Key result
In patients with neuromuscular scoliosis, an incomplete preoperative echocardiographic evaluation was significantly associated with a larger thoracic Cobb angle (50.5° vs 29.4°, p=0.010) and lower BMI (13 vs 17 kg/m2, p=0.014).
Why the study?
Does the severity of spinal deformity affect the feasibility of preoperative echocardiographic evaluation in patients with neuromuscular scoliosis?
Cohort (n=73)
No
Does the severity of spinal deformity affect the feasibility of preoperative echocardiographic evaluation in patients with neuromuscular scoliosis?
Absolute Event Rate: 50.5% vs 29.4%
p-value: p=0.010
Preoperative echocardiography is technically difficult and often incomplete in children with advanced neuromuscular scoliosis, particularly those with large thoracic deformities and low BMI, which may necessitate alternative cardiac assessments.
May warrant alternative cardiac assessments in severe neuromuscular scoliosis; leaves open whether deformity severity directly impairs echocardiographic feasibility.
INTRODUCTION: Echocardiography is an important component of perioperative cardiac risk stratification in patients with neuromuscular scoliosis (NMS). However, there are little data regarding the relationship between preoperative echocardiographic findings and spinal deformity. We retrospectively reviewed preoperative echocardiographic data to investigate the relationship between echocardiographic evaluation and spinal deformity in NMS. METHODS: We reviewed 73 NMS patients (mean age: 13.3 years, male 66%) who underwent spinal correction surgery between 2008 and 2016. Echocardiographic data including ejection fraction (EF), valvar disease, and inferior vena cava diameter were collected from the preoperative exam. Demographic and radiographic data were also collected. RESULTS: . Mean major Cobb angle before surgery was 86.6 ± 28.2°. Because of technical difficulty, complete echocardiographic data could only be collected and evaluated in 49.3% of patients. Neither right nor left sided cardiac evaluation could be completed in 20.5%. Patients in whom complete echocardiographic data could not be collected had significantly more extensive thoracic scoliosis with a more rigid curve and hypokyphosis, and were of lower weight and BMI than patients in whom complete data could be collected. Ten cases (13.7%) were diagnosed as having minor heart-related complications immediately after surgery, and they had higher right atrial pressures preoperatively. CONCLUSIONS: Echocardiography can be technically difficult in NMS patients with extensive spinal deformities. We found that perioperative cardiac function could only be evaluated by echocardiogram in about half of NMS patients undergoing spinal correction surgery. The absence of an adequate preoperative cardiac evaluation could render these patients more susceptible to perioperative heart-related complications. Echocardiography may not be sufficient to evaluate cardiac conditions in children with extensive NMS.
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Saito et al. (2018) conducted a cohort in Neuromuscular scoliosis (n=73). Incomplete preoperative echocardiographic evaluation vs. Complete preoperative echocardiographic evaluation was evaluated on Thoracic Cobb angle (p=0.010). In patients with neuromuscular scoliosis, an incomplete preoperative echocardiographic evaluation was significantly associated with a larger thoracic Cobb angle (50.5° vs 29.4°, p=0.010) and lower BMI (13 vs 17 kg/m2, p=0.014).
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