Does Spinal Fusion and Scoliosis Correction Improve Activity and Participation for Children With GMFCS level 4 and 5 Cerebral Palsy?
This study assesses whether spinal fusion for scoliosis improves activity and participation for children with severe CP. Retrospective cohort study of 70 children (39M:31F) with GMFCS level 4/5 CP and significant scoliosis. Thirty-six underwent observational and/or brace treatment as the sole treatment for their scoliosis, and 34 underwent surgery. Children in the operative group were older and had worse scoliosis than those in the observational group. Questionnaire and radiographic data were recorded over a 2-year period. The ASKp was used to measure activity and participation. In the observational group, Cobb angle and pelvic obliquity increased from 51o (40–90) and 10o (0–30) to 70o (43–111) and 14o (0–37). Mean ASKp decreased from 16.3 (1–38) to 14.2 (1–36). In the operative group, Cobb angle and pelvic obliquity decreased from 81o (50–131) and 14o (1–35) to 38o (10–76) and 9o (0–24). Mean ASKp increased from 10.5 (0–29) to 15.9 (3–38). Spinal-related pain correlated most with change in activity and participation in both groups. There was no difference in mobility, GMFCS level, feeding or communication in either group before and after treatment. In children with significant scoliosis and CP classified within GMFCS levels 4 and 5, spinal fusion was associated with an improvement in activity and participation, whereas nonoperative treatment was associated with a small reduction. Pain should be carefully...
ConclusionAdults with spastic diplegic CP who received their first orthopaedic intervention more than 15 years ago (based on ISA) showed similar incidence of spinal deformities as reported in the younger CP population, suggesting stability of spinal curvature into adulthood.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
by Drew Rosielle (@drosielle)A Series of Observations on Opioids By a Palliative Doc Who Prescribes A Lot of Opioids But Also Has Questions.This is the 5th post in a series about opioids, with a focus on how my thinking about opioids has changed over the years. See also:Part 1 – Introduction, General Disclaimers, Hand-Wringing, and a Hand-Crafted Graph.Part 2 – We Were Wrong 20 years Ago, Our Current Response to the Opioid Crisis is Wrong, But We Should Still Be Helping Most of our Long-Term Patients Reduce Their Opioid DosesPart 3 – Opioids Have Ceiling Effects, High-Doses are Rarely Therapeutic, and Ano...
AbstractPurpose of ReviewSpinal deformity is a common issue in pediatric patients with an underlying neurological diagnosis or syndrome. Management of neuromuscular scoliosis (NMS) is a major part of the orthopedic care of such patients, as the deformity is often progressive, and may affect gait, seating and positioning. In addition, untreated large spinal deformities may be associated with pain and/or cardiopulmonary issues over time.Recent FindingsRecent changes in medical management of the underlying disease process appears to alter the natural history of certain neuromuscular conditions, and in the case of patients wit...
ConclusionsSurgeon-caregiver agreement is greater where literature support for a particular surgical indication is strong (ie, spinal fusion’s known improvement of sitting posture in children with neuromuscular scoliosis). Stronger literature support may bolster surgeons’ confidence in recommending a particular procedure, fostering greater communication, understanding, and agreement on surgical necessity between caregivers and surgeons.Level of EvidenceLevel II, prospective comparative study.
CONCLUSIONS: There is moderate- and low-quality evidence that there may be a small additional reduction in pain up to 72 hours after surgery with epidural analgesia compared with systemic analgesia. Two very small studies showed epidural analgesia with local anaesthetic alone may accelerate the return of gastrointestinal function. The safety of this technique in children undergoing thoraco-lumbar surgery is uncertain due to the very low-quality of the evidence. The study in 'Studies awaiting classification' may alter the conclusions of the review once assessed. PMID: 30650189 [PubMed - as supplied by publisher]
CONCLUSIONS Simultaneous stabilisation of spine and pelvis makes it possible to achieve a good quality correction of the deformity and good clinical results over a long period of time. It allows for stability of the sitting position of the patients and improves the quality of their lives. Nowadays, the S2AI screws are considered to be biomechanically the best quality pelvic fixation, eliminating subcutaneous prominence of the instrumentation and reducing the risk of skin decubitus. Key words:neuromuscular deformity, sacral-alar-iliac screw, pelvic obliquity, stabilization, scoliosis. PMID: 30257778 [PubMed - in process]
For children with severe CP, surgery for scoliosis (sideways curvature of the spine) significantly improves the quality of life for them and their caregivers
CONCLUSIONS: There was no significant difference in length of stay, pain scores, or pain/spasticity medication use between groups after spinal fusion, but there was a significantly lower incidence of complications in the ITB therapy group.
ConclusionSpinal fusion for severe neuromuscular scoliosis is a difficult procedure, with a high rate of complications. Among them, pancreatic fracture should be considered when abdominal pain persists in the postoperative period. Conservative management is advocated especially in case of a poor general condition.
CONCLUSION: This study highlights possible discrepancies in postoperative pain management specific to girls with Rett syndrome and suggests further investigation is warranted to determine best practice for postoperative analgesic management for this vulnerable patient population. PMID: 28177174 [PubMed - as supplied by publisher]