Two-Surgeon Multidisciplinary Approach to Pediatric Cervical Spinal Fusion: A Single-Institution Series and Review of the Literature

Background: A collaborative 2-surgeon approach is becoming increasingly popular in surgery but is not widely used for pediatric cervical spine fusions. The goal of this study is to present a large single-institution experience with pediatric cervical spinal fusion using a multidisciplinary 2-surgeon team, including a neurosurgeon and an orthopedic surgeon. This team-based approach has not been previously reported in the pediatric cervical spine literature. Methods: A single-institution review of pediatric cervical spine instrumentation and fusion performed by a surgical team composed of neurosurgery and orthopedics during 2002–2020 was performed. Demographics, presenting symptoms and indications, surgical characteristics, and outcomes were recorded. Particular focus was given to describe the primary surgical responsibility of the orthopedic surgeon and the neurosurgeon. Results: A total of 112 patients (54% male) with an average age of 12.1 (range 2–26) years met the inclusion criteria. The most common indications for surgery were os odontoideum with instability (n=21) and trauma (n=18). Syndromes were present in 44 (39%) cases. Fifty-five (49%) patients presented with preoperative neurological deficits (26 motor, 12 sensory, and 17 combined deficits). At the time of the last clinical follow-up, 44 (80%) of these patients had stabilization or resolution of their neurological deficit. There was 1 new postoperative neural deficit (1%). The average time between surgery and successful radiologic arthrodesis was 13.2±10.6 mo. A total of 15 (13%) patients experienced complications within 90 days of surgery (2 intraoperative, 6 during admission, and 7 after discharge). Conclusions: A multidisciplinary 2-surgeon approach to pediatric cervical spine instrumentation and fusion provides a safe treatment option for complex pediatric cervical cases. It is hoped that this study could provide a model for other pediatric spine groups interested in implementing a multi-specialty 2-surgeon team to perform complex pediatric cervical spine fusions. Level of Evidence: Level IV—case series.

[1]  Gabriel N Friedman,et al.  Multidisciplinary Approaches to Complication Reduction in Complex Spine Surgery: A Systematic Review. , 2020, The spine journal : official journal of the North American Spine Society.

[2]  M. Proctor,et al.  Perioperative acute neurological deficits in instrumented pediatric cervical spine fusions. , 2019, Journal of neurosurgery. Pediatrics.

[3]  Shevaun M. Doyle,et al.  Reliability of the Modified Clavien-Dindo-Sink Complication Classification System in Pediatric Orthopaedic Surgery , 2018, JB & JS open access.

[4]  Justin K Scheer,et al.  Results of the 2015 Scoliosis Research Society Survey on Single Versus Dual Attending Surgeon Approach for Adult Spinal Deformity Surgery , 2017, Spine.

[5]  Quinlan D. Buchlak,et al.  A systematic multidisciplinary initiative for reducing the risk of complications in adult scoliosis surgery. , 2017, Journal of neurosurgery. Spine.

[6]  C. Chan,et al.  Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? A prospective propensity matching score analysis. , 2017, The spine journal : official journal of the North American Spine Society.

[7]  Vijay Yanamadala,et al.  Complication avoidance with pre-operative screening: insights from the Seattle spine team , 2016, Current Reviews in Musculoskeletal Medicine.

[8]  J. Emans,et al.  Cervical Spine Instrumentation in Children , 2016, The Journal of the American Academy of Orthopaedic Surgeons.

[9]  M. Mallory,et al.  Does “Two is Better Than One” Apply to Surgeons? Comparing Single-Surgeon Versus Co-surgeon Bilateral Mastectomies , 2016, Annals of Surgical Oncology.

[10]  D. Hedequist.  Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine , 2015, HSS Journal ®.

[11]  Natalie C. Moreland,et al.  The implementation and efficacy of the Northwestern High Risk Spine Protocol. , 2014, World neurosurgery.

[12]  L. McCahill,et al.  Esophagectomy outcomes at a mid-volume cancer center utilizing prospective multidisciplinary care and a 2-surgeon team approach. , 2014, American journal of surgery.

[13]  J. Leveque,et al.  The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates , 2014, Spine deformity.

[14]  K. Noonan,et al.  Comparing results of posterior spine fusion in patients with AIS: Are two surgeons better than one? , 2013, Journal of orthopaedics.

[15]  Tyler R Koski,et al.  Treatment algorithms and protocol practice in high-risk spine surgery. , 2013, Neurosurgery clinics of North America.

[16]  V. Deviren,et al.  Perioperative Outcomes and Complications of Pedicle Subtraction Osteotomy in Cases With Single Versus Two Attending Surgeons , 2013, Spine deformity.

[17]  W. Whitehead,et al.  Outcomes of instrumented fusion in the pediatric cervical spine. , 2012, Journal of neurosurgery. Spine.

[18]  A. Jea,et al.  Complications of occipital screw placement for occipitocervical fusion in children. , 2012, Journal of neurosurgery. Pediatrics.

[19]  N. Miller,et al.  A Multidisciplinary Approach Improves Infection Rates In Pediatric Spine Surgery , 2012, Journal of pediatric orthopedics.

[20]  M. Erickson,et al.  Pathways that distinguish simple from complex scoliosis repair and their outcomes. , 2011, Current opinion in pediatrics.

[21]  R. W. Gould,et al.  Standardizing Care for High-Risk Patients in Spine Surgery: The Northwestern High-Risk Spine Protocol , 2010, Spine.

[22]  T. Spalding,et al.  Simultaneous bilateral anterior cruciate ligament reconstruction: a safe option , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[23]  P. Carry,et al.  Evaluation of High-risk Patients Undergoing Spinal Surgery: A Matched Case Series , 2010, Journal of pediatric orthopedics.

[24]  F. Sklar,et al.  Screw fixation of the upper cervical spine in the pediatric population. Clinical article. , 2009, Journal of neurosurgery. Pediatrics.

[25]  Meic H. Schmidt,et al.  Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. , 2005, Journal of neurosurgery. Spine.

[26]  Badrinath R Konety,et al.  Two-surgeon versus single-surgeon radical cystectomy and urinary diversion: impact on patient outcomes and costs. , 2004, Urology.

[27]  P D Adelson,et al.  Upper cervical spine fusion in the pediatric population. , 1997, Journal of neurosurgery.

[28]  A. Li,et al.  Two‐team synchronous oesophagectomy , 1994, The British journal of surgery.

[29]  Victoria D. Vuong,et al.  Interdisciplinary Care Model Independently Decreases Use of Critical Care Services After Corrective Surgery for Adult Degenerative Scoliosis. , 2018, World neurosurgery.

[30]  Guidelines for standards in cardiac surgery. Advisory Council for Cardiothoracic Surgery, American College of Surgeons. , 1997, Bulletin of the American College of Surgeons.