Complications in the Surgical Treatment of 19,360 cases of Pediatric Scoliosis: A Review of the Scoliosis Research Society Database

Reames, Davis L.; Smith, Justin S.; Fu, Kai-Ming G.; Polly, David W. Jr; Ames, Christopher P.; Berven, Sigurd H.; Perra, Joseph H.; Glassman, Steven D.; McCarthy, Richard E.; Knapp, D. Raymond Jr; Heary, Robert; Shaffrey, Christopher I.; Scoliosis Research Society Morbidity and Mortality Committee

Spine., POST ACCEPTANCE, 5 January 2011

Abstract:

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 (SRS) 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 SRS M&M database from 2004-2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed.

Results: 19,360 cases met inclusion criteria. 1,971 total complications (10.2%) occurred. 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 neurological deficit also differed significantly based on scoliosis etiology (P<0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%), and idiopathic scoliosis (0.8%). Neuromuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurological deficits were associated with revision procedures (p<0.001) and with the use of corrective osteotomies (p<0.001). The rates of new neurological deficit were significantly higher for procedures utilizing 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 pre-operative counseling and surgical decision making in the treatment of pediatric scoliosis.

(C) 2011 Lippincott Williams & Wilkins, Inc.