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Reconstructive spine surgery in pediatric patients with major loss in vital capacity
B A Rawlins1, R B Winter, J E Lonstein
1Minnesota Spine Center, Minneapolis 55454-1419, USA.
Insights
Pediatric reconstructive spine surgery is safe for children with severe lung disease. Improved techniques and monitoring lead to acceptable outcomes, even with low vital capacity.
Area of Science:
- Pediatric Orthopedics
- Pulmonary Medicine
- Spine Surgery
Background:
- Severe restrictive lung disease in children often necessitates reconstructive spine surgery.
- Patients with vital capacities below 40% predicted pose unique challenges due to respiratory compromise.
Purpose of the Study:
- To evaluate the safety and outcomes of major reconstructive spine surgery in pediatric patients with severe restrictive lung disease.
- To identify risk factors for pulmonary complications and assess the impact of surgical approach.
Main Methods:
- Retrospective review of 32 pediatric patients (18 boys, 14 girls; mean age 13 years) with vital capacity < 40% predicted undergoing reconstructive spine surgery.
- Analysis of pulmonary complication rates, including pneumonia, reintubation, pneumothorax, respiratory arrest, and tracheostomy.
- Comparison of outcomes based on surgical approach (posterior only, anterior and posterior, thoracotomy, thoracoabdominal).
Main Results:
- Zero surgical and perioperative mortality.
- 19% incidence of pulmonary complications (6/32 patients), with 3 requiring tracheostomy.
- Thoracotomy or thoracoabdominal approaches were associated with a significantly higher rate of pulmonary complications.
Conclusions:
- Reconstructive spine surgery can be safely performed in pediatric patients with severe restrictive lung disease.
- Preoperative vital capacity should not be the sole determinant of operability.
- Multidisciplinary care involving pulmonologists and intensivists, alongside advanced surgical and perioperative management, is crucial for favorable outcomes.
Abstract:
Thirty-two pediatric patients with severe restrictive lung disease identified with vital capacities < 40% of predicted, who had undergone major reconstructive spine surgery, were reviewed. There were 18 boys and 14 girls, the mean age was 13 years (range, 7-17), and the mean vital capacity was 31% of predicted (range, 16-39%). Fifty-four procedures were performed, 13 posterior only, one of which was staged, and 19 anterior and posterior procedures, of which 15 were staged and four were sequential. The incidence of pulmonary complications (pneumonia, reintubation, pneumothorax, respiratory arrest, or the need for tracheostomy) was 19% (six patients), and only three patients required tracheostomy. The surgical and perioperative mortality rate was zero. Patients who had a thoracotomy or a thoracoabdominal approach had a significantly higher number of pulmonary complications. The use of preoperative decreased vital capacity as a measure of inoperability excludes the young patient most in need of surgical intervention. With improved preoperative, intraoperative, and postoperative techniques, careful monitoring, and the cooperation of pediatric pulmonologists and intensivists, reconstructive spine surgery can be performed in the pediatric patient with severe decreased vital capacity with very acceptable morbidity and mortality.
