Development of Consensus-Based Best Practice Guidelines for the Perioperative and Postoperative Care of Pediatric Patients With Spinal Deformity and Programmable Implanted Devices.

IF 2.6 2区 医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2024-12-01 Epub Date: 2024-06-11 DOI:10.1097/BRS.0000000000005061
Walter H Truong, Hiroko Matsumoto, Jaysson T Brooks, Tenner J Guillaume, Lindsay M Andras, Patrick J Cahill, Ryan E Fitzgerald, Ying Li, Brandon A Ramo, Benhoor Soumekh, Laurel C Blakemore, Christopher Carter, Michelle R Christie, Daniel Cortez, V Vivian Dimas, Christina K Hardesty, Luv R Javia, Benjamin C Kennedy, Peter D Kim, Robert F Murphy, Joseph H Perra, David W Polly, Jeffrey R Sawyer, Brian Snyder, Paul D Sponseller, Peter F Sturm, Burt Yaszay, Tim Feyma, Sara J Morgan
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Abstract

Study design: Modified Delphi consensus study.

Objective: To develop consensus-based best practices for the care of pediatric patients who have implanted programmable devices (IPDs) and require spinal deformity surgery.

Summary of background data: Implanted programmable devices (IPDs) are often present in patients with neuromuscular or syndromic scoliosis who require spine surgery. Guidelines for monitoring and interrogating these devices during the perioperative period are not available.

Methods: A panel was assembled consisting of 25 experts (i.e., spinal deformity surgeons, neurosurgeons, neuroelectrophysiologists, cardiologists, and otolaryngologists). Initial postulates were based on a literature review and results from a prior survey. Postulates addressed the following IPDs: vagal nerve stimulators (VNS), programmable ventriculoperitoneal shunts (VPS), intrathecal baclofen pumps (ITBP), cardiac pacemakers and implantable cardioverter-defibrillators (ICD), deep brain stimulators (DBS), and cochlear implants. Cardiologist and otolaryngologist participants responded only to postulates on cardiac pacemakers or cochlear implants, respectively. Consensus was defined as ≥80% agreement, items that did not reach consensus were revised and included in subsequent rounds. A total of 3 survey rounds and 1 virtual meeting were conducted.

Results: Consensus was reached on 39 total postulates across 6 IPD types. Postulates addressed general spine surgery considerations, the use of intraoperative monitoring and cautery, the use of magnetically controlled growing rods (MCGRs), and the use of an external remote controller to lengthen MCGRs. Across IPD types, consensus for the final postulates ranged from 94.4% to 100%. Overall, experts agreed that MCGRs can be surgically inserted and lengthened in patients with a variety of IPDs and provided guidance for the use of intraoperative monitoring and cautery, which varied between IPD types.

Conclusion: Spinal deformity correction surgery often benefits from the use of intraoperative monitoring, monopolar and bipolar cautery, and MCGRs. The final postulates from this study can inform the perioperative and postoperative practices of spinal deformity surgeons who treat patients with both scoliosis and IPDs.

Level of evidence: V-Expert opinion.

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为脊柱畸形和可编程植入器械的儿科患者制定基于共识的围手术期和术后护理最佳实践指南。
研究设计:改良德尔菲共识研究:为植入可编程设备(IPD)并需要脊柱畸形手术的儿科患者制定基于共识的最佳护理实践:需要进行脊柱手术的神经肌肉或综合症脊柱侧弯患者通常都有植入式可编程设备(IPD)。目前还没有在围手术期监控和询问这些设备的指南:方法:成立了一个由 25 位专家(即脊柱畸形外科医生、神经外科医生、神经电生理学家、心脏病专家和耳鼻喉科专家)组成的小组。最初的假设基于文献综述和之前的调查结果。假设涉及以下 IPD:迷走神经刺激器 (VNS)、可编程脑室腹腔分流术 (VPS)、鞘内巴氯芬泵 (ITBP)、心脏起搏器和植入式心律转复除颤器 (ICD)、脑深部刺激器 (DBS) 和人工耳蜗植入。心脏病专家和耳鼻喉科专家只分别对心脏起搏器或人工耳蜗的假设做出了回答。达成共识的定义为≥80%的一致意见,未达成共识的项目将进行修订并纳入后续调查。共进行了三轮调查和一次虚拟会议:结果:就六种 IPD 类型共 39 个假设达成了共识。假设涉及一般脊柱手术注意事项、术中监测和烧灼的使用、磁控生长棒(MCGR)的使用以及使用外部遥控器延长 MCGR。在所有 IPD 类型中,最终假设的共识率为 94.4%-100%。总体而言,专家们一致认为,可以通过手术插入 MCGRs 并延长各种 IPD 患者的脊柱,并为术中监测和烧灼的使用提供了指导,但不同 IPD 类型的术中监测和烧灼方法各不相同:结论:脊柱畸形矫正手术通常得益于术中监测、单极和双极烧灼以及 MCGRs 的使用。本研究的最终推论可为脊柱畸形外科医生治疗脊柱侧弯和IPD患者的围手术期和术后操作提供参考:专家意见。
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来源期刊
Spine
Spine 医学-临床神经学
CiteScore
5.90
自引率
6.70%
发文量
361
审稿时长
6.0 months
期刊介绍: Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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