine 38:119. https://doi.org/10.1097/BRS.0b013e318269fab1

    Article  PubMed  Google Scholar 

  4. Master DL, Son-Hing JP, Poe-Kochert C et al (2011) Risk factors for major complications after surgery for neuromuscular scoliosis. Spine. https://doi.org/10.1097/BRS.0b013e3181e193e9

    Article  PubMed  Google Scholar 

  5. Il SS, Kim JH, Cho KJ et al (2007) Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation? Eur Spine J. https://doi.org/10.1007/s00586-007-0334-x

    Article  Google Scholar 

  6. Luhmann SJ, Lenke LG, Kim YJ et al (2005) Thoracic adolescent idiopathic scoliosis curves between 70° and 100°: is anterior release necessary? Spine. https://doi.org/10.1097/01.brs.0000179299.78791.96

    Article  PubMed  Google Scholar 

  7. Powell ET, Krengel WF, King HA et al (1994) Comparison of same-day sequential anterior and posterior spinal fusion with delayed two-stage anterior and posterior spinal fusion. Spine. https://doi.org/10.1097/00007632-199405310-00011

    Article  PubMed  Google Scholar 

  8. Shufflebarger HL, Grimm JO, Bui V et al (1991) Anterior and posterior spinal fusion: staged versus same-day surgery. Spine. https://doi.org/10.1097/00007632-199108000-00011

    Article  PubMed  Google Scholar 

  9. Ferguson RL, Hansen MM, Nicholas DA et al (1996) Same-day versus staged anterior-posterior spinal surgery in a neuromuscular scoliosis population: the evaluation of medical complications. J Pediatr Orthop. https://doi.org/10.1097/01241398-199605000-00003

    Article  PubMed  Google Scholar 

  10. O’Brien T, Akmakjian J, Ogin G, Eilert R et al (1992) Comparison of one-stage versus two-stage anterior/posterior spinal fusion for neuromuscular scoliosis. J Pediatr Orthop. https://doi.org/10.1097/01241398-199209000-00009

    Article  PubMed  Google Scholar 

  11. Shen J, Qiu G, Wang Y et al (2006) Comparison of 1-stage versus 2-stage anterior and posterior spinal fusion for severe and rigid idiopathic scoliosis-a randomized prospective study. Spine. https://doi.org/10.1097/01.brs.0000240704.42264.c4

    Article  PubMed  Google Scholar 

  12. Tsirikos AI, Chang WN, Dabney KW et al (2003) Comparison of one-stage versus two-stage anteroposterior spinal fusion in pediatric patients with cerebral palsy and neuromuscular scoliosis. Spine. https://doi.org/10.1097/00007632-200306150-00015

    Article  PubMed  Google Scholar 

  13. Hopf CG, Eysel P (2000) One-stage versus two-stage spinal fusion in neuromuscular scolioses. J Pediatr Orthop Part B. https://doi.org/10.1097/01202412-200010000-00005

    Article  Google Scholar 

  14. McDonnell MF, Classman SD, Dimar JR et al (1996) Perioperative complications of anterior procedures on the spine. J Bone Jt Surg-Ser A. https://doi.org/10.2106/00004623-199606000-00006

    Article  Google Scholar 

  15. Gum JL, Lenke LG, Bumpass D et al (2016) Does planned staging for posterior-only vertebral column resections in spinal deformity surgery increase perioperative complications? Spine Deform. https://doi.org/10.1016/j.jspd.2015.08.005

    Article  PubMed  Google Scholar 

  16. Passias PG, Ma Y, Chiu YL et al (2012) Comparative safety of simultaneous and staged anterior and posterior spinal surgery. Spine. https://doi.org/10.1097/BRS.0b013e31821350d0

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jackson T, Yaszay B, Sponseller PD et al (2019) Factors associated with surgical approach and outcomes in cerebral palsy scoliosis. Eur Spine J. https://doi.org/10.1007/s00586-018-5745-3

    Article  PubMed  Google Scholar 

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Acknowledgements

The Fox Study Group.

Funding

The authors received no funding for the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, HUB Building, 4th floor, 3500 Civic Center Blvd., Philadelphia, PA, 19104-4399, USA

    Scott M. LaValva & Patrick J. Cahill

  2. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Scott M. LaValva & Patrick J. Cahill

  3. UCSF Benioff Children’s Hospital Oakland–Pediatric Orthopaedics, San Francisco, CA, USA

    Ishaan Swarup

  4. Children’s Hospital Colorado, Aurora, CO, USA

    Sumeet Garg

  5. Seattle Children’s Hospital, Seattle, WA, USA

    Burt Yaszay

  6. Washington University School of Medicine, Saint Louis, MO, USA

    Munish C. Gupta & Michael Patrick Kelly

  7. Texas Scottish Rite Hospital, Dallas, TX, USA

    Daniel J. Sucato

  8. Shriners Hospital for Children, Philadelphia, PA, USA

    Amer Samdani

  9. Columbia University Orthopedic Surgery, New York, NY, USA

    Lawrence Lenke

  10. Foundation of Orthopedics and Complex Spine (FOCOS), Pantang, Ghana

    Oheneba Boachie

Authors
  1. Scott M. LaValva
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  2. Ishaan Swarup
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  6. Daniel J. Sucato
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  7. Michael Patrick Kelly
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  8. Amer Samdani
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  9. Lawrence Lenke
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Consortia

on behalf of the Fox Study Group

Contributions

SMLV: Writing—original draft preparation; Formal analysis and investigation; Methodology; Writing—review and editing; Critical revision; Accountability; Final approval. IS: Conceptualization; Data Acquisition; Formal analysis and investigation; Writing—review and editing; Accountability; Final approval. SG. Conceptualization; Data Acquisition; Writing—review and editing; Critical revision; Accountability; Final approval. BY: Conceptualization; Data Acquisition; Critical revision; Accountability; Supervision; Final approval. MCG: Conceptualization; Data Acquisition; Writing—review and editing; Critical revision; Supervision; Accountability; Final approval. DJS: Conceptualization; Data Acquisition; Critical revision; Supervision; Accountability; Final approval. MPK: Conceptualization; Data Acquisition; Writing—review and editing; Critical revision; Supervision; Accountability; Final approval. AS: Conceptualization; Data Acquisition; Writing—review and editing; Critical revision; Supervision; Final approval. LL: Conceptualization; Data Acquisition; Critical revision; Supervision; Final approval. OB: Conceptualization; Data Acquisition; Critical revision; Supervision; Final approval. The Fox Study Group: Data Acquisition; Supervision; Accountability; Final approval. PJC: Conceptualization; Data Acquisition; Writing—review and editing; Critical revision; Supervision; Accountability; Final approval.

Corresponding author

Correspondence to Patrick J. Cahill.

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This study was given Ethical Approval by the Institutional Review Board prior to the conduct of this study.

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LaValva, S.M., Swarup, I., Garg, S. et al. Who gets staged surgery in severe pediatric and adolescent spine deformity?. Spine Deform 12, 383–390 (2024). https://doi.org/10.1007/s43390-023-00778-8

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  • DOI: https://doi.org/10.1007/s43390-023-00778-8

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