Abstract
Purpose
Operative and postoperative management of early onset scoliosis (EOS) patients with programmable implanted devices has not been well characterized in the literature. The aim of this study was to describe current practices for pediatric spine surgeons who operate on patients with these devices.
Methods
An electronic survey was distributed to 167 pediatric spine surgeons between January and March of 2021. The survey queried participants on operative and postoperative management of patients with the following implanted devices: vagal nerve stimulators, ventriculoperitoneal shunts, intrathecal baclofen pumps, pacemakers, and cochlear implants. Descriptive statistics were used to assess survey data.
Results
Fifty-three respondents (31.7% response rate) with a mean 16.5 (SD 12.0) years in practice completed the survey. Depending on the type of device present, surgeons report changing their operative plan anywhere from 28.6 to 60.1% of the time when inserting magnetically controlled growing rods. Most respondents reported performing transcranial motor evoked potentials (80.0–98.0%) and monopolar cautery (70.0–92.9%) across implanted devices. Only 10% (n = 5) of surgeons reported complications related to operative and/or postoperative management of these patients. No complications were related to cautery, neuromonitoring, or surgical placement of MCGRs.
Conclusions
This study demonstrates variation in operative and postoperative management of these patients with various programmable implanted devices. Much of this inconsistency in practice is likely due to decades old case reports, constantly changing device manufacturer recommendations, and/or published simulation studies. Reported heterogeneity in management across surgeons necessitates development of published guidelines regarding proper operative and postoperative management of patients with EOS and implanted devices.
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Data from this study are available upon written request to the corresponding author.
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Acknowledgements
PSSG: Pediatric Spine Study Group: Abdullah Saad Abdulfattah Abdullah, Edward Ahn, Behrooz Akbarnia, Harry Akoto, Stephen Albanese, Jason Anari, John Anderson, Richard Anderson, Lindsay Andras, Jennifer Bauer, Laura Bellaire, Randy Betz, Craig Birch, Laurel Blakemore, Oheneba Boachie-Adjei, Chris Bonfield, Daniel Bouton, Felix Brassard, Douglas Brockmeyer, Jaysson Brooks, David Bumpass, Pat Cahill, Olivier Chemaly, Jason Cheung, Kenneth Cheung, Robert Cho, Tyler Christman, Eduardo Colom Beauchamp, Daniel Couture, Haemish Crawford, Alvin Crawford, Benny Dahl, Gokhan Demirkiran, Dennis Devito, Mohammad Diab, Hazem El Sebaie, Ron El-Hawary, John Emans, Mark Erickson, Jorge Fabregas, Frances Farley, David Farrington, Graham Fedorak, Ryan Fitzgerald, Nicholas Fletcher, Lorena Floccari, Jack Flynn, Peter Gabos, Adrian Gardner, Sumeet Garg, Frank Gerow, Michael Glotzbecker, Jaime Gomez, David Gonda, Tenner Guillaume, Purnendu Gupta, Kyle Halvorson, Kim Hammerberg, Christina Hardesty, Daniel Hedequist, Michael Heffernan, John Heflin, Ilkka Helenius, Jose Herrera, Grant Hogue, Josh Holt, Jason Howard, Michael Timothy Hresko, Steven Hwang, Stephanie Ihnow, Brice Ilharreborde, Kenneth Illingworth, Viral Jain, Andrew Jea, Megan Johnson, Charles Johnston, Morgan Jones, Judson Karlen, Lawrence Karlin, Danielle Katz, Noriaki Kawakami, Brian Kelly, Derek Kelly, Raymond Knapp, Paul Koljonen, Kenny Kwan, Hubert Labelle, Robert Lark, A. Noelle Larson, William Lavelle, Lawrence Lenke, Sean Lew, Gertrude Li, Craig Louer, Scott Luhmann, Jean-Marc Mac-Thiong, Stuart Mackenzie, Erin MacKintosh, Francesco Mangano, David Marks, Sanchez Marquez, Jonathan Martin, Jeffrey Martus, Antonia Matamalas, Oscar Mayer, Richard McCarthy, Amy McIntosh, Jessica McQuerry, Jwalant Mehta, Lionel Metz, Daniel Miller, Firoz Miyanji, Greg Mundis, Josh Murphy, Robert Murphy, Karen Myung, Susan Nelson, Peter Newton, Matthew Newton Ede, Cynthia Nguyen, Susana Nunez, Matthew Oetgen, Timothy Oswald, Jean Ouellet, Josh Pahys, Kathryn Palomino, Stefan Parent, Alejandro Peiro Garcia, Ferran Pellise, Joseph Perra, Jonathan Phillips, Javier Pizones, Selina Poon, Nigel Price, Norman Ramirez-Lluch, Brandon Ramo, Gregory Redding, Todd Ritzman, Luis Rodriguez, Juan Carlos Rodriguez-Olaverri, David Roye, Benjamin Roye, Lisa Saiman, Amer Samdani, Francisco Sanchez Perez-Grueso, James Sanders, Jeffrey Sawyer, Christina Sayama, Michael Schmitz, Jacob Schulz, Richard Schwend, Suken Shah, Jay Shapiro, Harry Shufflebarger, David Skaggs, Kevin Smit, John Smith, Brian Snyder, Paul Sponseller, George Stephen, Joe Stone, Peter Sturm, Hamdi Sukkarieh, Ishaan Swarup, Michal Szczodry, John Thometz, George Thompson, Tanaka Tomoko, Walter Truong, Raphael Vialle, Michael Vitale, John Vorhies, Eric Wall, Shengru Wang, Bill Warner, Stuart Weinstein, Michelle Welborn, Klane White, David Wrubel, Nan Wu, Kwadwo Yankey, Burt Yaszay, Muharrem Yazici, Terry Jianguo Zhang.
Funding
Funding for this research was provided by the Spine Research Fund of Gillette Children’s Specialty Healthcare.
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RM: interpretation of data for the work; drafting of the work; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SM: substantial contributions to the conception or design of the work; acquisition, and analysis of data for the work; critically revising the work for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JB: substantial contributions to the conception or design of the work; critically revising the work for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PC: substantial contributions to the conception or design of the work; critically revising the work for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. RF: substantial contributions to the conception or design of the work; critically revising the work for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. YL: substantial contributions to the conception or design of the work; critically revising the work for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Pediatric Spine Study Group: substantial contributions to the conception or design of the work; Substantial contributions to the conception or design of the work; critically revising the work for important intellectual content; Final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. WT: substantial contributions to the conception or design of the work; acquisition, analysis, and interpretation of data for the work; critically revising the work for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Appendix
Appendix
Appendix 1 Surgeon survey on programmable implanted devices
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McMahon, R., Morgan, S.J., Brooks, J.T. et al. Does the presence of programmable implanted devices in patients with early onset scoliosis alter typical operative and postoperative practices? A survey of spine surgeons. Spine Deform 10, 951–964 (2022). https://doi.org/10.1007/s43390-022-00477-w
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DOI: https://doi.org/10.1007/s43390-022-00477-w