"Ultralow-dose" CT Without Sedation in Pediatric Patients With Neuromuscular Scoliosis.

Autor:	Yee NJ; Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Iorio C; Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.; Spine Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy., Shkumat N; Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.; Spine Surgery Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy., Rocos B; Duke Spine Center, Duke University Health System, Durham, North Carolina, US., Lebel D; Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada., Camp M; Division of Orthopaedic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2024 Aug 22. Date of Electronic Publication: 2024 Aug 22.
DOI:	10.1097/BPO.0000000000002786
Abstrakt:	Background: Children with neuromuscular scoliosis undergoing scoliosis surgery face substantial rates of complications. To mitigate surgical risks such as blood loss in pediatric patients with neuromuscular scoliosis, this study focuses on enabling instrumentation planning for their abnormal vertebral and pelvic anatomy and osteopenia. This study assessed the feasibility of an "ultralow-dose" CT (ULD CT) protocol without sedation in pediatric patients with neuromuscular scoliosis who often have comorbid movement disorders. Our prospective quality improvement study aims: (1) to determine if ULD CT without sedation is feasible in this patient group; (2) to quantify the radiation dose from ULD CT and compare it with preoperative spine radiographs (XR); and (3) to assess if ULD CT allows accurate anatomical assessment and intraoperative navigation given the prevalence of movement disorders. Methods: Children with neuromuscular scoliosis underwent spine XR and ULD CT scans. Chart reviews assessed disease etiology and comorbidities. Radiation dose was quantified through Monte-Carlo simulations giving dose indices and effective dose, with statistical analysis done using a paired student's t-test (α=0.05). CT image quality was assessed for its use in preoperative planning and intraoperative navigation. Results: Fourteen patients (5 males, 9 females, average age 14±3 y) participated. One patient needed sedation due to autism spectrum disorder and global developmental delay. The radiation dose for spine XR was 0.5±0.2 mSv, and ULD CT was 0.6±0.1 mSv. There was no statistically significant difference in radiation doses between methods. All ULD CT scans had adequate quality for preoperative assessment of pedicle diameter and orientation, obstacles impeding pedicle entry, S2 Alar-Iliac screw orientation, and intraoperative navigation. Conclusions: ULD CT without sedation is feasible for children with neuromuscular scoliosis. Radiation doses were comparable to standard radiographs. ULD CT provided accurate anatomical assessments and supported intraoperative navigation, proving beneficial despite movement disorders in these patients. Level of Evidence: Level 2-Development of diagnostic criteria on basis of consecutive patients (with universally applied reference widely accepted standard). Competing Interests: M.C. is a consultant for OrthoPediatrics Inc. and 7D Surgical Inc. (SeaSpine). The other authors declare no conflicts of interest. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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