Lins Laura A B, Nechyporenko Anatoliy V, Halanski Matthew A, Hetzel Scott J, Noonan Kenneth J
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA.
Spine Deform. 2020 Feb;8(1):115-121. doi: 10.1007/s43390-020-00034-3. Epub 2020 Jan 24.
Retrospective comparative study.
In patients with cerebral palsy (CP), we determine the impact of intrathecal baclofen pumps (ITBPs) on scoliosis curve progression before posterior spine fusion (PSF) and its effects on surgical outcome.
Children with CP can have rapid scoliosis progression, and high rates of surgical complications can be encountered. It is unknown whether the presence of pre-existing ITBP results in more difficult surgery and higher complication rates in similarly affected children.
This is a single-center retrospective study of CP patients undergoing PSF over a 15-year period. Demographics, comorbidities, curve magnitudes, and surgical methods were compared between patients with ITBP and those without. Postoperative complications, length of intensive care unit/hospital stay, drain use and output volume, and need for further surgery were also compared. Curve progression analysis after ITBP placement was performed on a subgroup of patients with high-quality consistent radiographs.
Nineteen patients with ITBP and 49 patients without ITBP met inclusion criteria. Age, comorbidities, number of levels fused, and fixation techniques during PSF were not significantly different between cohorts. ITBP patients were more likely to have PSF with osteotomy (p = 0.022). Increased intraoperative neurosurgical consultations were found for patients with ITBP (42.1% vs. 4.0%; p < 0.001). Median surgical time was 1.2 h greater in patients with ITBP (6.7 vs. 5.5 h, p = 0.039). There was no difference in hospital course and complications in patients with ITBP and those without ITBP. Thirty-one patients without ITB were compared with 15 ITBP patients for curve progression before PSF, demonstrating a mean rate of scoliosis progression of 9.6° ± 6.7°/year and 14.8° ± 9.1°/year (p = 0.0346), respectively.
The presence of an ITBP appears to be associated with the increase in scoliosis progression; and these patients will likely have a more challenging spine fusion. Fortunately, the final outcome is not affected by ITBP.
Level III.
回顾性比较研究。
在脑瘫（CP）患者中，我们确定鞘内注射巴氯芬泵（ITBP）对后路脊柱融合术（PSF）前脊柱侧弯曲线进展的影响及其对手术结果的影响。
CP患儿的脊柱侧弯可能进展迅速，且手术并发症发生率较高。对于同样受影响的儿童，预先存在ITBP是否会导致手术更困难及并发症发生率更高尚不清楚。
这是一项对15年间接受PSF的CP患者进行的单中心回顾性研究。比较了有ITBP和无ITBP患者的人口统计学、合并症、侧弯度数和手术方法。还比较了术后并发症、重症监护病房/住院时间、引流使用及引流量，以及再次手术的必要性。对一组有高质量一致X线片的患者进行了ITBP置入后的侧弯进展分析。
19例有ITBP和49例无ITBP患者符合纳入标准。两组患者的年龄、合并症、融合节段数和PSF期间的固定技术无显著差异。有ITBP的患者更有可能进行截骨的PSF（p = 0.022）。有ITBP的患者术中神经外科会诊增加（42.1%对4.0%；p < 0.001）。有ITBP的患者中位手术时间长1.2小时（6.7对5.5小时，p = 0.039）。有ITBP和无ITBP患者的住院过程和并发症无差异。将31例无ITBP患者与15例有ITBP患者在PSF前的侧弯进展进行比较，显示脊柱侧弯进展的平均速率分别为9.6°±6.7°/年和14.8°±9.1°/年（p = 0.0346）。
ITBP的存在似乎与脊柱侧弯进展增加有关；这些患者的脊柱融合可能更具挑战性。幸运的是，最终结果不受ITBP影响。
三级。
