Pediatric Scoliosis Surgery—A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Method, Data Acquisition, and Selection
2.2. Statistical Analysis
3. Results
3.1. Included Subjects, Gender, Age, Type of Operation Diagnosis
3.2. Curve Types and Direction
3.3. Idiopathic vs. Non-Idiopathic
3.4. Hospital Stay, Early Postoperative Complications, Operation Time
3.5. Correlations and Regression Analysis
4. Discussion
4.1. Adolescent Idiopathic Scoliosis
4.2. Neuromuscular Scoliosis
4.3. Total Operation Time and Length of the Hospital Stay
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Variable | AAO | TOT | TVI | POHS | CAB | CAA | PC |
---|---|---|---|---|---|---|---|
Age at operation (AAO) | 1 | ||||||
Total operation time (TOT) | −0.139 | 1 | |||||
Total vertebral instrumentation (TVI) | 0.073 | 0.410 (**) | 1 | ||||
Postoperative hospital stay (POHS) | −0.130 | 0.614 (**) | 0.526 (**) | 1 | |||
Cobb angle before (CAB) | −0.198 | 0.478 (**) | 0.440 (**) | 0.489 (**) | 1 | ||
Cobb angle afterwards (CAA) | −0.148 | 0.409 (**) | 0.243 (*) | 0.327 (**) | 0.530 (**) | 1 | |
Percentage correction (%C) | 0.060 | −0.166 | −0.092 | −0.081 | −0.036 | 0.837 (**) | 1 |
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Congenital: Failure of formation, Failure of segmentation | Idiopathic: Infantile (0–3 years) Juvenile (3–10 years) Adolescent (10+ years until skeletal maturity) |
Neuromuscular: (1) Myopathic: Arthrogryposis, Muscular dystrophy (2) Neuropathic: Upper Motor Neuron, Lower Motor Neuron, Dysautonomia | Others: Neurofibromatosis, Mesenchymal (Marfan’s, Ehler-Danlos), Traumatic, Tumors, Osteochondrodystrophies |
Category | Specific Cause | N |
---|---|---|
General | Lung related complications (infection, embolism) | 0 |
Prolonged ICU stay (>2 days for posterior, >3 days for anterior-posterior approach) | 2 | |
Development of pressure ulcer | 1 | |
Anemia requiring blood transfusion | 3 | |
Wound related | Surgical wound complications (skin closure defects, infection) | 1 |
Neurologic | Neurologic complications (neurological deficits) | 1 |
Urinary retention (requiring catheterization) and postoperative ileus | 1 | |
Instrumentation | Early revision surgery (problems with drainage, closure, infection, screw malposition) | 2 |
Death | 0 |
Diagnostic Groups | % (n) | Mean Age at Surgery | SD |
---|---|---|---|
All | 100 (69) | 14.6 | 2.9 |
Idiopathic scoliosis | 62.3 (43) | 15.4 | 2.1 |
| 52.2 (36) | 16.0 | 1.5 |
| 10.1 (7) | 11.9 | 1.1 |
| 0 | - | - |
Non-idiopathic scoliosis | 37.7 (26) | 13.4 | 3.7 |
| 24.6 (17) | 13.8 | 3.8 |
| 7.2 (5) | 12.6 | 3.5 |
| 5.8 (4) | 12.8 | 4.1 |
Variable | Idiopathic | (AIS) | Non-Idiopathic | (NEU) | p |
---|---|---|---|---|---|
Age at operation (in years) | 15.4 ± 2.1 | (16.0 ± 1.5) | 13.4 ± 3.7 | (13.8 ± 3.8) | ** (**) |
Total operation time (h:mm) | 4:46 ± 1:05 | (4:50 ± 1:07) | 6:05 ± 1:45 | (6:12 ± 1:39) | ** (**) |
N° of vertebrae instrumented | 9.1 ± 1.8 | (9.7 ± 1.9) | 10.7 ± 3.7 | (12.5 ± 2.7) | 0.062 (***) |
Postoperative hospital stay (in days) | 9.2 ± 1.9 | (9.2 ± 2.0) | 11.2 ± 3.1 | (11.8 ± 2.6) | ** (**) |
Cobb angle before (Cobb°) | 55.8 ± 14.7 | (56.3 ± 15.3) | 75.1 ± 23.6 | (78.7 ± 20.0) | ** (***) |
Cobb angle afterwards (Cobb°) | 21.1 ± 9.0 | (20.9 ± 9.2) | 37.0 ± 18.4 | (39.2 ± 19.4) | *** (***) |
Percentage decrease (%) | 62.0 ± 13.7 | (62.6 ± 13.9) | 49.7 ± 20.1 | (49.7 ± 21.1) | * (*) |
Associations with PCs | Without PC | MC with PC | p-Value |
---|---|---|---|
Age at operation (in years) | 14.5 ± 2.9 | +0.9 | 0.818 |
Total operation time (hh:mm) | 5:01 ± 1:09 | +1:33 | 0.056 |
N° of vertebrae instrumented | 9.7 ± 2.6 | +2.4 | * |
Postoperative hospital stay (in days) | 9.4 ± 2.3 | +3.1 | ** |
Cobb angle before (Cobb°) | 59.7 ± 17.6 | +21.5 | ** |
Cobb angle afterwards (Cobb°) | 25.0 ± 12.0 | +13.2 | 0.158 |
Percentage decrease (%) | 57.6 ± 17.4 | −1.5 | 0.737 |
Variables | Regression Coefficient | Standardized Coefficient | p-Value | 95% CI |
---|---|---|---|---|
Total operation time (hours) | 1.01 | 0.586 | <0.001 | 0.683–1.337 |
Presence of PC | 1.56 | 0.220 | 0.024 | 0.213–2.898 |
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Rüwald, J.M.; Upenieks, J.; Ositis, J.; Pycha, A.; Avidan, Y.; Rüwald, A.L.; Eymael, R.L.; Schildberg, F.A. Pediatric Scoliosis Surgery—A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia. Medicina 2020, 56, 201. https://doi.org/10.3390/medicina56040201
Rüwald JM, Upenieks J, Ositis J, Pycha A, Avidan Y, Rüwald AL, Eymael RL, Schildberg FA. Pediatric Scoliosis Surgery—A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia. Medicina. 2020; 56(4):201. https://doi.org/10.3390/medicina56040201
Chicago/Turabian StyleRüwald, Julian M., Janis Upenieks, Janis Ositis, Alexander Pycha, Yuval Avidan, Anna L. Rüwald, Robin L. Eymael, and Frank A. Schildberg. 2020. "Pediatric Scoliosis Surgery—A Comprehensive Analysis of Treatment-Specific Variables and Trends in Latvia" Medicina 56, no. 4: 201. https://doi.org/10.3390/medicina56040201