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Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
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Drain options after vertebral body tethering.

Lawrence Haber1, Hunter Starring2, Nicholas Newcomb3

  • 1Department of Orthopaedic Surgery, Ochsner Clinic Foundation, 1415 Jefferson Hwy, New Orleans, LA, 70121, USA.

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|October 11, 2022
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Summary

Vertebral body tethering (VBT) for adolescent idiopathic scoliosis (AIS) shows similar safety profiles for standard chest tubes (SCT) and bulb drains (BD). Bulb drains resulted in shorter hospital stays compared to chest tubes.

Keywords:
Adolescent idiopathic scoliosis (AIS)Bulb drainPleural closureStandard chest tube (SCT)Vertebral body tethering (VBT)

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Area of Science:

  • Spine surgery
  • Thoracic surgery
  • Pediatric orthopedics

Background:

  • Vertebral body tethering (VBT) is a surgical technique for adolescent idiopathic scoliosis (AIS).
  • Post-operative chest drainage management after VBT varies, with options including standard chest tubes (SCT) and bulb drains (BD).
  • The impact of different drainage systems and pleural closure on patient outcomes remains an area of investigation.

Purpose of the Study:

  • To evaluate the effect of different post-operative chest drainage systems on perioperative and 90-day complication rates in patients undergoing VBT for AIS.
  • To compare outcomes between standard chest tube (SCT), standard chest tube with pleural closure (SCTPC), and 10 French Bulb drain (BD) cohorts.

Main Methods:

  • A retrospective multicenter study involving 104 patients who underwent VBT for AIS.
  • Patients were divided into three groups: SCT, SCTPC, and BD.
  • Preoperative, perioperative, and 90-day postoperative data were analyzed to assess outcomes.

Main Results:

  • Length of stay was significantly shorter in the BD group (3.0 days) compared to SCT (3.7 days) and SCTPC (4.3 days) groups (p=0.009).
  • Post-operative drainage volume was lower in SCT and BD groups compared to SCTPC (p<0.001).
  • Intra-operative estimated blood loss (EBL) was significantly lower in the BD group (64 cc) compared to SCT (146 cc) and SCTPC (382 cc) groups (p<0.001).
  • Complication rates were similar across all groups, with minor events reported.

Conclusions:

  • All evaluated chest drainage methods (SCT, SCTPC, BD) demonstrated a similar safety profile for managing post-operative drainage after thoracic VBT.
  • Bulb drains (BD) were associated with a significantly shorter length of stay compared to chest tube methods.
  • The findings suggest that BD may be a safe and effective alternative for post-operative chest drainage in VBT procedures.