Ambulatory Neuromuscular Scoliosis Patients Have Superior Perioperative Results Than Nonambulatory Neuromuscular Scoliosis Patients and Can Approach Adolescent Idiopathic Scoliosis Outcomes After Posterior Spinal Fusion. Issue 5 (1st March 2022)

• Record Type: Journal Article
• Authors: Sarwahi, Vishal; Atlas, Aaron; Galina, Jesse; Hasan, Sayyida; Dimauro, Jon-Paul; Katyal, Chhavi; Djukic, Aleksandra; Thornhill, Beverly; Lo, Yungtai; Amaral, Terry D.; Moguilevich, Marina
• Is Part Of: Spine. Volume 47:Issue 5(2022)
• Page Start: E159
• Page End: E168
• Publication Date: 2022-03-01
• Subjects: adolescent idiopathic scoliosis -- ambulation status -- neuormuscular scoliosis -- outcomes; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000004191
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Neuromuscular patients that ambulate can expect perioperative outcomes comparable to adolescent idiopathic scoliosis patients after posterior spinal fusion, including radiographic outcomes, blood loss, operative time, and overall complication rates. Abstract : Study Design: Retrospective cohort study. Objective: This study aims to identify differences in perioperative outcomes between ambulatory patients with neuromuscular scoliosis (ANMS) and adolescent idiopathic scoliosis (AIS) following spinal fusion. Summary of Background Data: NMS patients have severe curves with more comorbidities and procedural complexity. These patients require extensive fusion levels, increased blood loss, and suffer increased periop complications. However, NMS patients have a variable severity spectrum, including ambulation status. Methods: Chart and radiographic review of NMS and AIS patients undergoing PSF from 2005 to 2018. NNMS included NMS patients who were completely dependent (GMFCS IV-V). ANMS consisted of community ambulators without significant reliance on wheeled assistive devices (GMFCS I-III). Subanalysis matched by age, sex, levels fused and preoperative Cobb angle was conducted as well. Wilcoxon Rank-Sum, Kruskal-Wallis, χ 2, and Fisher exact tests were performed. Results: There were 120 patients in the NNMS group, 54 in ANMS and 158 in the AIS group. EBL was significantly lower for ANMS and AIS patients ( P < 0.001). Complications within 30 days were similar between ANMS and AIS ( P = 1.0), but significantly higher for NNMS ( P < 0.001). Two (1.3%) AIS patients, (1.7%) nonambulatory NMS patients, and one (1.9%) ANMS patient required revision surgery ( P = 1.0). However, all NMS patients had increased fusion levels, fixation points, and surgery time ( P < 0.05). NNMS had significantly longer ICU ( P < 0.001), hospital stay ( P < 0.001), intraoperative transfusions ( P < 0.001), and fewer patients extubated in the OR ( P < 0.001) than ANMS and AIS patients. In the subanalysis, ANMS had similar radiographic measurements, EBL, transfusion, surgery time, extubation rate, and complication rate ( P > 0.05) to AIS. Conclusion: Our data show radiographic outcomes, infections, revisions, and overall complications for ANMS were similar to the AIS population. This suggests that NMS patients who ambulate primarily without assistance can expect surgical outcomes comparable to AIS patients with further room for improvement in length of ICU and hospital stay. Level of Evidence: 4