Mooney James F, Glazier Stephen S, Barfield William R
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
J Pediatr Orthop B. 2012 Nov;21(6):602-5. doi: 10.1097/BPB.0b013e328357ea38.
The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV.
患有复杂脊柱畸形的儿科患者的治疗通常需要骨科和神经外科的干预。多专科参与的原因包括但不限于存在需要松解的脊髓栓系或需要减压的脊髓空洞症。尽管文献中几乎没有证据支持单独干预，但分阶段进行这些手术一直是常见的做法。我们回顾了一系列连续同时接受脊柱畸形矫正和神经外科干预的患者，试图评估这种方法的安全性、有效性和可能的并发症。回顾了11例同时接受骨科和神经外科手术的患者。收集了患者的人口统计学数据、术前诊断、所进行的手术、术中和围手术期并发症，以及因任何原因意外返回手术室的情况。查阅手术记录和麻醉记录以确定估计失血量、手术时间和术中神经监测的使用情况。患者诊断包括脊髓发育不良（n = 6）、先天性脊柱侧凸和/或后凸（n = 4）以及与努南综合征相关的脊柱侧凸（n = 1）。手术时的平均年龄为9岁2个月（范围 = 14个月至17岁2个月）。估计平均失血量为605毫升（范围 = 50 - 3000毫升）。平均手术时间为313分钟（范围 = 157 - 477分钟）。没有术中并发症，包括意外的硬脊膜撕裂或术前神经状态恶化。一名患者出现与术后石膏固定相关的疼痛，导致深部伤口感染。当使用现代手术和神经监测技术时，患有严重脊柱畸形的儿科患者同时进行骨科和神经外科手术似乎可以安全地进行，且术中和术后并发症最少。证据级别 = 四级。
