Medical complications in scoliosis surgery

Abstract

Several medical complications can occur after scoliosis surgery in children and adolescents. They include the syndrome of inappropriate antidiuretic hormone; pancreatitis; cholelithiasis; superior mesenteric artery syndrome; ileus; pnemothorax; hemothorax; chylothorax; and fat embolism. This review focuses on the pathophysiology, diagnosis, and treatment of the various conditions that occur after correction of spinal deformity. Attention is given to recent literature specifically related to scoliosis surgery. Surgical complications like urinary tract infection, wound infection, and hardware failure will not be addressed.

Late superior mesenteric artery syndrome in paraplegia: case report and review

“…17 Under normal circumstances, retroperitoneal fat and lymphatic tissues serve as a cushion, holding the SMA o the spine and protecting the duodenum from compression by it. 5 The theory of fat providing protection of the duodenum explains why weight loss is a major risk factor of SMA syndrome. Furthermore, hyperextension of the spine with increased lumbar lordosis, prolonged supine position, or visceroptosis due to¯acid abdominal wall can favour SMA syndrome for anatomical reasons.…”

“…It is unlikely that correction of spine deformity in this patient caused the SMA syndrome. SMA syndrome has been described after acute reduction of the spinal curvature in scoliosis or hyper-kyphotic deformities, 5,21 when the spine was subjected to both high distraction forces and severe decreased thoracic kyphosis.…”

“…5 When the case is acute, a nasogastric tube must be inserted for gastric aspiration. Early correction of dehydration and prevention of electrolyte imbalance are necessary.…”

The acute surgical abdomen following Kyphoscoliosis corrective surgery

“…If the condition occurs a number of weeks after discharge and the patient presents at a different hospital in a toxic manor, the correct diagnosis may be delayed and result in gastric perforation. Investigations are limited to plain abdominal X-ray which usually shows grossly dilated stomach and fluid level; however, a contrast film series will invariably clinch it, 2,4,5,9 as typified by our case. The management of these patients relies on early recognition of clinical signs and instigation of swift conservative measures, NG tube, I.V.I.…”

Chylothorax in Infants and Children

“…2 It occurs as a postoperative complication after various surgeries involving structures in the neck and thorax. [39][40][41][42][43][44] Other surgeries that can be complicated by chylothorax in children include those for treatment of scoliosis, [45][46][47][48] vascular rings, 49,50 and diaphragmatic hernia. 51 In children, the reported incidence of chylothorax after cardiothoracic surgery is between 0.85% and 6.6%.…”