Question:
Discuss the management of the anterior surgical approach for adolescence Idiopathic Scoliosis treatment.
Answer:
Introduction
The Scoliosis Research Society defines Scoliosis as the lateral curvature or deformity of the spine in coronal plane.
A radiograph of the spine taken in standing position can detect this deformity.
The Cobb angle is the measurement of the degree of a curve. This is the angle between the most inclined end-plates in the vertebral column.
Adolescent idiopathic scoliosis is characterized by a curvature in the lumbar or thoracic spines.
AIS is a condition that causes a persistent lateral curve of more than 10° between the lumbar spine and the thoracic spine when the patient is standing straight.
This complex deformity is caused by spine rotation, various plane curvatures, and lateral curvature.
The treatment of scoliotic deformities is usually surgery. It is possible to get worse.
AIS surgery is recommended to adolescents with a spine curve that has Cobb angles greater than 45deg-50deg (Konieczny Senyurt & Krauspe 2013, 2013).
These procedures are intended to create a solid fusion and correct the deformity, as well as improve cosmetic appearance.
The curve progression is stopped.
This technique uses the spine as a structural scaffold to attach the pieces using bone paste (Donzelli and al., 2014).
To strengthen fusion stability, metal screws, rods, and wires can be used.
This fusion surgery can be performed in either an anterior or posterior approach.
Comparison of 2 Methods
Posterior approach – This involves making a straight incision at the midline.
This is used most often to correct curvature defects.
It is a simple exposure where it is relatively straightforward to reach the operating field.
You can save more space on your disk.
Neurovascular compromise is not associated with any significant risks (Charosky and al. 2012).
The posterior musculature is being violated.
Good control can be found along the sagittal plane in the vertebral column.
This approach is known for high rates of infection due to the absence or insufficient coverage of soft tissues (Yilmaz and al., 2012).
The hump is well managed and addressed the deformity in the coronal plane.
Pre-teen children are at greater risk for the Crankshaft phenomenon (curve worsens).
The thoracic cavity is not affected, and the pulmonary functions remain intact.
Hypokyphosis, or normal outward curvature loss, is not always corrected in thoracic regions of the spine.
Anterior approach – This involves cutting a straightincision in front the spine.
This is used when a single lumbar curve or thoracic deformity must be corrected.
Effectively stops the crankshaft phenomenon.
Rod breakage, screw pullout or even rod breaking can be caused by the use of a single cable or rod (Yagi-Patel & Boachie–Adjei 2015).
It can correct hypokyphosis thoracicus.
Due to its recent development, there is a high chance of non-union and permanent failure to heal the deformed spinal canal.
It corrects disc space evacuation and increases fusion area (Choudhry Ahmad & Verma 2016, 2016).
Application of anterior instruments in the lumbar spine region without an interbody device increases the risk of lumbar hypolordosis.
This allows for the insertion of larger spinal implant and provides superior stability.
A large chest incision can cause damage to the chest muscles, and worsen lung function.
To correct curvature deformities of the spine, surgeons are increasingly using the anterior approach.
This involves a thoracotomy through the chest wall (Cho and al., 2014).
In the 1970s, anterior spinal instrumentation was popularized for lumbar and thoracolumbar adolescent idiopathic scoliosis.
Because it prevents the Crankshaft phenomenon, surgeons prefer this approach.
It takes many hours to complete the entire procedure (Helenius 2013, 2013).
An anterior spinal fusion procedure involves the first administration of general anesthesia, then being sedated.
The patient is then rolled over to the side so that the operating side faces upward.
This is known as the lateral position decubitus (Ialenti and al., 2013).
These are the steps you should follow during this approach:
Depending on where the curve deformity is located in your spine, an incision can be made either on the left or the right side.
To reach the exact spine, the lung must be deflated.
If curves are found in the lumbar or thoracolumbar spines (Tao and al., 2012), the diaphragm must be detached.
The disc material is removed from the area between the vertebrae that curves.
The disc material is removed from the space between the vertebrae where the curve is present. This increases flexibility.
It also allows for a larger surface area of spinal fusion (Sudo and al., 2013).
Next, instrumentation is required to correct the spine.
Next, the screws are placed at the levels of the curve. Each rod is attached with one or two rods.
To correct spinal deformities, the rod is simultaneously rotated and compressed.
The bone surface between the vertebral body’s bones is roughened.
The space between the vertebral bodies is filled with a bone graft, or a substitute.
This encourages fusion.
This may be an allograft bone, a removed rib or the crest of the pelvis that can serve as the source of the bone graft.
The last step is to close the incision.
Chest cavity surgery involves a chest tube being inserted through the chest side.
This allows for the expansion of the lings following surgery (Hasler 2013, 2013).
The anterior approach is supported by those who believe it improves the correction of the lumbar and thoracolumbar curves. It also offers faster recovery times, fewer lumbar vertebrae are fused, and causes less pain.
The anterior approach is preferred for surgeries that only concern the lumbar region. This is because it saves one level of vertebra, which has a significant effect on the patient’s spinal flexibility.
The anterior approach has been proven to produce better curve corrections and rib hump.
It has better radiographic and lung function outcomes.
The anterior approach is more effective than the posterior in treating adolescent Idiopathic Scoliosis.
Management Theory
In severe cases of scoliosis, surgery is usually required.
Although the cost of scoliosis surgery or treatment varies from one region to another, it can be very high.
These costs do not include additional costs such as recovery time, revisions or the treatment of any unforeseen complications.
New managerial approaches will be required to address healthcare challenges (Yoder-Wise 2014).
There are many organizational theories that can be applied in the context of healthcare to improve the outcome of patients undergoing anterior surgery.
First, the Bureaucratic Theory is to be used.
This theory of management is the oldest and most widely used.
This theory is widely used in institutions and organizations of all sizes.
This management requires that there are few people at the top of the hierarchy who have authority to make decisions (Tummers & Bekkers 2014).
The tasks are efficiently executed by a chain of lower and middle managers.
They have limited authority.
These orders are sent by the highest levels of authority in a way that is similar to the military.
Figure 2 shows that the lines of authority and responsibility are clear and that duties are distributed in a formal manner.
The theory assigns individuals to positions that are most appropriate for their technical abilities.
This model places the highest importance on following procedures.
Multiple studies have shown that this theory is effective in creating a sense of predictability, stability, and consistency through careful management and consistent decision-making.
Other studies have confirmed that professionals can control the administrative structure of an organization using this theory.
Parallel administrative and professional hierarchies have been proven to be a key factor in the dominance of professional bureaucratic management within healthcare organizations (Gittell Godfrey & Thistlethwaite 2013, 2013).
This theory is problematic due to its closed-system perspective and internal focus.
This theory is valid across the healthcare system, but it assumes that external influences and static environment.
It is crucial to understand the human resource/relations theory.
In keeping with the above theory, a closed-system perspective is also adopted.
Research suggests that this theory emphasizes the contribution of creativity towards improving an organization’s performance when there are adequate support management resources.
Jiang et. al. (2012) recognize individual motivation and involvement as key features of the theory.
It has been proven to be effective in fostering harmonious social relations and the development of organizations (Figure 3).
This theory focuses on the development of interpersonal collaboration and communication skills to maximize individual contribution and motivate (Kramar 2014).
It has been proven to have a profound impact on healthcare professionals (S.Y.
It encourages professional growth and high-quality entry-level education among all levels that ultimately leads to positive patient outcomes (Alfes, et al. (2013)).
This model does not predict a stable environment.
The framework is not enough for complex healthcare situations.
Another model is patient-centered management.
Many organizations have adopted a patient-centered management model to manage their healthcare businesses and patient care.
Figure 4 shows that top managers may consider certain systems more efficient and easier.
But, it is important to organize according to the needs of each patient (Cipolle Strand & Morley 2012).
This theory encourages financial success through the provision of high-quality medical services.
Research has shown that top managers use the framework to encourage collaboration between departments and interdisciplinary approaches in medicine. This is in a way that is not typical of bureaucratic management (Hudon, 2012).
The Institutional theory describes how organizations can thrive when they are in harmony with the outside environment.
According to the theory, key stakeholders are responsible for ensuring that an organization is legitimate by adopting norms and values that reflect their beliefs (Thornton Ocasio & Lounsbury 2015).
The results show that healthcare systems have been governed by socialization and expectations from experts such as management consultants or professional organizations for many decades (Horisch, et al. 2014).
It can thus be said that all of the theories mentioned above have played a part in improving the healthcare industry.
Methodology
Management approaches
There are many ways to decrease hospitalization costs or lengthen stay times.
A consumer-directed plan with health savings accounts or health reimbursement arrangements focuses on helping employees to be better healthcare consumers.
Employees will be encouraged to make healthy choices by using management strategies.
To ensure that healthcare workers are fully informed about the cost of the procedure, tools and training will be provided.
Incentives to lower treatment costs can motivate them and help them achieve the desired results.
Communication strategies that are effective will encourage participants to adopt healthy behaviors (Knapp Vangelisti and Caughlin 2014).
Another approach is to use consume-directed health designs (Fischer 2015).
This will encourage healthcare consumption and help to keep costs down.
It is also possible to create a health savings account linked to high-deductible health plans.
The key to a patient’s recovery is pain management.
McQuay and colleagues, 2013, will establish a pain management policy.
The professionals will have a discussion with patients about pain management and give the patient the opportunity to express their opinions.
They will also be trained in cohesive-pain management.
Effective human resource coordination will ensure timely medication delivery after surgery.
Hospital stay can be reduced by keeping a log of daily admissions, managing elective admissions, and discharging patients as quickly as is clinically possible.
The incision can be in direct contact with water for up to two weeks after surgery.
In order to speed up healing, patients will be removed from opioids and other narcotics. Patients can switch to weaker pain medications like acetaminophen.
Six weeks after surgery, X-rays will take place to evaluate the healing process and efficiency of the fusion process.
Physical therapy can be administered to patients to improve surgical healing.
Data collection
Data collection includes administering the Scoliosis Research Society-30 outcome questionnaire (SRS-30), to all 30 patients in preoperative, postoperative, and final follow up periods.
The questionnaire measures health-related quality and life (HRQoL), among patients with adolescent idiopathic scoliosis who have undergone anterior approach surgery (Carrico Meves & Avanzi 2012).
Comparing the patient and control groups will allow for comparisons of self-image, pain, mental and physical health, function and satisfaction.
SPSS 21 will be used to analyze the responses.
The Work So Far
The questionnaire has been completed.
It has been sent to those who are going to have anterior scoliosis-fusion surgery.
The questionnaire asked them to respond to the surgical treatment.
All precautions have been taken to ensure their privacy.
The questionnaire has been sent out to all respondents again after the surgery.
For the following semester, the plan includes a follow-up where participants will provide their responses for a 4 month follow-up.
The SPSS 21 statistical software will be used to analyze the data.
Simulation modeling will help improve decision-making related to the anterior approach for adolescent Idiopathic Scoliosis.
The study will allow us to compare fusion rates between patients with AIS.
This analysis will allow us to review major neurological and vascular complications that may occur after surgery.
The data will also provide insight into patient satisfaction, financial status, and current level of physical activity. This will help to develop management strategies that can be used to reduce hospital stay, lower healthcare costs, manage pain, and increase overall satisfaction.
Conclusion
Scoliosis can be described as a three-dimensional spinal deformity.
Patients aged 10 years and older are at risk for developing adolescent idiopathic spine.
This causes an idiopathic structural-lateral curve.
Cobb technology is used to measure the angle of the curvature.
The diagnosis is made using a longitudinal radiograph that measures the vertebral rotation of your spine.
Surgery is generally considered the best option for patients with skeletally impaired patients who are experiencing a progressive 40 degree scoliosis, or for patients who are skeletally mature and have a painful or curvature of the spine greater than 45 degrees.
Crankshaft phenomenon is a result of anterior growth in skeletally mature patients following posterior fusion surgery.
Crankshaft phenomenon is a post-surgical increase in rib height.
This is why anterior fusion surgery is used to stop this from happening.
Anterior surgery aims to prevent pain from spinal fusion and restore truncal balance.
The progress report used several management theories that can all be applied across the healthcare system to improve care delivery.
These management frameworks can be used to improve patient outcomes, reduce hospital stays and lower treatment costs.
They will help with pain management and improve healing abilities after surgery.
A questionnaire will be used to collect the data.
It can be concluded that the questionnaire responses will provide valuable information for managing adolescents with adolescent-idiopathic Scoliosis.
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