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Title: Unplanned Return to OR (UPROR) for Early Onset Scoliosis Children: A Comprehensive Evaluation of all Diagnoses and Instrumentation Strategies

Authors: Anari JB, Flynn JM, Cahill PJ, Vitale MG, Smith JT, Gomez JA, Garg S, Baldwin KD, CSSG.

Journal: Spine Deformity

Date: February 06, 2020

Excerpt: Currently, there are many instrumentation strategies (VEPTR/TGR/MCGR/SHILLA) to control the early spine deformity and drive growth; now we must also consider ways to limit the negative effects of repeat anesthesia on the developing brain.

Keywords: Surgery, EOS, Growing systems, VEPTR, Cast, VEPTR, TGR, MCGR, Anesthesia

Summary:

 What is the purpose of this study?

The purpose of this study is to review anesthetic risk in patients receiving multiple surgeries that require anesthetic especially in unplanned return to the OR. Reasonable long-term goals in the early onset population are acceptable lung growth, and control of any spine curve and deformity; all while limiting anesthetic risks to provide an opportunity for normal brain growth. 

Results:

- The most likely reasons for unplanned return to operating room for unplanned surgery were implant attachment failure (59%) and infection (21%).

- All instrument types had the same rate of re-operation within 2 years at 35%.

Important Discussion Points:

- Magnetic growing rods are gaining popularity as they do not require anesthesia to expand.

- Growing rods that require a regular expansion (VEPTR, TGR) allow for a designated surgical time to addresss any complications or issues while the patient is under planned anesthesia.

- Although magnetic rods have no anesthetic exposure during lengthening, there is still risk of complications arising and further anesthesia required due to complications.

- Complications are common in surgical treatment of young children with scoliosis, the goal is to have a better planning strategy on a patient by patient basis based on risk factors.