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Published on: October 16, 2013
Scoliosis surgery for handicapped children
Naoyuki Nakamura1, Yutaka Inaba2, Shinya Kato1
1Department of Pediatric Orthopedic Surgery, Kanagawa Children's Medical Center, Kanagawa, Japan.
Insights
Scoliosis surgery in handicapped children showed high complication rates but high caregiver satisfaction. Most caregivers recommended the procedure despite challenges, indicating perceived value in treatment outcomes.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Spinal Deformity Correction
Background:
- Scoliosis surgery in handicapped children presents unique challenges.
- Assessing treatment outcomes and caregiver satisfaction is crucial for these patients.
Purpose of the Study:
- To evaluate treatment outcomes of scoliosis surgery in handicapped children.
- To compare outcomes and complications with adolescent idiopathic scoliosis (AIS) patients.
- To assess caregiver satisfaction with surgical interventions for handicapped children.
Main Methods:
- Retrospective analysis of 26 handicapped children undergoing scoliosis surgery.
- Comparison with 40 AIS patients who had surgery during the same period.
- Data collection included preoperative and postoperative parameters, operative details, complications, and caregiver satisfaction via a modified Bridwell's questionnaire.
Main Results:
- Handicapped children had higher preoperative Cobb angles (94.2°) and required more fusion levels (14.6) compared to AIS patients (59.7° and 9.0 levels).
- Postoperative complications were significantly higher in handicapped children (e.g., adynamic ileus, dysphagia, pneumonia) versus AIS patients.
- Despite complications, median caregiver satisfaction was high (9/10), with 73% recommending the surgery.
Conclusions:
- Scoliosis surgery in handicapped children is associated with a high incidence of postoperative complications.
- Caregiver satisfaction remains high, suggesting the perceived benefits outweigh the risks and challenges.
- Further research into optimizing surgical strategies for this population is warranted.
Introduction:
This study aimed to assess treatment outcomes and caregivers' satisfaction regarding scoliosis surgery for handicapped children.
Methods:
Handicapped children are, by definition, noncommunicatory and/or nonambulatory. We recruited 26 handicapped children who were followed-up for >1 year after a scoliosis surgery. We recruited 40 patients with adolescent idiopathic scoliosis (AIS) who underwent a surgery during the same period as controls. We used a posterior approach in all the children. We determined preoperative body mass index (BMI), main Cobb angle, Cincinnati correction index (CCI), and fusion level; intraoperative time and blood loss per level; and postoperative complications. We also assessed caregivers' satisfaction with surgical treatments for these patients using the modified Bridwell's questionnaire.
Results:
We have described the results as handicapped children/AIS. Median preoperative BMI was 16.1/18.6 kg/m2. Preoperative and final Cobb angles were 94.2°/59.7° and 39.7°/17.0°, respectively and CCI was 2.0/1.7. The number of fusion levels was 14.6/9.0. The operative time and blood loss per level were 40.1/44.1 minutes and 264/138 ml, respectively. Postoperative complications in handicapped children were adynamic ileus in 8 cases, dysphagia in 5, pneumonia in 3, urinary tract infection in 2, and superior mesenteric artery syndrome (SMA), surgical site deep infection, infectious enteritis, agitation, and liver dysfunction in 1 each. However, in the AIS group, there was only 1 case of SMA. Median caregivers' satisfaction score on the 0-10 visual analog scale was 9. Caregivers for 19 of the 26 handicapped cases (73%) recommended surgical treatment to caregivers of other children with the same disease.
Conclusions:
Surgical treatment for neuromuscular and syndromic scoliosis was associated with a high rate of postoperative complications. However, the caregivers' satisfaction score after surgery was high.
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