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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 radiograph images showing spinal fusion and instrumentation from T3-S1 with significant improvement of the deformity. Unilateral pelvic fixation was carried out in this patient.
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fig10: Immediate postoperative radiograph images showing spinal fusion and instrumentation from T3-S1 with significant improvement of the deformity. Unilateral pelvic fixation was carried out in this patient.

Mentions: Moreover, the patient is nonverbal, nonambulatory, feeding tube dependent, and asthmatic. Using a similar approach, the patient was instrumented with pedicle screws from T3-S1. No remarkable neuromonitoring changes occurred during the surgery. Total surgical duration was 7 hours with an estimated blood loss of 800 mL. Patient received 2 units of packed red blood cells and 1 unit of platelets intraoperatively. Patient was extubated POD #1 and was transferred to the floor. Pain management was similar to the previously described case. Patient was discharged on POD #5. The postoperative X-rays demonstrate pelvic fixation and show good correction in the coronal and sagittal planes (Figure 10).


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 radiograph images showing spinal fusion and instrumentation from T3-S1 with significant improvement of the deformity. Unilateral pelvic fixation was carried out in this patient.
© Copyright Policy
Related In: Results  -  Collection

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

fig10: Immediate postoperative radiograph images showing spinal fusion and instrumentation from T3-S1 with significant improvement of the deformity. Unilateral pelvic fixation was carried out in this patient.
Mentions: Moreover, the patient is nonverbal, nonambulatory, feeding tube dependent, and asthmatic. Using a similar approach, the patient was instrumented with pedicle screws from T3-S1. No remarkable neuromonitoring changes occurred during the surgery. Total surgical duration was 7 hours with an estimated blood loss of 800 mL. Patient received 2 units of packed red blood cells and 1 unit of platelets intraoperatively. Patient was extubated POD #1 and was transferred to the floor. Pain management was similar to the previously described case. Patient was discharged on POD #5. The postoperative X-rays demonstrate pelvic fixation and show good correction in the coronal and sagittal planes (Figure 10).

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