Morbidity and mortality in the surgical treatment of six hundred five pediatric patients with isthmic or dysplastic spondylolisthesis

Study Design. Retrospective analysis of prospectively collected database. Objective. To analyze the rate of complications, includ-ing neurologic deficits, associated with operative treatment of pediatric isthmic and dysplastic spondylolisthesis. Summary Of Background Data. Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon dis-orders. Several prior studies have suggested a high rate of complication associated with operative intervention. How-ever, most of these studies were performed with sufficiently small sample sizes such that the presence of one complica-tion could significantly affect the overall rate. The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. This multicentered, multisurgeon database permits analysis of the surgi-cal treatment of this relatively rare condition on an aggre-gate scale and provides surgeons with useful information for preoperative counseling. Methods. Patients who underwent surgical treatment for isthmic or dysplastic spondylolisthesis from 2004 to 2007 were identified from the SRS M&M database. Inclu-sion criteria for analysis included age ≤21 and a primary diagnosis of isthmic or dysplastic spondylolisthesis. Results. Of 25,432 pediatric cases reported, there were a total of 605 (2.4%) cases of pediatric dysplastic (n = 62, 10%) and isthmic (n = 543, 90%) spondylolisthesis, with a mean age of 15 years (range, 4-21). Approximately 50% presented with neural element compression, and less than 1% of cases were revisions. Surgical procedures included fusions in 92%, osteotomies in 39%, and reduc-tions in 38%. The overall complication rate was 10.4%. The most common complications included postoperative neurologic deficit (n = 31, 5%), dural tear (n = 8, 1.3%), and wound infection (n = 12, 2%). Perioperative deep venous thrombosis and pulmonary embolus were re-ported in 2 (0.3%) and 1 (0.2%) patients, respectively. There were no deaths in this series. Conclusion. Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders, repre-senting only 2.4% of pediatric spine procedures in the present study. Even among experienced spine surgeons, surgical treatment of these spinal conditions is associated with a relatively high morbidity.