Bixby Elise C, Skaggs Kira, Marciano Gerard F, Simhon Matthew E, Menger Richard P, Anderson Richard C E, Vitale Michael G
1Department of Orthopedics, Columbia University Irving Medical Center, New York, New York.
2USA Health, Mobile, Alabama; and.
J Neurosurg Pediatr. 2021 Jul 2;28(3):250-259. doi: 10.3171/2020.12.PEDS20783. Print 2021 Sep 1.
Institutions investigating value and quality emphasize utilization of two attending surgeons with different areas of technical expertise to treat complex surgical cases and to minimize complications. Here, the authors chronicle the 12-year experience of using a two-attending surgeon, two-specialty model to perform hemivertebra resection in the pediatric population.
Retrospective cohort data from 2008 to 2019 were obtained from the NewYork-Presbyterian Morgan Stanley Children's Hospital operative database. This database included all consecutive pediatric patients < 21 years old who underwent hemivertebra resection performed with the two-attending surgeon (neurosurgeon and orthopedic surgeon) model. Demographic information was extracted. Intraoperative complications, including durotomy and direct neurological injury, were queried from the clinical records. Intraoperative neuromonitoring data were evaluated. Postoperative complications were queried, and length of follow-up was determined from the clinical records.
From 2008 to 2019, 22 patients with a median (range) age of 9.1 (2.0-19.3) years underwent hemivertebra resection with the two-attending surgeon, two-specialty model. The median (range) number of levels fused was 2 (0-16). The mean (range) operative time was 5 hours and 14 minutes (2 hours and 59 minutes to 8 hours and 30 minutes), and the median (range) estimated blood loss was 325 (80-2700) ml. Navigation was used in 14% (n = 3) of patients. Neither Gardner-Wells tongs nor halo traction was used in any operation. Neuromonitoring signals significantly decreased or were lost in 14% (n = 3) of patients. At a mean ± SD (range) follow-up of 4.6 ± 3.4 (1.0-11.6) years, 31% (n = 7) of patients had a postoperative complication, including 2 instances of proximal junctional kyphosis, 2 instances of distal junctional kyphosis, 2 wound complications, 1 instance of pseudoarthrosis with hardware failure, and 1 instance of screw pullout. The return to the operating room (OR) rate was 27% (n = 6), which included patients with the abovementioned wound complications, distal junctional kyphosis, pseudoarthrosis, and screw pullout, as well as a patient who required spinal fusion after loss of motor evoked potentials during index surgery.
Twenty-two patients underwent hemivertebra resection with a two-attending surgeon, two-specialty model over a 12-year period at a specialized children's hospital, with a 14% rate of change in neuromonitoring, 32% rate of nonneurological complications, and a 27% rate of unplanned return to the OR.
研究价值与质量的机构强调利用两名具有不同技术专长领域的主治外科医生来治疗复杂手术病例并尽量减少并发症。在此，作者记录了采用两名主治外科医生、两个专业模式在儿科患者中进行半椎体切除术的12年经验。
从纽约长老会摩根士丹利儿童医院手术数据库中获取2008年至2019年的回顾性队列数据。该数据库包括所有连续的21岁以下接受两名主治外科医生（神经外科医生和骨科医生）模式下的半椎体切除术的儿科患者。提取人口统计学信息。从临床记录中查询术中并发症，包括硬脊膜切开术和直接神经损伤。评估术中神经监测数据。查询术后并发症，并从临床记录中确定随访时间。
2008年至2019年，22例年龄中位数（范围）为9.1（2.０ - 19.3）岁的患者采用两名主治外科医生、两个专业模式进行了半椎体切除术。融合节段的中位数（范围）为2（0 - 16）。平均（范围）手术时间为5小时14分钟（2小时59分钟至8小时30分钟），估计失血量中位数（范围）为325（80 - 2700）ml。14%（n = 3）的患者使用了导航。所有手术均未使用Gardner-Wells钳或头环牵引。14%（n = 3）的患者神经监测信号显著下降或消失。在平均±标准差（范围）为4.6±3.4（1.0 - 11.6）年的随访中，31%（n = 7）的患者出现术后并发症，包括2例近端交界性后凸畸形、2例远端交界性后凸畸形、2例伤口并发症、1例假关节伴内固定失败和1例螺钉拔出。再次手术率为27%（n = 6），其中包括出现上述伤口并发症、远端交界性后凸畸形、假关节和螺钉拔出的患者，以及一名在初次手术中运动诱发电位消失后需要进行脊柱融合的患者。
在一家专科医院，22例患者在12年期间采用两名主治外科医生、两个专业模式进行了半椎体切除术，神经监测变化率为14%，非神经并发症发生率为32%，计划外再次手术率为27%。
