Lundine Kristopher, Lu Matthias, Borden Timothy C, Yoon Samuel, Percival Mia, Johnson Michael B
Royal Children's Hospital, Melbourne, Australia.
Murdoch Children's Research Institute, Melbourne, Australia.
Eur Spine J. 2025 Aug 26. doi: 10.1007/s00586-025-09282-1.
Patients with neuromuscular scoliosis due to Cerebral Palsy (CP) are complex due to their curve severity and associated medical comorbidities. Spinal fusion is associated with high risk of peri-operative complications and large blood loss requiring allogenic red blood cell (RBC) transfusion. In June 2017, our tertiary paediatric institution implemented a new minimally-invasive approach for the treatment of neuromuscular scoliosis, Bipolar Spinal Correction (Bipolar), a technique first published by Miladi et al. in 2018. This study represents an analysis of the initial experience of this technique to see if it achieves the goal of minimally invasive surgery by decreasing surgical stress in this high-risk population.
We identified patients with an underlying diagnosis of CP who underwent primary single-day surgical correction for their scoliosis between 2010 and 2024 at a single paediatric institution. Patients either underwent a primary posterior spinal fusion (PSF) or Bipolar surgeries. Revision procedures and patients undergoing anterior spinal surgery were excluded. Patient charts and x-rays were reviewed to collect data on demographics, pre-operative curve severity and peri-operative details.
PSF cohort included 46 patients and Bipolar included 78 patients. Demographic and curve severity data were similar between the groups. Bipolar surgery resulted in shorter operative times than PSF (228 min vs. 270 min) and reduced blood loss based on cell-saver return (113 mL vs. 382 mL) and lowest post-operative Hgb level (99.8 g/L vs. 89.6 g/L). Allogenic RBC transfusion rate was markedly reduced in the Bipolar cohort compared to the PSF cohort both intra-operatively (2.6% vs. 23.9%) and post-operatively (14.1% vs. 23.9%). No patient in the Bipolar cohort required mass transfusion protocol, defined as needing more than 3 units of allogenic RBC, compared with 2 patients in the PSF cohort. Post-operative hospital length-of-stay was reduced in the Bipolar cohort compared to PSF (6.5 days vs. 8 days).
When compared with traditional posterior spinal fusion, Bipolar Spinal Correction resulted in decreased operative times, less surgical blood loss, decreased allogenic transfusion rate, and reduced post-operative hospital length of stay in the treatment of children with CP and scoliosis.
Level III, Retrospective Comparative Cohort.
因脑瘫（CP）导致神经肌肉型脊柱侧弯的患者情况复杂，这是由于其侧弯严重程度以及相关的合并症所致。脊柱融合术与围手术期并发症的高风险以及大量失血相关，而大量失血需要异体红细胞（RBC）输血。2017年6月，我们的三级儿科机构实施了一种治疗神经肌肉型脊柱侧弯的新微创方法——双极脊柱矫正术（Bipolar），该技术由米拉迪等人于2018年首次发表。本研究旨在分析该技术的初步经验，以确定其是否通过降低这一高风险人群的手术应激来实现微创手术的目标。
我们确定了在一家儿科机构于2010年至2024年间因脊柱侧弯接受初次单日手术矫正且潜在诊断为CP的患者。患者要么接受初次后路脊柱融合术（PSF），要么接受双极脊柱矫正术。排除翻修手术和接受前路脊柱手术的患者。查阅患者病历和X光片以收集人口统计学、术前侧弯严重程度及围手术期详细信息的数据。
PSF队列包括46例患者，双极脊柱矫正术队列包括78例患者。两组间的人口统计学和侧弯严重程度数据相似。双极脊柱矫正术的手术时间比PSF短（228分钟对270分钟），基于血液回收机回输量的失血量减少（113毫升对382毫升），术后最低血红蛋白水平也较低（99.8克/升对89.6克/升）。与PSF队列相比，双极脊柱矫正术队列术中（2.6%对23.9%）和术后（14.1%对23.9%）的异体RBC输血率显著降低。双极脊柱矫正术队列中没有患者需要大量输血方案（定义为需要超过3单位异体RBC），而PSF队列中有2例患者需要。与PSF相比，双极脊柱矫正术队列的术后住院时间缩短（6.5天对8天）。
与传统后路脊柱融合术相比，双极脊柱矫正术在治疗CP和脊柱侧弯患儿时，手术时间缩短、手术失血量减少、异体输血率降低且术后住院时间缩短。
三级，回顾性比较队列研究。
