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The surgical management of spinal deformity in children with a Fontan circulation: The development of an algorithm for treatment. Bone Joint J 2014 Jan;96-B(1):94-9

Date

01/08/2014

Pubmed ID

24395318

DOI

10.1302/0301-620X.96B1.32581

Scopus ID

2-s2.0-84892621395   4 Citations

Abstract

The management of spinal deformity in children with univentricular cardiac pathology poses significant challenges to the surgical and anaesthetic teams. To date, only posterior instrumented fusion techniques have been used in these children and these are associated with a high rate of complications. We reviewed our experience of both growing rod instrumentation and posterior instrumented fusion in children with a univentricular circulation. Six children underwent spinal corrective surgery, two with cavopulmonary shunts and four following completion of a Fontan procedure. Three underwent growing rod instrumentation, two had a posterior fusion and one had spinal growth arrest. There were no complications following surgery, and the children undergoing growing rod instrumentation were successfully lengthened. We noted a trend for greater blood loss and haemodynamic instability in those whose surgery was undertaken following completion of a Fontan procedure. At a median follow-up of 87.6 months (interquartile range (IQR) 62.9 to 96.5) the median correction of deformity was 24.2% (64.5° (IQR 46° to 80°) vs 50.5° (IQR 36° to 63°)). We believe that early surgical intervention with growing rod instrumentation systems allows staged correction of the spinal deformity and reduces the haemodynamic insult to these physiologically compromised children. Due to the haemodynamic changes that occur with the completed Fontan circulation, the initial scoliosis surgery should ideally be undertaken when in the cavopulmonary shunt stage.

Author List

Evans S, Ramasamy A, Marks DS, Spilsbury J, Miller P, Tatman A, Gardner AC

Author

David S. Marks MD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Algorithms
Blood Loss, Surgical
Bone Nails
Child
Fontan Procedure
Heart Bypass, Right
Hemodynamics
Humans
Perioperative Care
Retrospective Studies
Scoliosis
Spinal Fusion
Treatment Outcome