Department of Pediatric Orthopedics, Cohen Children's Medical Center, Northwell Health System, New Hyde Park, NY.
Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY.
Spine (Phila Pa 1976). 2022 Mar 1;47(5):E159-E168. doi: 10.1097/BRS.0000000000004191.
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: This study aims to identify differences in perioperative outcomes between ambulatory patients with neuromuscular scoliosis (ANMS) and adolescent idiopathic scoliosis (AIS) following spinal fusion. SUMMARY OF BACKGROUND DATA: NMS patients have severe curves with more comorbidities and procedural complexity. These patients require extensive fusion levels, increased blood loss, and suffer increased periop complications. However, NMS patients have a variable severity spectrum, including ambulation status. METHODS: Chart and radiographic review of NMS and AIS patients undergoing PSF from 2005 to 2018. NNMS included NMS patients who were completely dependent (GMFCS IV-V). ANMS consisted of community ambulators without significant reliance on wheeled assistive devices (GMFCS I-III). Subanalysis matched by age, sex, levels fused and preoperative Cobb angle was conducted as well. Wilcoxon Rank-Sum, Kruskal-Wallis, χ2, and Fisher exact tests were performed. RESULTS: There were 120 patients in the NNMS group, 54 in ANMS and 158 in the AIS group. EBL was significantly lower for ANMS and AIS patients (P < 0.001). Complications within 30 days were similar between ANMS and AIS (P = 1.0), but significantly higher for NNMS (P < 0.001). Two (1.3%) AIS patients, (1.7%) nonambulatory NMS patients, and one (1.9%) ANMS patient required revision surgery (P = 1.0). However, all NMS patients had increased fusion levels, fixation points, and surgery time (P < 0.05). NNMS had significantly longer ICU (P < 0.001), hospital stay (P < 0.001), intraoperative transfusions (P < 0.001), and fewer patients extubated in the OR (P < 0.001) than ANMS and AIS patients. In the subanalysis, ANMS had similar radiographic measurements, EBL, transfusion, surgery time, extubation rate, and complication rate (P > 0.05) to AIS. CONCLUSION: Our data show radiographic outcomes, infections, revisions, and overall complications for ANMS were similar to the AIS population. This suggests that NMS patients who ambulate primarily without assistance can expect surgical outcomes comparable to AIS patients with further room for improvement in length of ICU and hospital stay.Level of Evidence: 4.
研究设计：回顾性队列研究。 目的：本研究旨在比较门诊型神经肌肉型脊柱侧凸（ANMS）和青少年特发性脊柱侧凸（AIS）患者脊柱融合术后围手术期结局的差异。 背景资料概要：NMS 患者的脊柱弯曲严重，合并症更多，手术过程更复杂。这些患者需要广泛的融合节段、大量失血，并增加围手术期并发症。然而，NMS 患者的严重程度存在差异，包括活动能力。 方法：对 2005 年至 2018 年间接受 PSF 的 NMS 和 AIS 患者进行图表和影像学检查。NNMS 包括完全依赖（GMFCS IV-V）的 NMS 患者。ANMS 由无需依靠轮式助行器（GMFCS I-III）即可独立行走的社区步行者组成。还进行了年龄、性别、融合节段和术前 Cobb 角匹配的亚分析。采用 Wilcoxon 秩和检验、Kruskal-Wallis 检验、χ2 检验和 Fisher 确切概率法进行检验。 结果：NNMS 组有 120 例患者，ANMS 组 54 例，AIS 组 158 例。ANMS 和 AIS 患者的术中出血量明显低于 NNMS 组（P<0.001）。ANMS 和 AIS 患者术后 30 天内的并发症发生率相似（P=1.0），但 NNMS 组明显更高（P<0.001）。两名（1.3%）AIS 患者、（1.7%）非步行 NMS 患者和一名（1.9%）ANMS 患者需要接受翻修手术（P=1.0）。然而，所有 NMS 患者的融合节段、固定点数和手术时间均增加（P<0.05）。NNMS 患者 ICU 时间（P<0.001）、住院时间（P<0.001）、术中输血（P<0.001）和更少的患者在手术室拔管（P<0.001）均显著长于 ANMS 和 AIS 患者。在亚分析中，ANMS 的影像学测量、出血量、输血、手术时间、拔管率和并发症发生率与 AIS 相似（P>0.05）。 结论：我们的数据表明，ANMS 的影像学结果、感染、翻修和总体并发症与 AIS 人群相似。这表明，主要无需辅助即可行走的 NMS 患者可以预期与 AIS 患者相似的手术结果，进一步改善 ICU 和住院时间还有空间。 证据等级：4 级。
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