Pediatric spine surgery

Pediatric spine surgery refers to surgical procedures performed on children and adolescents to address various spinal conditions and abnormalities. These surgeries can range from relatively minor procedures to complex spinal reconstructions, depending on the specific condition being treated.

Common indications for pediatric spine surgery include:

Scoliosis: This refers to an abnormal sideways curvature of the spine. Surgery may be recommended for severe cases of scoliosis that do not respond to non-surgical treatments such as bracing. Kyphosis: Kyphosis is an excessive forward curvature of the spine, leading to a hunched or rounded back. Surgery may be required for severe cases or when other treatments are ineffective. Spinal deformities: These include congenital abnormalities of the spine, such as spinal dysraphism (e.g., spina bifida) or congenital scoliosis, which may require surgical correction. Spinal tumors: Surgery may be necessary to remove tumors affecting the spinal cord or surrounding structures. Tumors can be benign or malignant, and the treatment approach depends on factors such as tumor type, location, and extent. Traumatic injuries: Severe spinal injuries in children, such as fractures or dislocations, may require surgical intervention to stabilize the spine and prevent further damage. Pediatric spine surgery often involves a multidisciplinary team of healthcare professionals, including pediatric orthopedic surgeons, neurosurgeons, anesthesiologists, and nurses, to ensure comprehensive care and optimal outcomes. The goals of surgery are typically to correct spinal deformities, relieve pain, improve function, and prevent or minimize long-term complications.

The specific surgical techniques and approaches used in pediatric spine surgery vary depending on the underlying condition and the age and overall health of the child. Minimally invasive techniques are increasingly being utilized when appropriate, as they can offer advantages such as smaller incisions, reduced blood loss, and faster recovery times compared to traditional open surgery.

As with any surgical procedure, pediatric spine surgery carries risks, including infection, bleeding, nerve injury, and anesthesia-related complications. The decision to undergo surgery is carefully weighed against the potential benefits and risks, and families are typically involved in the decision-making process.

Postoperative rehabilitation and follow-up care are important aspects of pediatric spine surgery to ensure optimal recovery and long-term outcomes. Physical therapy, bracing, and regular monitoring may be recommended depending on the specific needs of the child.

Antifibrinolytics have gained increasing attention in minimizing blood loss and mitigating the risks associated with massive transfusions, including infection and coagulopathy in pediatric patients undergoing spine surgery. Nevertheless, the selection of optimal agent is still a matter of debate.

Aghajanian et al. aim to review the utility of these agents and compare the efficacy of antifibrinolytics in pediatric and adolescent spine surgeries. A comprehensive search was performed in Scopus, Web of Science, and MEDLINE databases for relevant works. Studies providing quantitative data on predefined outcomes were included. Primary outcome was perioperative bleeding between the groups. Secondary outcomes included transfusion volume, rate of complications, and operation time. Twenty-eight studies were included in the meta-analysis incorporating 2553 patients. The use of Tranexamic acid (RoM: 0.71, 95%CI: [0.62-0.81], p < 0.001, I2 = 88%), Aprotinin (RoM: 0.54, 95%CI: [0.46-0.64], p < 0.001, I2 = 0%), and Epsilon-aminocaproic acid (RoM: 0.71, 95%CI: [0.62-0.81], p < 0.001, I2 = 60%) led to a 29%, 46%, and 29% reduction in perioperative blood loss, respectively. Network meta-analysis revealed higher probability of efficacy with Tranexamic acid compared to Epsilon-aminocaproic acid (P score: 0.924 vs. 0.571). The rate of complications was not statistically different between each two antifibrinolytic agent or antifibrinolytics compared to placebo or standard of care. The network meta-analysis suggests a superior efficacy of all antifibrinolytics compared to standard of care/placebo in reducing blood loss and transfusion rate. Further adequately-powered randomized clinical trials are recommended to reach definite conclusion on comparative performance of these agents and to also provide robust objective assessments and standardized outcome data and safety profile on antifibrinolytics in pediatric and adolescent pediatric surgeries ¹⁾