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Single-stage deformity correction in children with neurogenic kyphoscoliosis: nuances and a proposal for risk
Suhas Udayakumaran1, Sajesh K Menon2, Chiazor U Onyia3
1Divisions of 1 Paediatric Neurosurgery and.
Insights
Single-stage surgery for pediatric neurogenic kyphoscoliosis corrects deformity and addresses neurological issues simultaneously. This approach reduces costs and complications compared to staged procedures, offering a safe and effective treatment option.
Area of Science:
- Pediatric Orthopedics
- Pediatric Neurosurgery
- Spinal Deformity Correction
Background:
- Neurogenic kyphoscoliosis in children presents complex management challenges.
- Current standard practice often involves staged orthopedic and neurosurgical interventions, separated by 3-6 months.
- This staged approach can increase costs and introduce risks associated with multiple surgeries.
Purpose of the Study:
- To evaluate the safety and efficacy of single-stage surgical treatment for pediatric neurogenic kyphoscoliosis.
- To report the authors' experience with combined orthopedic deformity correction and neurosurgical procedures in a single session.
- To propose a risk stratification system for guiding treatment timing.
Main Methods:
- Retrospective analysis of 10 pediatric patients (<15 years) with neurogenic kyphoscoliosis undergoing simultaneous deformity correction and neurosurgery.
- Data collected included demographics, preoperative/postoperative Cobb angles, surgical details, complications, costs, and neurological outcomes.
- Patients underwent procedures such as foramen magnum decompression, spinal cord detethering, or tumor excision.
Main Results:
- All 10 patients tolerated the single-stage procedure without intraoperative complications.
- No new postoperative neurological deficits were observed.
- Significant correction of the mean Cobb angle from 59.5° to 12.6° was achieved.
- Mean operative time was 4.4 hours with a mean blood loss of 1177 ml.
Conclusions:
- Simultaneous surgical correction of neurogenic kyphoscoliosis and neurosurgical intervention is feasible and safe in pediatric patients.
- This single-stage approach minimizes morbidity, cost, and the risks associated with staged surgeries.
- The proposed risk stratification system can aid in patient selection and optimizing outcomes.
Abstract:
OBJECTIVE Neurogenic kyphoscoliosis in pediatric patients has varied causes and diverse management options. The most common management strategy is to stage the orthopedic and neurosurgical aspects of the correction at an interval of 3-6 months from each other. The aim of this study was to report the authors' experience with correction of deformity in children with associated neurological abnormalities requiring intervention as a single-stage surgical treatment. METHODS Of 591 pediatric patients with scoliosis treated at the Amrita Institute of Medical Sciences and Research Centre between January 2001 and January 2011, the authors identified all patients with neurogenic kyphoscoliosis who underwent deformity correction and a neurosurgical procedure in the same surgical session when they were younger than 15 years. Data regarding the demographic details, preoperative Cobb angle/kyphotic angle, surgical details, postoperative complications, cost of the procedure, and long-term neurological outcome were collected for each case and analyzed. Based on the results of this analysis, the authors propose a 2-category risk stratification system for the timing of deformity correction depending on the primary neurogenic etiology. RESULTS Ten cases involving patients with neurogenic kyphoscoliosis requiring both deformity correction and neurosurgical procedure met the criteria and were included in the analysis. All 10 patients were younger than 15 years; their mean age was 10.8 years. The average Cobb angle was 59.5°. Five patients underwent foramen magnum decompression, 5 patients underwent spinal cord detethering, and 1 patient had intraspinal intradural tumor excision. The mean estimated blood loss was 1177 ml (range 700-1550 ml), and the mean operative time was 4.4 hours (range 3-5.5 hours). There were no intraoperative complications. None of the patients had any new postoperative neurological deficits. The mean postoperative Cobb angle of the main thoracic curve was 12.6°. CONCLUSIONS Simultaneous deformity correction along with a definitive neurosurgical procedure in patients with neurogenic kyphoscoliosis can be performed without added morbidity and avoids both the added costs and the risk of complications associated with a second surgery. The risk stratification system proposed in this paper may serve as a guideline for case selection and help to optimize outcome.
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