Saito Wataru, Inoue Gen, Imura Takayuki, Nakazawa Toshiyuki, Miyagi Masayuki, Shirasawa Eiki, Kuroda Akiyoshi, Uchida Kentaro, Takaso Masashi
Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Spine Surg Relat Res. 2018 Jan 27;2(1):48-52. doi: 10.22603/ssrr.2017-0018. eCollection 2018.
Echocardiography is an important component of perioperative cardiac risk stratification in patients with neuromuscular scoliosis (NMS). However, there are little data regarding the relationship between preoperative echocardiographic findings and spinal deformity. We retrospectively reviewed preoperative echocardiographic data to investigate the relationship between echocardiographic evaluation and spinal deformity in NMS.
We reviewed 73 NMS patients (mean age: 13.3 years, male 66%) who underwent spinal correction surgery between 2008 and 2016. Echocardiographic data including ejection fraction (EF), valvar disease, and inferior vena cava diameter were collected from the preoperative exam. Demographic and radiographic data were also collected.
Preoperative diagnoses included Duchenne muscular dystrophy, Fukuyama congenital muscular dystrophy, other dystrophy, spinal muscular atrophy, and congenital myopathies. Mean Body Mass Index (BMI) was 15.6 kg/m. Mean major Cobb angle before surgery was 86.6 ± 28.2°. Because of technical difficulty, complete echocardiographic data could only be collected and evaluated in 49.3% of patients. Neither right nor left sided cardiac evaluation could be completed in 20.5%. Patients in whom complete echocardiographic data could not be collected had significantly more extensive thoracic scoliosis with a more rigid curve and hypokyphosis, and were of lower weight and BMI than patients in whom complete data could be collected. Ten cases (13.7%) were diagnosed as having minor heart-related complications immediately after surgery, and they had higher right atrial pressures preoperatively.
Echocardiography can be technically difficult in NMS patients with extensive spinal deformities. We found that perioperative cardiac function could only be evaluated by echocardiogram in about half of NMS patients undergoing spinal correction surgery. The absence of an adequate preoperative cardiac evaluation could render these patients more susceptible to perioperative heart-related complications. Echocardiography may not be sufficient to evaluate cardiac conditions in children with extensive NMS.
超声心动图是神经肌肉型脊柱侧凸（NMS）患者围手术期心脏风险分层的重要组成部分。然而，关于术前超声心动图检查结果与脊柱畸形之间的关系，数据较少。我们回顾性分析术前超声心动图数据，以研究NMS患者超声心动图评估与脊柱畸形之间的关系。
我们回顾了2008年至2016年间接受脊柱矫正手术的73例NMS患者（平均年龄：13.3岁，男性占66%）。术前检查收集了包括射血分数（EF）、瓣膜疾病和下腔静脉直径在内的超声心动图数据。还收集了人口统计学和影像学数据。
术前诊断包括杜氏肌营养不良症、福山先天性肌营养不良症、其他肌营养不良症、脊髓性肌萎缩症和先天性肌病。平均体重指数（BMI）为15.6kg/m。术前平均主弯Cobb角为86.6±28.2°。由于技术困难，仅49.3%的患者能够收集并评估完整的超声心动图数据。20.5%的患者无法完成左右心脏评估。无法收集完整超声心动图数据的患者，其胸椎侧凸范围更广，曲线更僵硬，后凸减小，体重和BMI均低于能够收集完整数据的患者。10例（13.7%）患者术后立即被诊断为有轻微心脏相关并发症，他们术前右心房压力较高。
对于脊柱畸形广泛的NMS患者，超声心动图检查在技术上可能存在困难。我们发现，在接受脊柱矫正手术的NMS患者中，只有约一半的患者能够通过超声心动图评估围手术期心脏功能。术前缺乏充分的心脏评估可能使这些患者更容易发生围手术期心脏相关并发症。超声心动图可能不足以评估脊柱畸形广泛的儿童的心脏状况。
