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Journal of Children's Orthopaedics

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Open Access 01-10-2015 | Original Clinical Article

The lifetime risk of pneumonia in patients with neuromuscular scoliosis at a mean age of 21 years: the role of spinal deformity surgery

Authors: Heli Keskinen, Heikki Lukkarinen, Katariina Korhonen, Tuomas Jalanko, Antti Koivusalo, Ilkka Helenius

Published in: Journal of Children's Orthopaedics | Issue 5/2015

Abstract

Background

Patients with neuromuscular disorders often have an increased risk of pneumonia and decreased lung function, which may further be compromised by scoliosis. Scoliosis surgery may improve pulmonary function in otherwise healthy patients, but no study has evaluated its effect on the risk of pneumonia in patients with neuromuscular scoliosis (NMS).

Methods

The patient charts of 42 patients (mean age 14.6 years) who had undergone surgery for severe NMS (mean scoliosis 86°) were retrospectively reviewed from birth to a mean of 6.1 years (range 2.8–9.5) after scoliosis surgery. The main outcome was radiographically confirmed pneumonia as a primary cause for hospitalization. We excluded postoperative (3 months) pneumonia from the analyses.

Results

The lifetime annual incidence of pneumonia was 8.0/100 before and 13.4/100 after scoliosis surgery (p > 0.10). The mean number of hospital days per year due to pneumonia were 0.59 (SD 2.3) before scoliosis surgery and 2.24 (SD 6.9) after surgery (p > 0.10). Multivariate analysis demonstrated that lifetime risk factors for pneumonia were epilepsy (RR 15.2, 95 % CI 1.3–176.8, p = 0.027), non-cerebral palsy (CP) etiology (RR = 10.2, 95 % CI 3.2–32.7, p < 0.001) and major scoliosis (main curve >70°; RR = 11.3, 95 % CI 1.8–70.7, p = 0.01).

Conclusions

Epilepsy, non-CP etiology and major scoliosis are significant risk factors for pneumonia in patients with NMS. Scoliosis surgery does not decrease the incidence of pneumonia in patients with severe NMS.

Level of Evidence

Retrospective comparative study, Level III.

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Inal-Ince D, Savci S, Arikan H et al (2009) Effects of scoliosis on respiratory muscle strength in patients with neuromuscular disorders. Spine J 9:981–986CrossRefPubMed

Young NL, McCormick AM, Gilbert T et al (2011) Reasons for hospital admissions among youth and young adults with cerebral palsy. Arch Phys Med Rehabil 92:46–50CrossRefPubMed

Panitch HB (2009) The Pathophysiology of respiratory impairment in pediatric neuromuscular diseases. Pediatrics 123:215–218CrossRef

Gozal D (2000) Pulmonary manifestations of neuromuscular disease with special reference to Duchenne muscular dystrophy and spinal muscular atrophy. Pediatr Pulmonol 29:141–150CrossRefPubMed

Saito N, Ebara S, Ohotsuka K et al (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351:1687–1692CrossRefPubMed

Pehrsson K, Larsson S, Oden A et al (1992) Long-term follow-up of patients with untreated scoliosis. Spine 17:1091–1096CrossRefPubMed

Roberto R, Fritz A, Hagar Y et al (2011) The natural history of cardiac and pulmonary function decline in patients with Duchenne muscular dystrophy. Spine 36:1009–1017CrossRef

Chng SY, Wong YQ, Hui JH et al (2003) Pulmonary function and scoliosis in children with spinal muscular atrophy types II and III. J Paediatr Child Health 39:673–676CrossRefPubMed

Kinali M, Messina S, Mercuri E et al (2006) Management of scoliosis in Duchenne muscular dystrophy: a large 10-year retrospective study. Dev Med Child Neurol 48:513–518CrossRefPubMed

10.

Alexander WM, Smith M, Freeman BJC et al (2013) The effect of posterior spinal fusion on respiratory function in Duchenne muscular dystrophy. Eur Spine J 22:411–416PubMedCentralCrossRefPubMed

11.

Galasko CSB, Delaney C, Morris P (1992) Spinal stabilisation in Duchenne muscular dystrophy. J Bone Jt Surg 74-B:210–214

12.

Gill I, Eagle M, Mehta JS et al (2006) Correction of neuromuscular scoliosis in patients with pre-existing respiratory failure. Spine 31:2478–2483CrossRefPubMed

13.

Velasco MV, Colin AA, Zurakowski D et al (2007) Posterior spinal fusion for scoliosis in Duchenne muscular dystrophy diminishes the rate of respiratory decline. Spine 32:459–465CrossRefPubMed

14.

Suk KS, Lee BH, Lee HM et al (2014) Functional outcomes in Duchenne muscular dystrophy scoliosis. Comparison of the differences between surgical and nonsurgical treatment. J Bone Jt Surg Am 96:409–415CrossRef

15.

Pehrsson K, Bake B, Larsson S et al (1991) Lung function in adult idiopathic scoliosis: a 20 year follow up. Thorax 46(7):474–478PubMedCentralCrossRefPubMed

16.

Newton PO, Faro FD, Gollogly S et al (2005) Results of preoperative pulmonary function testing of adoslescents with idiopathic scoliosis: a study of six hundred and thirty-one patients. J Bone Jt Surg 87-A:1937–1946CrossRef

17.

Kim YJ, Lenke LG, Bridwell KH et al (2007) Prospective pulmonary function comparison following posterior segmental spinal instrumentation and fusion of adolescent idiopathic scoliosis: is there a relationship between major thoracic curve correction and pulmonary function test improvement? Spine 32:2685–2693CrossRefPubMed

18.

Kim YJ, Lenke LG, Bridwell KH et al (2005) Pulmonary function in adolescent idiopathic scoliosis relative to surgical procedure. J Bone Jt Surg 87-A:1534–1541CrossRef

19.

Newton PO, Perry A, Bastrom TP et al (2007) Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine 32:1875–1882CrossRefPubMed

20.

Noble-Jamieson CM, Heckmatt JZ, Dubowitz V et al (1986) Effect of posture and spinal bracing on respiratory function in neuromuscular disease. Arch Dis Child 61:178–181PubMedCentralCrossRefPubMed

21.

Mattila M, Jalanko T, Puisto V et al (2012) Hybrid versus total pedicle screw instrumentation in patients undergoing surgery for neuromuscular scoliosis. J Bone Jt Surg 94-B:1393–1398CrossRef

22.

Kim YJ, Lenke LG, Bridwell KH et al (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342CrossRefPubMed

23.

Cobb JR (1948) Outline for the study of scoliosis. In: Edwards JW, Arbor A (eds) AAOS instructional course lectures, vol 5. Rosemont: American Academy of Orthopaedic Surgeons pp 261–275

24.

O´Brien MF, Kuklo TR, Blanke KM, et al Spienal deformity study group. Radiographic measurement manual. Memphis, PA: Medronic Sofamor Danek Inc 2004

25.

Larsson E-L, Aaro SI, Normelli HC et al (2005) Long-term follow-up of functioning after spinal surgery in patients with neuromuscular scoliosis. Spine 30:2145–2152CrossRefPubMed

26.

Obid P, Bevot A, Goll A et al (2013) Quality of life after surgery for neuromuscular scoliosis. Orthop Rev 5:1CrossRef

27.

Jokinen C, Heiskanen L, Juvonen H et al (1993) Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 137(9):977–988PubMed

28.

Jalanko T, Helenius I, Pakarinen M et al (2014) The effects of surgical correction of neuromuscular scoliosis on gastric myoelectrical activity, emptying and upper gastrointestinal symptoms—a prospective follow-up study. J Pediatr Gastroenterol Nutr 58(1):38–45CrossRefPubMed

29.

DeToledo JC, Lowe MR, Gonzalez J et al (2004) Risk of aspiration pneumonia after an epileptic seizure: a retrospective analysis of 1634 adult patients. Epilepsy Behav 5:593–595CrossRefPubMed

30.

Verrotti A, Scaparrotta A, Grosso S et al (2014) Anticonvulsant drugs and hematological disease. Neurol Sci 35(7):983–993CrossRefPubMed

31.

Hasler CC (2013) Operative treatment for spinal deformities in celebral palcy. J Child Orthop 7:419–423PubMedCentralCrossRefPubMed

Title: The lifetime risk of pneumonia in patients with neuromuscular scoliosis at a mean age of 21 years: the role of spinal deformity surgery
Authors: Heli Keskinen
Heikki Lukkarinen
Katariina Korhonen
Tuomas Jalanko
Antti Koivusalo
Ilkka Helenius
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: Journal of Children's Orthopaedics / Issue 5/2015
Print ISSN: 1863-2521
Electronic ISSN: 1863-2548
DOI: https://doi.org/10.1007/s11832-015-0682-8

At a glance: The STEP trials

Springer Medicine

The lifetime risk of pneumonia in patients with neuromuscular scoliosis at a mean age of 21 years: the role of spinal deformity surgery

Abstract

Background

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of Evidence

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