Our Summary

This research paper looks into the complications related to tracheostomy, a surgical procedure to create an opening through the neck into the windpipe, in children with scoliosis, a condition where the spine twists and curves to the side. The researchers reviewed the records of patients who have both a tracheostomy and scoliosis.

Of the 102 patients studied, most had scoliosis in the middle part of their spine, a few had issues with incorrect positioning of the tracheostomy tube, and about a third had some emergencies like accidental removal of the tube or bleeding. Around one in five patients had to have their tube replaced due to its bad positioning, and a small number had problems changing the tube at home. Some required a custom length tube.

The researchers also found that over a third of the patients had abnormalities in their windpipe, like blockages or softening of the windpipe walls. Scoliosis repair surgery was performed in a few patients, but only a small number were able to have their tracheostomy tube removed. Overall, only about one in ten patients could have their tracheostomy tube removed.

The findings suggest that children with scoliosis who depend on a tracheostomy may have a higher risk of complications, including problems with the windpipe and the positioning of the tracheostomy tube. More research is needed to understand if scoliosis increases the risk of these complications.

FAQs

  1. What complications are associated with tracheostomy in children with scoliosis?
  2. What percentage of patients with scoliosis and a tracheostomy were able to have their tubes removed?
  3. Does having scoliosis increase the risk of complications from a tracheostomy?

Doctor’s Tip

A doctor might tell a patient considering pediatric scoliosis surgery that there is a higher risk of complications if they already have a tracheostomy in place. It is important to closely monitor the positioning of the tracheostomy tube and be prepared for potential emergencies such as accidental removal or bleeding. Additionally, there may be abnormalities in the windpipe that could impact the success of the surgery. It is important to discuss these risks with the surgical team and have a plan in place to address any potential complications.

Suitable For

Typically, pediatric patients who are recommended for scoliosis surgery are those with severe curvature of the spine that is causing significant pain, difficulty breathing, or impacting their quality of life. Patients who have not responded to non-surgical treatments such as bracing or physical therapy may also be candidates for surgery. Additionally, patients with progressive scoliosis that is worsening over time may be recommended for surgery to prevent further curvature of the spine.

It is important for patients and their families to discuss the risks and benefits of scoliosis surgery with their healthcare provider to determine if surgery is the best course of action for their specific situation.

Timeline

Before pediatric scoliosis surgery:

  • Patient is diagnosed with scoliosis through physical exam, imaging tests, and possibly lung function tests
  • Patient undergoes non-surgical treatments like bracing, physical therapy, and monitoring of the curve progression
  • If the curve worsens or causes symptoms like pain or difficulty breathing, surgery may be recommended
  • Patient and their family meet with the surgical team to discuss the procedure, risks, and expected outcomes

After pediatric scoliosis surgery:

  • Patient undergoes the surgical procedure to correct the curvature of the spine, which may involve the use of rods, screws, or other implants
  • Patient is monitored closely in the hospital for pain management, wound healing, and any complications
  • Patient may require physical therapy to regain strength and mobility in the spine
  • Patient follows up with the surgical team for regular check-ups and monitoring of the spine
  • Over time, the patient may experience improved posture, reduced pain, and improved lung function as a result of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pediatric scoliosis surgery in relation to tracheostomy include:

  1. What specific risks or complications are associated with having both scoliosis surgery and a tracheostomy?
  2. How will the presence of a tracheostomy affect the scoliosis surgery and recovery process?
  3. Are there any additional precautions or special considerations that need to be taken during the surgery due to the tracheostomy?
  4. Will the tracheostomy need to be removed or modified as a result of the scoliosis surgery?
  5. How will the scoliosis surgery impact the management of the tracheostomy in terms of positioning, care, and potential complications?
  6. Are there any long-term implications for having both conditions and surgeries simultaneously?
  7. What is the likelihood of needing ongoing care or interventions related to the tracheostomy after the scoliosis surgery?
  8. Will the scoliosis surgery impact the effectiveness or function of the tracheostomy in any way?
  9. Are there any specific post-operative instructions or follow-up care that should be followed for someone with both scoliosis and a tracheostomy?
  10. How will the medical team coordinate care between specialists involved in managing the scoliosis and tracheostomy to ensure the best possible outcome for the patient?

Reference

Authors: Appachi S, Marcet-Gonzalez J, Brown JN, Ongkasuwan J, Lambert EM. Journal: Laryngoscope. 2022 May;132(5):944-948. doi: 10.1002/lary.29747. Epub 2021 Jul 27. PMID: 34313335