Skip to main content

Advertisement

SpringerLink
Log in

Quality, Safety, and Value of Innovating Classic Operative Techniques in Scoliosis Surgery: Intraoperative Traction and Navigated Sequential Drilling

  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective cohort study.

Objectives

This study aims to measure and describe the clinical and financial implications of the systematic implementation of intraoperative skull-femoral traction (IOSFT) and navigated sequential drilling (NSD) for posterior spinal instrumentation and fusion (PSIF) in adolescent idiopathic scoliosis (AIS) at our institution.

Summary of Background Data

PSIF has been the standard surgical treatment for AIS. This retrospective single-center quality improvement study describes the perioperative outcomes and impact on health resource utilization following the systematic application of two classic surgical strategies modified using current technology: IOSFT and NSD.

Methods

We reviewed the medical records of 125 patients who underwent a single-stage PSIF for AIS. We identified three cohorts based on surgical strategies used intraoperatively. Traditional techniques (n = 28), IOSFT (n = 45), and IOSFT plus NSD (n = 52). The primary outcome measures were operative time, prevalence of cases requiring extended operating room time, need for blood transfusion, length of hospital stay, and cost per surgery. Secondary outcomes included implant density, degree of spine deformity correction, and perioperative complications.

Results

All primary outcome measures improved significantly (p < .001). Median operating time decreased by 59%. Use of late operating room hours fell from 89% to 0% and transfusion rates from 64% to 1.9%. Length of hospital stay decreased from 6 to 4 days. Comprehensive cost per case decreased by 24%.

Discussion

Together, IOSFT and NSD improved the quality, safety, and value of care. These surgical strategies were performed without increased perioperative complications, while reducing cost per case by 24%.

Conclusions

The data presented may have significant implications in health resource utilization for AIS surgery.

Level of Evidence

Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop 2013;7:3–9.

    Article  PubMed  Google Scholar 

  2. Weinstein SL, Dolan LA, Cheng JC, et al. Adolescent idiopathic scoliosis. Lancet 2008;371:1527–37.

    Article  PubMed  Google Scholar 

  3. Hresko MT. Clinical practice. Idiopathic scoliosis in adolescents. N Engl J Med 2013;368:834–41.

    Article  CAS  PubMed  Google Scholar 

  4. Berry JG, Lieu TA, Forbes PW, et al. Hospital volumes for common pediatric specialty operations. Arch Pediatr Adolesc Med 2007; 161:38–43.

    Article  PubMed  Google Scholar 

  5. Vigneswaran HT, Grabel ZJ, Eberson CP, et al. Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr 2015;16:322–8.

    Article  PubMed  Google Scholar 

  6. Martin CT, Pugely AJ, Gao Y, et al. Increasing hospital charges for adolescent idiopathic scoliosis in the United States. Spine (Phila Pa 1976) 2014;39:1676–82.

    Article  Google Scholar 

  7. Miyanji F, Slobogean GP, Samdani AF, et al. Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization? A multicenter analysis of 325 adolescent idiopathic scoliosis curves. J Bone Joint Surg Am 2012;94:809–13.

    Article  PubMed  Google Scholar 

  8. Cotrel Y, Dubousset J, Guillaumat M. New universal instrumentation in spinal surgery. Clin Orthop Relat Res 1988;227:10–23.

    CAS  PubMed  Google Scholar 

  9. Da Cunha RJ, Al Sayegh S, LaMothe JM, et al. Intraoperative skull-femoral traction in posterior spinal arthrodesis for adolescent idiopathic scoliosis: the impact on perioperative outcomes and health resource utilization. Spine (Phila Pa 1976) 2015;40:E154–60.

    Article  Google Scholar 

  10. Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop Relat Res 1986;203:7–17.

    Google Scholar 

  11. Gelalis ID, Paschos NK, Pakos EE, et al. Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 2012;21:247–55.

    Article  PubMed  Google Scholar 

  12. Larson AN, Aubin CE, Polly Jr DW, et al. Are more screws better? A systematic review of anchor density and curve correction in adolescent idiopathic scoliosis. Spine Deform 2013;1:237–47.

    Article  PubMed  Google Scholar 

  13. Lang TA, Altman DG. Statistical analyses and methods in the published literature: the SAMPL guidelines. In: Moher D, Altman DG, Schulz KF, et al., editors. Guidelines for reporting health research: a user’s manual. Chichester, UK: John Wiley & Sons, Ltd.; 2014. p. 264–74.

    Google Scholar 

  14. Chiu CK, Chan CY, Aziz I, et al. Assessment of intraoperative blood loss at different surgical stages during posterior spinal fusion surgery in the treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2016;41:E566–73.

    Article  Google Scholar 

  15. Gotfryd AO, Avanzi O. Randomized clinical study on surgical techniques with different pedicle screw densities in the treatment of adolescent idiopathic scoliosis types Lenke 1A and 1B. Spine Deform 2013;1:272–9.

    Article  PubMed  Google Scholar 

  16. Xiao R, Miller JA, Sabharwal NC, et al. Clinical outcomes following spinal fusion using an intraoperative computed tomographic 3D imaging system. J Neurosurg Spine 2017;26:628–37.

    Article  PubMed  Google Scholar 

  17. Nooh A, Aoude A, Fortin M, et al. Use of computer assistance in lumbar fusion surgery: analysis of 15 222 patients in the ACS-NSQIP database. Global Spine J 2017;7:617–23.

    Article  PubMed  PubMed Central  Google Scholar 

  18. McLeod LM, French B, Flynn JM, et al. Antifibrinolytic use and blood transfusions in pediatric scoliosis surgeries performed at US children’s hospitals. J Spinal Disord Tech 2015;28:E460–6.

    Article  Google Scholar 

  19. Minhas SV, Chow I, Bosco J, et al. Assessing the rates, predictors, and complications of blood transfusion volume in posterior arthrodesis for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2015;40:1422–30.

    Article  Google Scholar 

  20. Wainwright TW, Immins T, Middleton RG. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery. Best Pract Res Clin Anaesthesiol 2016;30:91–102.

    Article  PubMed  Google Scholar 

  21. Fletcher ND, Andras LM, Lazarus DE, et al. Use of a novel pathway for early discharge was associated with a 48% shorter length of stay after posterior spinal fusion for adolescent idiopathic scoliosis. J Pediatr Orthop 2017;37:92–7.

    Article  PubMed  Google Scholar 

  22. Sanders AE, Andras LM, Sousa T, et al. Accelerated discharge protocol for posterior spinal fusion patients with adolescent idiopathic scoliosis decreases hospital postoperative charges 22. Spine (Phila Pa 1976) 2017;42:92–7.

    Article  Google Scholar 

  23. Ahn H, Kreder H, Mahomed N, et al. Empirically derived maximal acceptable wait time for surgery to treat adolescent idiopathic scoliosis. CMAJ 2011;183:E565–70.

    Article  Google Scholar 

  24. Cahill PJ, Pahys JM, Asghar J, et al. The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am 2014;96:1333–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada

    Jonathan Bourget-Murray MD, CM, Alejandro Peiro-Garcia MD, Madalene A. Earp PhD, David L. Parsons MD, FRCSC & Fábio Ferri-de-Barros MD, MSc, FSBOT, FRCSC

  2. Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada

    Jonathan Bourget-Murray MD, CM

  3. Department of Surgery, Division of Pediatric Orthopedic Surgery, Alberta Children’s Hospital, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada

    Garielle E. Brown BSc, MSc, Alejandro Peiro-Garcia MD, David L. Parsons MD, FRCSC & Fábio Ferri-de-Barros MD, MSc, FSBOT, FRCSC

Authors
  1. Jonathan Bourget-Murray MD, CM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Garielle E. Brown BSc, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alejandro Peiro-Garcia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Madalene A. Earp PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David L. Parsons MD, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Fábio Ferri-de-Barros MD, MSc, FSBOT, FRCSC
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fábio Ferri-de-Barros MD, MSc, FSBOT, FRCSC.

Additional information

Author disclosures: JBM (none), GEB (none), APG (none), MAE (none), DLP (none), FFB (none).

Sources of funding: None.

IRB approval: This study was performed in accordance with our institute’s ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bourget-Murray, J., Brown, G.E., Peiro-Garcia, A. et al. Quality, Safety, and Value of Innovating Classic Operative Techniques in Scoliosis Surgery: Intraoperative Traction and Navigated Sequential Drilling. Spine Deform 7, 588–595 (2019). https://doi.org/10.1016/j.jspd.2018.09.070

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2018.09.070

Keywords

Search

Navigation