Major complications following surgical correction of spine deformity in 257 patients with cerebral palsy

Abstract

Study design Observational. Objectives To report on the rate of major complications following spinal fusion and instrumentation to treat spinal deformity in patients with cerebral palsy (CP). Summary of background data Understanding the risk of major complications following the surgical treatment of spine deformities in patients with CP is critical. Methods A prospectively collected, multicenter database of patients with CP who had surgical correction of their spinal deformity (scoliosis or kyphosis) was reviewed for all major complications. Patients with ≥ 2 year follow-up or who died ≤ 2 years of surgery were included. A complication was defined as major if it resulted in reoperation, re-admission to the hospital, prolongation of the hospital stay, was considered life-threatening, or resulted in residual disability. Overall complication and revision rates were calculated for the perioperative (Peri-op; occurring ≤ 90 days postoperative) and delayed postoperative (Delayed; > 90 days) time periods. Results Two hundred and fifty-seven patients met inclusion. Seventy-eight (30%) patients had a major complication, 18 (7%) had > 1. There were 92 (36%) major complications; 64 (24.9%) occurred Peri-op. The most common Peri-op complications were wound ( n = 16, 6.2%) and pulmonary issues ( n = 28, 10.9%), specifically deep infections ( n = 12, 4.7%) and prolonged ventilator support ( n = 21, 8.2%). Delayed complications ( n = 28, 10.9%) were primarily deep infections (n = 8, 3.1%) and instrumentation-related ( n = 6, 2.3%). There were 42 additional surgeries for an overall unplanned return to the operating room rate of 16% (Peri-op: 8.6%, Delayed: 7.8%). Thirty-six (14.0%) reoperations were spine related surgeries (wound or instrumentation-related). Eleven (4.3%) patients died between 3 months to 5.6 years postoperatively; 4 occurred ≤ 1 year of surgery. Two deaths were directly related to the spinal deformity surgery. Conclusion Spinal deformity surgery in CP patients with greater than 2 years of follow-up have a postoperative major complication rate of 36% with a spine-related reoperation rate of 14.0%. Level of evidence Therapeutic-IV.

Spinal deformity surgery is accompanied by serious complications: report from the Morbidity and Mortality Database of the Scoliosis Research Society from 2013 to 2020

“…There were several years in which NM patients had a higher mortality rate than the other kyphosis group (2016-2017, 2019-2020). In their prospectively collected, multicenter database in cerebral palsy patients treated surgically, Yaszay et al found that 11 of 257 (4.3%) patients died between 3 months and 5.6 years postoperatively [17]. In addition, 4 (1.5%) patients died less than a year after surgery and 2 (0.7%) deaths were directly related to the surgical procedure.…”

The Early and Late Postoperative Complications of Pediatric Neuromuscular Scoliosis at King Abdulaziz Medical City, Riyadh, Saudi Arabia: A Case Series

“…Scoliosis correction surgery is a procedure associated with high risks as reported by numerous studies; pulmonary complications being the most common [9][10][11][12]. Patients suffering from a neuromuscular disorder e.g.…”

“…All of the mentioned factors along with the long duration of the surgery can influence the frequency and severity of postoperative complications [8]. Studies conducted with regard to the complications of correctional surgery of NMS have showcased similar complication rates, especially pulmonary complications [9][10][11][12]. One retrospective study conducted by Luhmann and Furdock found that the highest postoperative complications were pulmonary complications with a rate of 15.3% among 111 NMS patients [9].…”

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

“…CSM surgery for patients with CP remains challenging because of perioperative instrumentation failure caused by the patient’s repetitive involuntary neck movements, complicated cervical spine deformities, and comorbidities. Several studies have reported postoperative complications in patients with CSM without CP or scoliosis with CP [ 24 , 33 ]. However, there exist only a few reports regarding postoperative complications in patients with CSM and CP.…”

“…In previous studies, complication rates in NCP patients who underwent cervical surgery due to CSM were 9–30% [ 17 , 23 , 26 , 31 ]. Yaszay et al [ 33 ] reported a rate of 36% for postoperative major complications (e.g., wound infections, pulmonary issues, instrument-related complications) in patients with CP with >2 years of follow-up after spinal surgery, with a spine-related reoperation rate of 14.0%. Samdani et al [ 24 ] reported a 39% complication rate in 127 patients with CP who underwent spinal surgery.…”