ORCID Profile
0000-0002-4854-2816
Current Organisations
Shriners Hospitals for Children - Canada
,
Friedreich's Ataxia Research Alliance
,
Hôpital du Sacré-Coeur de Montréal
,
Université de Montréal
,
Hôpital Sainte-Justine
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Publications
Anterior Vertebral Body Tethering Compared with Posterior Spinal Fusion for Major Thoracic Curves
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-10-2022
Abstract: Anterior vertebral body tethering (AVBT) is an alternative to posterior spinal fusion (PSF) for the surgical treatment of scoliosis. The present study utilized a large, multicenter database and propensity matching to compare outcomes of AVBT to PSF in patients with idiopathic scoliosis. Patients with thoracic idiopathic scoliosis who underwent AVBT with a minimum 2-year follow-up retrospectively underwent 2 methods of propensity-guided matching to PSF patients from an idiopathic scoliosis registry. Radiographic, clinical, and Scoliosis Research Society 22-Item Questionnaire (SRS-22) data were compared preoperatively and at the ≥2-year follow-up. A total of 237 AVBT patients were matched with 237 PSF patients. In the AVBT group, the mean age was 12.1 ± 1.6 years, the mean follow-up was 2.2 ± 0.5 years, 84% of patients were female, and 79% of patients had a Risser sign of 0 or 1, compared with 13.4 ± 1.4 years, 2.3 ± 0.5 years, 84% female, and 43% Risser 0 or 1 in the PSF group. The AVBT group was younger (p 0.001), had a smaller mean thoracic curve preoperatively (48 ± 9° range, 30° to 74° compared with 53 ± 8° range, 40° to 78° in the PSF group p 0.001), and had less initial correction (41% ± 16% correction to 28° ± 9° compared with 70% ± 11% correction to 16° ± 6° in the PSF group p 0.001). Thoracic deformity at the time of the latest follow-up was 27° ± 12° (range, 1° to 61°) for AVBT compared with 20° ± 7° (range, 3° to 42°) for PSF (p 0.001). A total of 76% of AVBT patients had a thoracic curve of ° at the latest follow-up compared with 97.4% of PSF patients (p 0.001). A residual curve of ° was present in 7 AVBT patients (3%), 3 of whom underwent subsequent PSF, and in 0 PSF patients (0%). Forty-six subsequent procedures were performed in 38 AVBT patients (16%), including 17 conversions to PSF and 16 revisions for excessive correction, compared with 4 revision procedures in 3 PSF patients (1.3% p 0.01). AVBT patients had lower median preoperative SRS-22 mental-health component scores (p 0.01) and less improvement in the pain and self-image scores between preoperatively and the ≥2-year follow-up (p 0.05). In the more strictly matched analysis (n = 108 each), 10% of patients in the AVBT group and 2% of patients in the PSF group required a subsequent surgical procedure. At a mean follow-up of 2.2 years, 76% of thoracic idiopathic scoliosis patients who underwent AVBT had a residual curve of ° compared with 97.4% of patients who underwent PSF. A total of 16% of cases in the AVBT group required a subsequent surgical procedure compared with 1.3% in the PSF group. An additional 4 cases (1.3%) in the AVBT group had a residual curve of ° that may require revision or conversion to PSF. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation
Publisher: Springer Science and Business Media LLC
Date: 24-07-2013
Guided Imagery for Adolescent Post-spinal Fusion Pain Management: A Pilot Study
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.PMN.2014.06.004
Abstract: Orthopedic surgery for adolescent idiopathic scoliosis entails anxiety and severe postoperative pain. The aim of this pilot study was to investigate an intervention for adolescent post-spinal fusion pain management in patients from a tertiary care hospital in Montreal, Canada. Participants were adolescents and young adults ages 11 to 20 years undergoing spinal fusion. Participants were randomized to standard care or standard care with adjunct intervention. The intervention consisted of a DVD with information and guided imagery/relaxation exercises to practice at least three times a week at home. A nurse screened the DVD with the patient preoperatively and at discharge (T1) and telephoned 2 weeks post-discharge (T2) to reinforce the technique. Both groups completed questionnaires at T1, T2, and T3 (1-month postoperative follow-up). Outcome measures included pain intensity, anxiety, coping mechanisms, and daily activities. From March 2010 to June 2011, we enrolled 40 of 45 eligible participants (n = 20 per group), average age 15 ± 2.1 years, 7 participants were male. Compared with the control group, the experimental group experienced significantly less overall pain at all time points, with moderate to large effect sizes at T2, T3 (p ≤ .007). Worst pain in 24 hours was moderately decreased at T2 (p = .01). State-trait anxiety remained high. On a 10-point scale, a median 2.5-point benefit was seen in eating and sleeping (Mann-Whitney test, p = .002), and 2 points in walking (Mann-Whitney test, p = .003). Coping strategies showed no significant differences. Addition of a guided imagery and relaxation exercise DVD for home use was more effective than standard care alone for postoperative pain. Our nonpharmacologic adjunct looks promising. Larger s le size and longer (6-9 months) follow-up will permit refinement.
Operative differences for posterior spinal fusion after vertebral body tethering: Are we fusing more levels in the end?
Publisher: Springer Science and Business Media LLC
Date: 21-12-2022
Related Organisations
Related Funding Activities
No related grants have been discovered for Stefan Parent.