TY - JOUR
T1 - Complications in the surgical treatment of 19,360 cases of pediatric scoliosis
T2 - A review of the scoliosis research society morbidity and mortality database
AU - Reames, Davis L.
AU - Smith, Justin S.
AU - Fu, Kai Ming G.
AU - Polly, David W.
AU - Ames, Christopher P.
AU - Berven, Sigurd H.
AU - Perra, Joseph H.
AU - Glassman, Steven D.
AU - McCarthy, Richard E.
AU - Knapp, Raymond D.
AU - Heary, Robert
AU - Shaffrey, Christopher I.
PY - 2011/8/15
Y1 - 2011/8/15
N2 - Study Design.: Retrospective review of a multicenter database. Objective.: To determine the complication rates associated with surgical treatment of pediatric scoliosis and to assess variables associated with increased complication rates. Summary of Background Data.: Wide variability is reported for complications associated with the operative treatment of pediatric scoliosis. Limited number of patients, surgeons, and diagnoses occur in most reports. The Scoliosis Research Society Morbidity and Mortality (M&M) database aggregates deidentified data, permitting determination of complication rates from large numbers of patients and surgeons. Methods.: Cases of pediatric scoliosis (age ≤18 years), entered into the Scoliosis Research Society M&M database between 2004 and 2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed. Results.: A total of 19,360 cases fulfilled inclusion criteria. Of these, complications occurred in 1971 (10.2%) cases. Overall complication rates differed significantly among idiopathic, congenital, and neuromuscular cases (P < 0.001). Neuromuscular scoliosis had the highest rate of complications (17.9%), followed by congenital scoliosis (10.6%) and idiopathic scoliosis (6.3%). Rates of neurologic deficit also differed significantly based on the etiology of scoliosis (P < 0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%) and idiopathic scoliosis (0.8%). Neur-omuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurologic deficits were associated with revision procedures (P < 0.001) and with the use of corrective osteotomies (P < 0.001). The rates of new neurologic deficit were significantly higher for procedures using anterior screw-only constructs (2.0%) or wire-only constructs (1.7%), compared with pedicle screw-only constructs (0.7%) (P < 0.001). Conclusion.: In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups. These data may be useful for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.
AB - Study Design.: Retrospective review of a multicenter database. Objective.: To determine the complication rates associated with surgical treatment of pediatric scoliosis and to assess variables associated with increased complication rates. Summary of Background Data.: Wide variability is reported for complications associated with the operative treatment of pediatric scoliosis. Limited number of patients, surgeons, and diagnoses occur in most reports. The Scoliosis Research Society Morbidity and Mortality (M&M) database aggregates deidentified data, permitting determination of complication rates from large numbers of patients and surgeons. Methods.: Cases of pediatric scoliosis (age ≤18 years), entered into the Scoliosis Research Society M&M database between 2004 and 2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed. Results.: A total of 19,360 cases fulfilled inclusion criteria. Of these, complications occurred in 1971 (10.2%) cases. Overall complication rates differed significantly among idiopathic, congenital, and neuromuscular cases (P < 0.001). Neuromuscular scoliosis had the highest rate of complications (17.9%), followed by congenital scoliosis (10.6%) and idiopathic scoliosis (6.3%). Rates of neurologic deficit also differed significantly based on the etiology of scoliosis (P < 0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%) and idiopathic scoliosis (0.8%). Neur-omuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurologic deficits were associated with revision procedures (P < 0.001) and with the use of corrective osteotomies (P < 0.001). The rates of new neurologic deficit were significantly higher for procedures using anterior screw-only constructs (2.0%) or wire-only constructs (1.7%), compared with pedicle screw-only constructs (0.7%) (P < 0.001). Conclusion.: In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups. These data may be useful for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.
KW - complications
KW - congenital scoliosis
KW - idiopathic scoliosis
KW - neuromuscular scoliosis
KW - pediatric scoliosis
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=79958071410&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79958071410&partnerID=8YFLogxK
U2 - 10.1097/BRS.0b013e3181f3a326
DO - 10.1097/BRS.0b013e3181f3a326
M3 - Review article
C2 - 21037528
AN - SCOPUS:79958071410
VL - 36
SP - 1484
EP - 1491
JO - Spine
JF - Spine
SN - 0362-2436
IS - 18
ER -