Our Summary

This research paper looks at how recent changes in technology and surgical techniques have affected the treatment of pediatric neuromuscular scoliosis (NMS), a condition that affects the spines of children. The authors used a large national database to look at trends in surgery for NMS from 2002 to 2011. They found that the number of spinal fusion procedures (a type of surgery that joins together two or more vertebrae) increased by 93% over this period.

The study also investigated factors affecting hospital complications, outcomes, and costs. They found that over the study period, there was an increase in the number of patients with Medicaid insurance, patients with at least one other health condition, and patients needing blood transfusions.

The use of a surgical technique called posterior-only fusions increased, while the use of a combined technique decreased. The use of intraoperative neurophysiological monitoring (a technique to monitor the nervous system during surgery) also increased over this period.

The study found that the use of intraoperative neurophysiological monitoring was associated with fewer complications and a shorter hospital stay. However, the average hospital costs increased by nearly 75% over the study period.

The study also identified several factors that increased the likelihood of complications, including nonwhite race, higher household income, more health conditions, certain surgical techniques, and the use of blood transfusions.

In conclusion, the study suggests that the increasing use of certain surgical techniques and monitoring could help reduce the high complication rates in NMS. However, the increasing number of health conditions, blood transfusions, and costs may indicate a more aggressive approach to these cases.

FAQs

  1. How has the treatment of pediatric neuromuscular scoliosis changed over the years according to the research paper?
  2. What factors were found to affect hospital complications, outcomes, and costs in the treatment of pediatric neuromuscular scoliosis?
  3. What benefits and drawbacks were identified in the increased use of certain surgical techniques and monitoring for pediatric neuromuscular scoliosis?

Doctor’s Tip

A doctor might advise a patient undergoing spinal fusion to discuss the use of intraoperative neurophysiological monitoring with their surgeon, as it has been shown to reduce complications and shorten hospital stays. The patient should also be aware of the increased costs associated with these advancements in technology and surgical techniques. Additionally, the patient should be mindful of factors such as race, income, and overall health condition, as they may impact the likelihood of complications during surgery.

Suitable For

Patients who are typically recommended spinal fusion include those with severe spinal deformities, such as scoliosis, kyphosis, or spondylolisthesis, that have not responded to conservative treatments such as physical therapy, bracing, or medication. Patients with spinal instability due to trauma, tumors, infections, or degenerative conditions may also be recommended for spinal fusion surgery. Additionally, patients with spinal stenosis or other conditions causing nerve compression may benefit from spinal fusion to stabilize the spine and relieve pressure on the nerves. Ultimately, the decision to undergo spinal fusion surgery is based on a thorough evaluation by a spine specialist who considers the patient’s symptoms, medical history, and imaging studies.

Timeline

Before spinal fusion:

  1. Patient experiences symptoms of neuromuscular scoliosis such as back pain, difficulty breathing, and changes in posture.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, and CT scans to determine the severity of the condition.
  3. Patient may undergo non-surgical treatments such as physical therapy, bracing, or medication to manage symptoms.
  4. If non-surgical treatments are not effective, patient and their healthcare team may decide on spinal fusion surgery as a treatment option.

After spinal fusion:

  1. Patient undergoes spinal fusion surgery, where the surgeon joins together two or more vertebrae to stabilize the spine.
  2. Patient is monitored closely in the hospital for complications and to ensure proper healing.
  3. Patient may undergo physical therapy to regain strength and mobility in the spine.
  4. Patient may experience some pain and discomfort during the recovery period, which can be managed with medication.
  5. Patient gradually returns to normal activities and follows up with their healthcare team for monitoring and follow-up care.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal fusion for pediatric neuromuscular scoliosis include:

  1. What are the potential risks and complications associated with spinal fusion surgery for pediatric neuromuscular scoliosis?
  2. What are the expected outcomes and long-term effects of spinal fusion surgery in children with neuromuscular scoliosis?
  3. What surgical techniques will be used in the procedure, and why is this technique chosen for my child’s specific case?
  4. Will intraoperative neurophysiological monitoring be used during the surgery, and how does this technology help improve outcomes?
  5. How many spinal fusion procedures has the surgeon performed for pediatric neuromuscular scoliosis, and what is their success rate?
  6. What is the expected length of hospital stay and recovery time following spinal fusion surgery?
  7. What post-operative care and rehabilitation will be necessary for my child after the surgery?
  8. Are there any alternative treatment options to spinal fusion for pediatric neuromuscular scoliosis that we should consider?
  9. How will the surgery and potential complications impact my child’s quality of life and long-term health?
  10. What are the expected costs associated with spinal fusion surgery for pediatric neuromuscular scoliosis, and will insurance cover these expenses?

Reference

Authors: Rumalla K, Yarbrough CK, Pugely AJ, Koester L, Dorward IG. Journal: J Neurosurg Spine. 2016 Oct;25(4):500-508. doi: 10.3171/2016.2.SPINE151377. Epub 2016 May 20. PMID: 27203810