One stage or two? A cohort analysis of anterior–posterior spinal fusions for severe pediatric scoliosis

Study design Retrospective case-series study of prospectively collected data. Objective We sought to identify the differences in outcomes between one-stage (single surgical episode) and two­stage (separate day) anterior and posterior spinal fusion and segmental spinal instrumentation surgeries in se...
Ausführliche Beschreibung

Study design Retrospective case-series study of prospectively collected data. Objective We sought to identify the differences in outcomes between one-stage (single surgical episode) and two­stage (separate day) anterior and posterior spinal fusion and segmental spinal instrumentation surgeries in severe non-idiopathic and idiopathic scoliosis cases. Background Patients with severe pediatric spine deformity may require combined anterior and posterior fusion procedures. Given their increased complexity and morbidity, surgeons may consider staging these procedures on separate days. Methods A retrospective cohort study was performed on a prospective Pediatric Spine Database. Patients 21 years of age or under with pediatric scoliosis who underwent primary anterior and posterior spinal deformity correction surgery either through a one-stage or planned two-stage sequence with greater than 2-year follow-up were included. Differences in demographics, comorbidities, surgical details, perioperative morbidity, complications, and outcomes were assessed based on scoliosis etiology. Multivariate models were utilized to control for confounders. Results There were 70 non-idiopathic (14 two-stage vs. 56 one-stage) and 65 idiopathic scoliosis (8 two-stage vs. 57 one-stage) patients. Mean follow-up was 90.1 ± 54.7 months. In non-idiopathic scoliosis patients, two-stage surgery was independently associated with a 140-min increased surgical time (95% confidence interval: 52–229 min, p = 0.002) and an 8.2-day (95% confidence interval: 2.3–14.1 days, p = 0.007) increased hospital length of stay. In idiopathic scoliosis patients, two-stage surgery was independently associated with a 2108 ml increase in crystalloid use (95% confidence interval: 834–3381 ml p = 0.002) and a 5.3-day increased hospital length of stay (95% confidence interval: 4.0–6.5 days, p < 0.001). There were no significant differences in blood loss, transfusions, complications, or post-operative curves on multivariate analysis between one-stage and two-stage surgery cohorts in either non-idiopathic or idiopathic scoliosis patient groups. Conclusion Two-stage surgery was associated with increased crystalloid use in idiopathic scoliosis patients and longer operative times in non-idiopathic scoliosis patients, and longer hospital length of stay in both populations, without significant difference in complications or deformity correction. In the appropriate patient, one-stage anterior–posterior scoliosis surgery may be preferable to two-stage surgery. Level of evidence Level III Retrospective Comparative Study Ausführliche Beschreibung

Autor*in:	Du, Jerry Y. [verfasserIn] Poe-Kochert, Connie [verfasserIn] Thompson, George H. [verfasserIn] Son-Hing, Jochen P. [verfasserIn] Hardesty, Christina K. [verfasserIn] Mistovich, R. Justin [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2020

Schlagwörter:	Scoliosis Severe scoliosis Anterior–posterior scoliosis Neuromuscular scoliosis Complications

Übergeordnetes Werk:	Enthalten in: Spine deformity - Amsterdam [u.a.] : Elsevier, 2013, 8(2020), 5 vom: 12. Mai, Seite 939-949
Übergeordnetes Werk:	volume:8 ; year:2020 ; number:5 ; day:12 ; month:05 ; pages:939-949

Links:	Volltext

DOI / URN:	10.1007/s43390-020-00128-y

Katalog-ID:	SPR041212606