title: The surgical management of spinal deformity in children with a Fontan circulation: The development of an algorithm for treatment.
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.
authors.affiliation: Royal Orthopaedic Hospital, Spinal Unit, Bristol Road, Birmingham B31 2AP, UK.
authors.forename: S
authors.initials: S
authors.lastname: Evans
authors.forename: A
authors.initials: A
authors.lastname: Ramasamy
authors.forename: D S
authors.initials: DS
authors.lastname: Marks
authors.forename: J
authors.initials: J
authors.lastname: Spilsbury
authors.forename: P
authors.initials: P
authors.lastname: Miller
authors.forename: A
authors.initials: A
authors.lastname: Tatman
authors.forename: A C
authors.initials: AC
authors.lastname: Gardner
mesh_terms: D000293:Adolescent; D000465:Algorithms; D016063:Blood Loss, Surgical; D001858:Bone Nails; D002648:Child; D018729:Fontan Procedure; D018610:Heart Bypass, Right; D006439:Hemodynamics; D006801:Humans; D019990:Perioperative Care / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome
keywords: Congenital heart disease; Fontan circulation; Growing rod instrumentation; Posterior spinal fusion; Scoliosis surgery; Spinal deformity