Mortality in Neuromuscular Early Onset Scoliosis Following Spinal Deformity Surgery.
Journal
Journal of pediatric orthopedics
ISSN: 1539-2570
Titre abrégé: J Pediatr Orthop
Pays: United States
ID NLM: 8109053
Informations de publication
Date de publication:
01 Mar 2022
01 Mar 2022
Historique:
pubmed:
24
12
2021
medline:
12
2
2022
entrez:
23
12
2021
Statut:
ppublish
Résumé
The purpose of this study was to report mortality and associated risk factors in neuromuscular early onset scoliosis following spinal deformity surgery. This is a multicenter retrospective cohort study of patients with cerebral palsy (CP), spinal muscular atrophy, myelodysplasia, muscular dystrophy, or myopathy undergoing index spine surgery from 1994 to 2020. Mortality risk was calculated up to 10 years postoperatively. Proportional hazard modeling was utilized to investigate associations between risk factors and mortality rate. A total of 808 patients [mean age 7.7 y; 439 (54.3%) female] were identified. Postoperative 30-day, 90-day, and 120-day mortality was 0%, 0.001%, and 0.01%, respectively. 1-year, 2-year, 5-year, and 10-year mortality was 0.5%, 1.1%, 5.4%, and 17.4%, respectively. Factors associated with increased mortality rate: CP diagnosis [hazard ratio (HR): 3.14, 95% confidence interval (CI): 1.71; 5.79, P<0.001]; nonambulatory status (HR: 3.01, 95% CI: 1.06; 8.5, P=0.04)]; need for respiratory assistance (HR: 2.17, 95% CI: 1.00; 4.69, P=0.05). In neuromuscular patients with early onset scoliosis, mortality risk at 10 years following spine surgery was 17.4%. As mortality was 1.1% at 2 years, premature death was unlikely a direct result of spine surgery. Diagnosis (CP) and markers of disease severity (nonambulatory status, respiratory assistance) were associated with increased mortality rate. Prognostic level II.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study was to report mortality and associated risk factors in neuromuscular early onset scoliosis following spinal deformity surgery.
METHODS
METHODS
This is a multicenter retrospective cohort study of patients with cerebral palsy (CP), spinal muscular atrophy, myelodysplasia, muscular dystrophy, or myopathy undergoing index spine surgery from 1994 to 2020. Mortality risk was calculated up to 10 years postoperatively. Proportional hazard modeling was utilized to investigate associations between risk factors and mortality rate.
RESULTS
RESULTS
A total of 808 patients [mean age 7.7 y; 439 (54.3%) female] were identified. Postoperative 30-day, 90-day, and 120-day mortality was 0%, 0.001%, and 0.01%, respectively. 1-year, 2-year, 5-year, and 10-year mortality was 0.5%, 1.1%, 5.4%, and 17.4%, respectively. Factors associated with increased mortality rate: CP diagnosis [hazard ratio (HR): 3.14, 95% confidence interval (CI): 1.71; 5.79, P<0.001]; nonambulatory status (HR: 3.01, 95% CI: 1.06; 8.5, P=0.04)]; need for respiratory assistance (HR: 2.17, 95% CI: 1.00; 4.69, P=0.05).
CONCLUSIONS
CONCLUSIONS
In neuromuscular patients with early onset scoliosis, mortality risk at 10 years following spine surgery was 17.4%. As mortality was 1.1% at 2 years, premature death was unlikely a direct result of spine surgery. Diagnosis (CP) and markers of disease severity (nonambulatory status, respiratory assistance) were associated with increased mortality rate.
LEVEL OF EVIDENCE
METHODS
Prognostic level II.
Identifiants
pubmed: 34939971
doi: 10.1097/BPO.0000000000002036
pii: 01241398-202203000-00004
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e234-e241Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Davies G, Reid L. Effect of scoliosis on growth of alveoli and pulmonary arteries and on right ventricle. Arch Dis Child. 1971;46:623–632.
Karol LA. Early definitive spinal fusion in young children: what we have learned. Clin Orthop Relat Res. 2011;469:1323–1329.
Campbell RM, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85-A:399–408.
Vitale MG, Matsumoto H, Roye DP, et al. Health-related quality of life in children with thoracic insufficiency syndrome. J Pediatr Orthop. 2008;28:239–243.
Goldberg CJ, Gillic I, Connaughton O, et al. Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine (Phila Pa 1976). 2003;28:2397–2406.
Phillips JH, Knapp DRJ, Herrera-Soto J. Mortality and morbidity in early-onset scoliosis surgery. Spine (Phila Pa 1976). 2013;38:324–327.
Russo C, Trupia E, Campbell M, et al. The association between the classification of early-onset scoliosis and smith complications after initiation of growth-friendly spine surgery. J Pediatr Orthop. 2019;39:e737–e741.
Vialle R, Thévenin-Lemoine C, Mary P. Neuromuscular scoliosis. Orthop Traumatol Surg Res. 2013;99(suppl):S124–S139.
Mary P, Servais L, Vialle R. Neuromuscular diseases: diagnosis and management. Orthop Traumatol Surg Res. 2018;104:S89–S95.
Mohamad F, Parent S, Pawelek J, et al. Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop. 2007;27:392–397.
Rumalla K, Yarbrough CK, Pugely AJ, et al. Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine. 2016;25:500–508.
Sharma S, Wu C, Andersen T, et al. Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J. 2013;22:1230–1249.
Cognetti D, Keeny HM, Samdani AF, et al. Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database. Neurosurg Focus. 2017;43:E10 . doi:10.3171/2017.7.FOCUS17384.
doi: . doi:10.3171/2017.7.FOCUS17384.
Barsdorf AI, Sproule DM, Kaufmann P. Scoliosis surgery in children with neuromuscular disease. Arch Neurol. 2010;67:231–235.
Tsirikos AI, Chang W-N, Dabney KW, et al. Life expectancy in pediatric patients with cerebral palsy and neuromuscular scoliosis who underwent spinal fusion. Dev Med Child Neurol. 2003;45:677–682.
Sewell MD, Malagelada F, Wallace C, et al. A preliminary study to assess whether spinal fusion for scoliosis improves carer-assessed quality of life for children with GMFCS level IV or V cerebral palsy. J Pediatr Orthop. 2016;36:299–304.
Difazio RL, Vessey JA, Zurakowski D, et al. Differences in health-related quality of life and caregiver burden after hip and spine surgery in non-ambulatory children with severe cerebral palsy. Dev Med Child Neurol. 2016;58:298–305.
Miyanji F, Nasto LA, Sponseller PD, et al. Assessing the risk-benefit ratio of scoliosis surgery in cerebral palsy: surgery is worth it. J Bone Jt Surg Am. 2018;100:556–563.
Shaw KA, Reifsnyder J, Hire JM, et al. The effect of spinal arthrodesis on health-related quality of life for patients with nonambulatory cerebral palsy: a critical analysis review. JBJS Rev. 2019;7:1–9.
Garrett A, Perry J, Nickel V. Stabilization of the collapsing spine. J Bone Jt Surg. 1961;43-A:474–484.
Palisano R, Rosenbaum P, Walter S, et al. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39:214–223.
Pedersen AB, Mikkelsen EM, Cronin-Fenton D, et al. Missing data and multiple imputation in clinical epidemiological research. Clin Epidemiol. 2017;9:157–166.
Michel C, Collins C. Pediatric neuromuscular disorders. Pediatr Clin N Am. 2020;67:45–57.
Office of Communications and Public Liaison, National Institute if Neurological Disorders and Stroke, National Institute of Health. Cerebral Palsy: Hope through Research. NIH Publ. 2013;53:1689–1699.
Bos I, Wynia K, Almansa J, et al. The prevalence and severity of disease-related disabilities and their impact on quality of life in neuromuscular diseases. Disabil Rehabil. 2019;41:1676–1681.
Morrison BM. Neuromuscular diseases. Senminars Neurol. 2016;36:409–418.
Ryder S, Leadley RM, Armstrong N, et al. The burden, epidemiology, costs and treatment for Duchenne muscular dystrophy: an evidence review. Orphanet J Rare Dis. 2017;12:1–22.
McDonnell MF, Glassman SD, Dimar JR II, et al. Perioperative complications of anterior procedures on the spine. J Bone Jt Surg Am. 1996;78:839–847.
Shaffrey E, Smith JS, Lenke LG, et al. Defining rates and causes of mortality associated with spine surgery: comparison of 2 data collection approaches through the scoliosis research society. Spine (Phila Pa 1976). 2014;39:579–586.
Kristensen MT, Kehlet H. The basic mobility status upon acute hospital discharge is an independent risk factor for mortality up to 5 years after hip fracture surgery: survival rates of 444 pre-fracture ambulatory patients evaluated with the Cumulated Ambulation Score. Acta Orthop. 2018;89:47–52.
Chang R, Wong YK. Prognostic indicators of neuromuscular disorders for palliative care referral. Ann Palliat Med. 2018;7:335–338.