Abstract
Purpose
The purpose of this study was to evaluate differences in pain, opiate utilization and oxygen (O2) consumption during the immediate post-operative course for patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) with and without thoracoplasty.
Methods
Patients aged 10–21 years old that had undergone PSF for AIS were identified from 1/1/16–8/1/18. A cohort of patients that did not have a thoracoplasty group was used as a control group. A standardized pain protocol (rapid response pathway) was implemented on all patients. A retrospective chart review was performed. Pre-operative, operative and post-operative data and SRS scores were analyzed.
Results
Forty-six patients (38 girls, 8 boys) were included, 23 in each group. The average age was 15.2 years (range 12.0–19.3) and BMI was 20.9 (range 13.1–37.6). Differences in visual analog scores, post-operative oxygen and narcotic consumption were not statistically significant on any POD. Total opiate utilization was 146.06 morphine milligram equivalents (MME) in the control group and 149.41 MME in the thoracoplasty group (p = 0.78). One-year SRS self-image scores were higher in the thoracoplasty group (4.24 vs 3.96) (p = 0.007). There was no difference in length of hospitalization (3.6 vs 3.5 days), levels fused (12.9 vs 12.9) or blood loss (334.1 vs 413.5 mL). There was one pleural effusion and no instances of intercostal neuralgia or pneumothorax in the thoracoplasty group.
Conclusion
There is no increase in immediate post-operative pain, narcotic use or oxygen consumption when a thoracoplasty is performed with a PSF for AIS. Improved SRS self-image scores were seen after thoracoplasty.
Similar content being viewed by others
References
Dunn J, Henrikson NB, Morrison CC, Nguyen M, Blasi PR, Lin JS (2018) U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. In: Screening for Adolescent Idiopathic Scoliosis: a systematic evidence review for the U.S. preventive services task force. Agency for healthcare research and quality (US), Rockville (MD),
Soultanis KC, Stavropoulos NA, Grivas TB, Tsiavos K, Starantzis K, Papagelopoulos PJ (2015) Rib hump deformity assessment using the rib index in adolescent idiopathic scoliotics treated with full screw or hybrid constructs: aetiological implications. Scoliosis 10(Suppl 2):S10. https://doi.org/10.1186/1748-7161-10-s2-s10
Wever DJ, Veldhuizen AG, Klein JP, Webb PJ, Nijenbanning G, Cool JC, Horn JR (1999) A biomechanical analysis of the vertebral and rib deformities in structural scoliosis. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 8(4):252–260. https://doi.org/10.1007/s005860050169
Winter RB, Lonstein JE, Denis F (2007) How much correction is enough? Spine 32(24):2641–2643. https://doi.org/10.1097/BRS.0b013e31815a5207
Rushton PR, Grevitt MP (2013) Comparison of untreated adolescent idiopathic scoliosis with normal controls: a review and statistical analysis of the literature. Spine 38(9):778–785. https://doi.org/10.1097/BRS.0b013e31827db418
Ward WT, Friel NA, Kenkre TS, Brooks MM, Londino JA, Roach JW (2017) SRS-22r scores in nonoperated adolescent idiopathic scoliosis patients with curves greater than forty degrees. Spine 42(16):1233–1240. https://doi.org/10.1097/brs.0000000000002004
Rushton PR, Grevitt MP (2013) What is the effect of surgery on the quality of life of the adolescent with adolescent idiopathic scoliosis? A review and statistical analysis of the literature. Spine 38(9):786–794. https://doi.org/10.1097/BRS.0b013e3182837c95
Suk SI, Kim JH, Kim SS, Lee JJ, Han YT (2008) Thoracoplasty in thoracic adolescent idiopathic scoliosis. Spine 33(10):1061–1067. https://doi.org/10.1097/BRS.0b013e31816f2888
Newton PO, Perry A, Bastrom TP, Lenke LG, Betz RR, Clements D, D’Andrea L (2007) Predictors of change in postoperative pulmonary function in adolescent idiopathic scoliosis: a prospective study of 254 patients. Spine 32(17):1875–1882. https://doi.org/10.1097/BRS.0b013e31811eab09
Clement JL, Chau E, Geoffray A, Suisse G (2014) Restoration of thoracic kyphosis by simultaneous translation on two rods for adolescent idiopathic scoliosis. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 23(Suppl 4):S438-445. https://doi.org/10.1007/s00586-014-3340-9
CDC (2018) 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes - United States. Surveillance Special Report 2. Centers for disease Control and Prevention, U.S. Department of Heath and Human Services. https://www.cdc.gov/drugoverdose/resources/data.html. Accessed August 1st, 2019
Samdani AF, Hwang SW, Miyanji F, Lonner B, Marks MC, Sponseller PD, Newton PO, Cahill PJ, Shufflebarger HL, Betz RR (2012) Direct vertebral body derotation, thoracoplasty, or both: which is better with respect to inclinometer and scoliosis research society-22 scores? Spine 37(14):E849-853. https://doi.org/10.1097/BRS.0b013e31824a4911
Lee AC, Feger MA, Singla A, Abel MF (2016) Effect of Surgical Approach on pulmonary function in adolescent idiopathic scoliosis patients: a systemic review and meta-analysis. Spine 41(22):E1343-e1355. https://doi.org/10.1097/brs.0000000000001619
Duray C, Ferrero E, Julien-Marsollier F, Simon AL, Michelet D, Mazda K, Ilharreborde B (2019) Pulmonary function after convex thoracoplasty in adolescent idiopathic scoliosis patients treated by posteromedial translation. Spine deformity 7(5):734–740. https://doi.org/10.1016/j.jspd.2019.02.006
Greggi T, Bakaloudis G, Fusaro I, Di Silvestre M, Lolli F, Martikos K, Vommaro F, Barbanti-Brodano G, Cioni A, Giacomini S (2010) Pulmonary function after thoracoplasty in the surgical treatment of adolescent idiopathic scoliosis. Journal of spinal disorders & techniques 23(8):e63-69. https://doi.org/10.1097/BSD.0b013e3181d268b9
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. All authors contributed to material preparation, data collection and analysis. The initial draft of the manuscript was written by Benjamin Sherman and all authors revised it critically. All authors read and approved the final manuscript. All authors agree to the accountability of this work.
Corresponding author
Ethics declarations
Conflicts of interest
Dr. Aminian is a paid speaker for Medicrea USA, corp. No other authors claim any conflicts of interest.
Ethics approval
Institutional review board approved.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sherman, B., Madi, P. & Aminian, A. The effects of thoracoplasty on immediate post-operative recovery in adolescent idiopathic scoliosis. Eur Spine J 30, 733–739 (2021). https://doi.org/10.1007/s00586-020-06715-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-020-06715-x