Long-term reoperation rates following spinal fusion for neuromuscular scoliosis in nonambulatory patients with cerebral palsy.

Autor: Seaver CD; Research Department, Gillette Children's, St. Paul, MN, USA.; University of Minnesota Medical School, Minneapolis, MN, USA., Morgan SJ; Research Department, Gillette Children's, St. Paul, MN, USA.; Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA.; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA., Legister CS; Research Department, Gillette Children's, St. Paul, MN, USA.; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA., Palmer CL; University of Minnesota Medical School, Minneapolis, MN, USA., Beauchamp EC; Department of Orthopaedic Surgery, Gillette Children's, 200 University Ave E, Internal Zip 490105, St. Paul, MN, 55101, USA.; Twin Cities Spine Center, Minneapolis, MN, USA., Guillaume TJ; Department of Orthopaedic Surgery, Gillette Children's, 200 University Ave E, Internal Zip 490105, St. Paul, MN, 55101, USA., Truong WH; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.; Department of Orthopaedic Surgery, Gillette Children's, 200 University Ave E, Internal Zip 490105, St. Paul, MN, 55101, USA., Koop SE; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.; Department of Orthopaedic Surgery, Gillette Children's, 200 University Ave E, Internal Zip 490105, St. Paul, MN, 55101, USA., Perra JH; Department of Orthopaedic Surgery, Gillette Children's, 200 University Ave E, Internal Zip 490105, St. Paul, MN, 55101, USA.; Twin Cities Spine Center, Minneapolis, MN, USA., Lonstein JE; Twin Cities Spine Center, Minneapolis, MN, USA., Miller DJ; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA. danmiller@gillettechildrens.com.; Department of Orthopaedic Surgery, Gillette Children's, 200 University Ave E, Internal Zip 490105, St. Paul, MN, 55101, USA. danmiller@gillettechildrens.com.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2024 Sep; Vol. 12 (5), pp. 1393-1401. Date of Electronic Publication: 2024 Apr 29.
DOI: 10.1007/s43390-024-00878-z
Abstrakt: Purpose: To describe the incidence of reoperation and factors contributing to surgical revision within a minimum of 10 years after spinal fusion for scoliosis in patients with nonambulatory cerebral palsy (CP).
Methods: We conducted a retrospective review of consecutive nonambulatory patients with CP who underwent primary spinal fusion at a single specialty care center with a minimum of 10 years from their index surgery (surgery dates 2001-2011). Causes of reoperation were classified as implant failure/pseudoarthrosis, surgical site infection (SSI), proximal junctional kyphosis, prominent/symptomatic implants, and implant removal. Reoperation rates with 95% confidence intervals were calculated for each time interval, and an actuarial survival curve was generated.
Results: 144 patients met inclusion criteria (mean age = 14.3 ± 2.6 years, 62.5% male); 85.4% had 5 years follow-up data; and 66.0% had 10 years follow-up data. Estimates from the actuarial analysis suggest that 14.9% (95% CI: 10.0-22.0) underwent reoperation by 5 years postsurgery, and 21.7% (95% CI: 15.4-30.1) underwent reoperation by 10 years postsurgery. The most common causes for reoperation were implant failure/pseudoarthrosis, SSI, and prominent/symptomatic implants.
Conclusions: To our knowledge, this study is the largest long-term follow-up of nonambulatory patients with CP and neuromuscular scoliosis who underwent spinal fusion. Approximately 22% of these patients required reoperation 10 years after their index surgery, primarily due to implant failure/pseudoarthrosis, SSI, and prominent/symptomatic implants. Complications and reoperations continued throughout the 10 years period after index surgery, reinforcing the need for long-term follow-up as these patients transition into adulthood.
Level of Evidence: III.
(© 2024. The Author(s).)
Databáze: MEDLINE
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