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Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Gambassi M, Plakas C, Liao B, Kalantre S, Katyal C - Biomed Res Int (2015)

Bottom Line: However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients.We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis.Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Orthopedics, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA.

ABSTRACT
Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

No MeSH data available.


Related in: MedlinePlus

Immediate postoperative radiographic images showing excellent correction of the deformity. Patient is well-balanced in coronal and sagittal planes. The pelvis and shoulder are level.
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fig8: Immediate postoperative radiographic images showing excellent correction of the deformity. Patient is well-balanced in coronal and sagittal planes. The pelvis and shoulder are level.

Mentions: She had underlying diagnoses of Rett syndrome. Patient was noncommunicative but was able to ambulate independently. Patient had minimal pelvic obliquity, 5.4 cm of coronal imbalance, and normal sagittal parameters. Patient underwent posterior spine fusion from T3-S1 utilizing pedicle screw instrumentation and the approach described above. Multimodality neuromonitoring was utilized with no changes throughout the surgery. Total duration was 5 hours and estimated blood loss was 600 mL. Patient received 1 unit of packed red blood cells intraoperatively and was successfully extubated at the end of the procedure. Her PICU stay was one day and she was able to get out of bed and ambulate with a walker on POD #2. Her pain was controlled with Tylenol and Toradol around the clock, with oxycodone for breakthrough pain. She was discharged home on POD #4 with her pain controlled on oral medication. At most recent follow-up, she was at her preoperative levels of activity, ambulating, and with no significant pain. Postoperative X-rays are shown in Figure 8.


Minimally Invasive Scoliosis Surgery: A Novel Technique in Patients with Neuromuscular Scoliosis.

Sarwahi V, Amaral T, Wendolowski S, Gecelter R, Gambassi M, Plakas C, Liao B, Kalantre S, Katyal C - Biomed Res Int (2015)

Immediate postoperative radiographic images showing excellent correction of the deformity. Patient is well-balanced in coronal and sagittal planes. The pelvis and shoulder are level.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663285&req=5

fig8: Immediate postoperative radiographic images showing excellent correction of the deformity. Patient is well-balanced in coronal and sagittal planes. The pelvis and shoulder are level.
Mentions: She had underlying diagnoses of Rett syndrome. Patient was noncommunicative but was able to ambulate independently. Patient had minimal pelvic obliquity, 5.4 cm of coronal imbalance, and normal sagittal parameters. Patient underwent posterior spine fusion from T3-S1 utilizing pedicle screw instrumentation and the approach described above. Multimodality neuromonitoring was utilized with no changes throughout the surgery. Total duration was 5 hours and estimated blood loss was 600 mL. Patient received 1 unit of packed red blood cells intraoperatively and was successfully extubated at the end of the procedure. Her PICU stay was one day and she was able to get out of bed and ambulate with a walker on POD #2. Her pain was controlled with Tylenol and Toradol around the clock, with oxycodone for breakthrough pain. She was discharged home on POD #4 with her pain controlled on oral medication. At most recent follow-up, she was at her preoperative levels of activity, ambulating, and with no significant pain. Postoperative X-rays are shown in Figure 8.

Bottom Line: However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients.We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis.Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Orthopedics, Cohen Children's Medical Center, New Hyde Park, NY 11040, USA.

ABSTRACT
Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented in our neuromuscular patients. Our technique allows easy passage of contoured rods, placement of pedicle screws without image guidance, partial/complete facet resection, and all standard reduction maneuvers. Operative time needed to complete this surgery is comparable to the standard procedure and the majority of our patients have been extubated at the end of procedure, spending 1 day in the PICU and 5-6 days in the hospital. We feel that MIS is not only a feasible but also a superior option in patients with neuromuscular scoliosis. Long-term results are unavailable; however, short-term results have shown multiple benefits of this approach and fewer limitations.

No MeSH data available.


Related in: MedlinePlus