Surgical complications in neuromuscular scoliosis surgery: systematic review and meta-analysis of the last ten years.

PURPOSE: Surgical correction of neuromuscular scoliosis is often a challenging and extensive procedure. Due to this complexity and the high disease burden that these patients carry, per and post-operative complications are not uncommon. The purpose of this study was to systematically review and describe the pooled rates of postoperative complications and analyze risk factors for complications in neuromuscular scoliosis surgery described in the literature in the last ten years. METHODS: A systematic review of the English literature across multiple databases was conducted using search criteria (neuromuscular scoliosis AND complications) and using PRISMA guidelines (Jan 2012-July 2022). Studies with less than 30 patients and follow-up of < 2 years were excluded. Data extraction and meta-analysis were performed using random mode effect. Statistical analysis was conducted using OpenMeta software. Meta-regression analysis was used to detect risk factors (surgical approach, intraoperative time, intraoperative blood loss, preoperative Cobb angle and patient diagnosis) associated with each complication group. Confidence interval (CI) was set at 95%. RESULTS: Twenty-two studies met the inclusion criteria involving 2155 patients. The level of evidence among studies were III (9) and IV (13). The most common primary diagnosis was cerebral palsy (43%) followed by Duchenne muscle dystrophy (20%), myelomeningocele (7.4%), spinal muscle atrophy (7.1%), Rett syndrome (< 2%) and combined other pathologies (20.2%). The pooled incidence rate of wound complications was the highest, amongst all complications, at 13.3% (CI 10.838 to 16.861); closely followed by respiratory complications (11.8%;CI 5.7 to 19.7). Implant failure occurred in 7.1% cases (CI 6.418 to 11.465), gastrointestinal complications was 5.2%; CI 2.4 to 8), pseudarthrosis in (4.6%;CI 2.2 to 6.9) and neurological deficit in 2.9% (CI 1.989 to 6.086). The pooled rate of revision surgery was (9.6%; CI 6.2 to 12.9). Heterogeneity was assessed using I2 test which results were moderately heterogeneous. Meta-regression analysis revealed that the diagnosis of myelomeningocele or Duchenne muscle dystrophy or spinal muscle atrophy were strongly associated with wound and respiratory complications (p = 0.007 and p = 0.005, respectively). CONCLUSION: Wound-related (13.3%) and respiratory complications (11.8%) remain the most common complications among studies after corrective surgery for neuromuscular scoliosis. Both are significantly associated with Duchenne muscle dystrophy, spinal muscle atrophy and myelomeningocele.

Hip reduction surgery versus scoliosis correction in non-ambulant neuromuscular patients: which surgery is the first step?

PURPOSE: Children and young adults with neuromuscular disorders have a high incidence of both spine and hip deformities. The aim of this study was to evaluate the outcome of either primary scoliosis or hip surgery in children and young adults with neuromuscular disorders. METHODS: A retrospective study was conducted on all children and young adults with neuromuscular-related synchronous hip subluxation/dislocation and scoliosis undergoing hip or scoliosis surgery in our institution between 2012 and 2021 with a minimum follow-up of 24 months. Demographic and operative data were collected; radiological parameters were measured preoperatively and postoperatively at final follow-up. RESULTS: Forty neuromuscular patients with synchronous hip displacement and scoliosis were included. Twenty patients with an average age of10.2 years had hip correction surgery performed primarily, with a mean follow-up of 54.9 (24-96) months. The other 20 patients with an average age of 12.4 years had scoliosis correction first, with a mean follow-up of 40 (24-60) months. In the "Hip first" group, pelvic obliquity, hip MP and Cobb angle were 16.8°, 71%, and 49°, respectively. At final follow-up, the mean pelvic obliquity and Cobb angles significantly progressed to 27.2° (p = 0.003) and 82.2° (p = 0.001), respectively. Eighteen patients (90%) required scoliosis correction after the hip surgery. In the "Scoliosis first" group, the mean pelvic obliquity, hip MP and Cobb angle were 21.2°, 49% and 65.5°, respectively. At final follow-up, both pelvic obliquity and Cobb angle significantly improved to 8.44° (p = 0.002) and 23.4° (p = 0.001), respectively. In 11/20 (55%) patients, the hip MP had significantly increased following the spinal surgery to 62% (p = 0.001), but only 5/20 (25%) patients underwent hip surgery after scoliosis correction. CONCLUSION: In neuromuscular patients presenting with synchronous hip displacement and scoliosis deformity, corrective scoliosis surgery is associated with a significant correction of pelvic obliquity and lower rates of secondary hip surgery. On the other hand, primary hip surgery does not reduce the risk of pelvic obliquity and scoliosis deformity progression.

Superior survivorship and plate-related results of TomoFix compared to Puddu plate fixation for opening-wedge high tibial osteotomy: A systematic review of the literature.

PURPOSE: This systematic review aimed to compare survivorship and plate-related results of Puddu and TomoFix plates in opening-wedge high tibial osteotomy (OWHTO). METHODS: PubMed, Scopus, EMBASE, and CENTRAL databases were searched from January 2000 until September 2021 for clinical studies involving patients with medial compartment knee disease and varus deformity undergoing OWHTO using the Puddu or TomoFix plating systems. We extracted survival data, plate-related complications, and functional and radiological outcomes. The risk of bias assessment had been carried out using Cochrane Collaboration's quality assessment tool for randomised controlled trials (RCTs) and Methodological Index for Non-Randomised Studies (MINORS). RESULTS: Twenty-eight studies were included. The total number of knees was 2568 in 2372 patients. The Puddu plate was used in 677 knees, while the TomoFix plate was used in 1891. The follow-up ranged from 5.8 to 147.6 months. Both plating systems were able to delay conversion to arthroplasty at different follow-up intervals. However, osteotomies fixed by the TomoFix plate achieved higher survival rates, especially at mid-term and long-term follow-ups. In addition, fewer complications were reported with the TomoFix plating system. Although both implants achieved satisfactory functional outcomes, high scores could not be maintained throughout long-term intervals. Regarding radiological results, TomoFix plate was able to achieve and maintain larger degrees of varus deformity, while preserving the posterior tibial slope. CONCLUSIONS: This systematic review demonstrated the superiority of the TomoFix over the Puddu system as a safer and more effective fixation device in OWHTO. Nevertheless, these results should be interpreted with caution due to the lack of comparative evidence through high-quality RCTs.

Health-Related Quality of Life Assessment in Idiopathic Early-Onset Scoliosis Treated by Serial Mehta Casting.

BACKGROUND: This was a retrospective clinical study of patients with idiopathic early-onset scoliosis (IEOS) treated by serial Mehta derotational cast in a single facility. METHODS: A standardized casting protocol was used for patients aged ≤5 years with IEOS (curve ≥20°). Patients' demographics, clinical and radiological outcomes, and major curve Cobb angle were recorded, and health-related quality of life (HRQoL) using the 24-item early-onset scoliosis questionnaire (EOSQ-24) was assessed. RESULTS: A total of 15 patients with IEOS were managed by serial Mehta cast between October 2014 and September 2018 with a mean follow-up period of 42.33 ± 6.37 (range 32-55) months. The mean precast curve was 56.8° ± 12.01°, and the mean final postcast curve was 26.4° ± 19.12° (P = 0.0008). The EOSQ-24 was inversely proportional to the magnitude of the residual curve. There were 2 cases with superficial skin irritation and a single case with repeated vomiting after casting. CONCLUSION: IEOS can be managed effectively by serial Mehta cast, which is proved not only by the clinical and radiological outcome but also by the improvement of the quality of life of the patients and their families as measured by the EOSQ-24.

Transforaminal Lumbar Interbody Fusion With Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis.

BACKGROUND: A retrospective study of patients treated by transforaminal lumbar interbody fusion (TLIF) with local bone graft alone for single-level isthmic spondylolisthesis (IS) between April 2009 and July 2014 in a single facility. METHODS: Demographic and operative data, complications, preoperative and postoperative clinical records, and radiographs were revised. The Visual Analogue Scale (VAS) and Denis Work Scale were used for clinical and functional assessment. Modified Lee et al. classification was used for assessment of union. RESULTS: Twenty-three patients with mean age of 45.04 ± 7.19 years had single-level TLIF with local bone graft alone for symptomatic IS with mean follow-up period of 28.39 ± 4.01 months and mean operative time of 170.09 ± 11.22 minutes. The VAS and Denis Work Scale improved from 8.48 ± 0.58 and 4.67 ± 0.47 preoperative to 2.91 ± 1.25 and 1.33 ± 0.58 at the latest follow up, respectively. Anterior vertebral translation improved from 27.22 ± 9.54% preoperatively to 8.38 ± 3.63% postoperatively and 10.39 ± 3.49 at the latest follow up. Disc space height was 9.67 ± 5.55% preoperatively, 21.60 ± 4.11% postoperative, and 16.24 ± 4.02% at the latest follow up. Lumbar lordosis improved from 29.39 ± 10.33° to 45.13 ± 6.84° postoperatively and 39.96 ± 7.52° at the latest follow up. Eighteen patients had definitive union, 4 patients with possible union, 1 patient with possible pseudoarthrosis. CONCLUSIONS: Transforaminal lumbar interbody fusion with local bone graft alone is an appropriate option for single-level IS, yet we do not recommend it for higher grades of slippage with anterior vertebral translation more than 25%.

Cementless total hip arthroplasty in the treatment after acetabular fractures.

INTRODUCTION: The outcomes of total hip arthroplasty (THA) for the treatment of posttraumatic arthritis after acetabular fractures were inferior to those after primary non-traumatic THA. METHODS: This study was performed in academic level I trauma center. From January 2011 to December 2014, a consecutive series of 21 patients (9 females), with average age of 56.7 years (range 29-75 years) who had posttraumatic hip joint arthritis after acetabular fractures, were included in our study. All patients underwent cementless THA. The average duration of follow-up was 26 months (range 24-36 months). RESULTS: At the latest follow-up, all patients could walk independently, thirteen (62%) patients had excellent Harris hip score, five (24%) had good HHS, and 3 (14%) had fair score. WOMAC scale decreased from 63 (range 42-92) to 4 (range 0-19). Two patients (9.5%) had heterotopic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups or around the femoral stem. CONCLUSION: Cementless THA is an ideal treatment for posttraumatic hip arthritis with anatomic restoration of the hip center to improve the functional results and decrease the incidence of complications and revision rate.

Simultaneous open reduction and internal fixation and total hip arthroplasty for the treatment of osteoporotic acetabular fractures.

INTRODUCTION: Surgical treatment of acetabular fractures in elderly people is challenging. The main aim of this study is to evaluate retrospectively the indications, results and the complications of simultaneous open reduction and internal fixation (ORIF) and acute total hip replacement (THR) in the management of displaced acetabular fractures. METHODS: This study was performed in an academic level I trauma centre. From January 2011 to December 2014, a consecutive series of 18 patients (eight females), with average age of 66 years (range 35-81 years) who had displaced acetabular fractures were included in our study. All patients underwent ORIF and simultaneous acute THR. The average duration of follow up was 21.7 months (range 12-36 months). RESULTS: At the latest follow up, all patients could walk independently. Thirteen patients (72.7 %) had excellent Harris hip scores HHS, five, patients (27.7 %) had good results. All fractures were healed and the acetabular autologous bone grafts were well incorporated. There were no delayed unions or non-unions. Two patients (11 %) had heterotropic bone formation which did not affect the activity of the patients. There were no signs of loosening of the acetabular cups however one patient had 2 mm medial migration of the cup. No vertical migration was observed, and there were no signs of loosening around the femoral stem. CONCLUSION: ORIF and simultaneous THR is a good option for the treatment of certain types of acetabular fractures particularly in elderly population.

Effect of intra-abdominal instillation of lidocaine during minor laparoscopic procedures.

OBJECTIVE: To assess the effect of intraperitoneal instillation of lidocaine on postoperative pain after minor gynecological laparoscopic surgery. METHOD: A prospective, double-blind, placebo-controlled clinical trial of 75 patients undergoing gynecological laparoscopy randomized to receive intraperitoneal instillation of either 120 mg of lidocaine (n=60) or normal saline (n=15) at the end of surgery. Postoperative pain was evaluated by Wong-Baker Faces Pain Rating Scale (WBFS) score at 15 minutes and at 1, 2, 4, 12, and 24 hours postoperatively. RESULTS: The WBFS score was lower for the lidocaine group than for the control group at 1, 2, and 4 hours after surgery (P=0.023). There was no difference in WBFS scores between the 2 groups at 15 minutes (P=0.46), 12 hours (P=0.13), and 24 hours (P=0.07) after surgery. CONCLUSION: Intraperitoneal instillation of lidocaine was effective in reducing postoperative pain after minor gynecological laparoscopic procedures.