Who gets staged surgery in severe pediatric and adolescent spine deformity?

Background There is significant debate regarding the indications of staged surgery for severe adolescent spinal deformity, and the factors associated with the decision to perform staged compared to same-day surgery have not been previously investigated. Thus, the purpose of this study was to determi...

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Bibliographic Details
Published in:Spine deformity 2024-03, Vol.12 (2), p.383-390
Main Authors: LaValva, Scott M., Swarup, Ishaan, Garg, Sumeet, Yaszay, Burt, Gupta, Munish C., Sucato, Daniel J., Kelly, Michael Patrick, Samdani, Amer, Lenke, Lawrence, Boachie, Oheneba, Cahill, Patrick J.
Format: Article
Language:English
Subjects:
Adolescent
Case Series
Child
Humans
Medicine
Medicine & Public Health
Orthopedics
Prospective Studies
Retrospective Studies
Scoliosis - diagnostic imaging
Scoliosis - surgery
Spinal Fusion - methods
Spine - abnormalities
Spine - surgery
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Summary:Background There is significant debate regarding the indications of staged surgery for severe adolescent spinal deformity, and the factors associated with the decision to perform staged compared to same-day surgery have not been previously investigated. Thus, the purpose of this study was to determine which factors were most strongly associated with this decision. Methods A prospective multicenter registry of adolescent patients with severe spinal deformity was reviewed. Two cohorts were identified: those who underwent a planned staged surgical procedure for deformity correction and those who underwent a same-day procedure. Patients who underwent an unplanned staged procedure secondary to complications during the initial procedure were excluded. Comparisons were made between these cohorts with respect to preoperative patient and radiographic variables to determine which factors were associated with the decision to perform a staged procedure. Surgical data was also compared to evaluate for differences in the intraoperative management of staged versus same-day patients. Results Two hundred and twenty-nine patients with severe spinal deformities were identified. Forty patients (17%) underwent a planned staged procedure and 189 patients (80%) underwent a same-day procedure. On univariate analysis of preoperative variables, patients who underwent staged surgery had a significantly younger age at surgery, greater major curve magnitude, greater major curve AVT to CSVL, lesser thoracic spine height, greater radiographic trunk shift, and a greater proportion of patients undergoing revision surgery (as opposed to primary correction) compared to those who underwent a planned single-stage procedure. Multivariate logistic regression of pre-operative variables showed that age 
ISSN:2212-134X
2212-1358
DOI:10.1007/s43390-023-00778-8