Perioperative complications and risk factors in neuromuscular scoliosis surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>High rates of perioperative complications are associated with deformity correction in neuromuscular scoliosis. The current study aimed to evaluate complications associated with surgical correction of neuromuscular scoliosis and to characterize potential risk factors.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Data were retrospectively collected from a single-center cohort of 102 consecutive patients who underwent spinal fusions for neuromuscular scoliosis between January 2008 and December 2016 and who had a minimum of 6 months of follow-up. A subgroup analysis was performed on data from patients who had at least 2 years of follow-up. Univariate and multivariate regression analyses, as well as binary correlational models and Student t-tests, were employed for further statistical analysis.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The present cohort had 53 boys and 49 girls with a mean age at surgery of 14.0 years (± 2.7 SD, range 7.5–19.5 years). The most prevalent diagnoses were cerebral palsy (26.5%), spinal cord injury (24.5%), and neurofibromatosis (10.8%). Analysis reflected an overall perioperative complication rate of 27% (37 complications in 27 patients), 81.1% of which constituted major complications (n = 30) compared to a rate of 18.9% for minor complications (n = 7). Complications were predicted by nonambulatory status (p = 0.037), increased intraoperative blood loss (p = 0.012), increased intraoperative time (p = 0.046), greater pelvic obliquity at follow-up (p = 0.028), and greater magnitude of sagittal profile at follow-up (p = 0.048). Pulmonary comorbidity (p = 0.001), previous operations (p = 0.013), history of seizures (p = 0.046), diagnosis of myelomeningocele (p = 0.046), increase in weight postoperatively (p &lt; 0.005), and increased lumbar lordosis at follow-up (p = 0.015) were identified as risk factors for perioperative infection.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>These results suggest that in neuromuscular scoliosis, patients with preexisting pulmonary compromise and greater intraoperative blood loss have the greatest risk of experiencing a major perioperative complication following surgical deformity correction.</jats:p></jats:sec>

Current concepts in neuromuscular scoliosis

“…Note that the screws are in line with the remainder of the fusion construct with a notable decrease in wound infections, respiratory complications, and implant-related complications. Toll et al [37] reviewed 102 patients and found a rate of complications of 27%. Eighty percent of those were considered major complications.…”

Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders

“…Owing to preexisting underlying diseases, as well as difficulties in the operation itself, patients with NMDs have more complications. According to Toll et al, 56 a 27% complication rate was reported among 102 patients, and nonambulatory status, pulmonary comorbidity, and history of seizure were the risk factors for complications. In addition, it was reported that a diagnosis of myelomeningocele and higher intraoperative blood loss were associated with a high risk of complications.…”

“…Generally, thoracolumbar deformity surgery in patients with NMDs is more likely to have higher complication rates than that in non-NMD patients. [56][57][58] Rumalla et al 57 reported an overall complication rate of 40.1% in patients undergoing fusion surgery out of 2,154 neuromuscular scoliosis patients between 2002 and 2011. In a review study of the Scoliosis Research Society Morbidity and Mortality database, Reames et al 59 reported that complications occurred in 1,971 cases out of a total of 19,360 cases (10.2%), including 6.3% in patients with idiopathic scoliosis, 10.6% in patients with congenital scoliosis, and 17.9% in patients with neuromuscular scoliosis, which was the highest complication rate.…”

“…In a review of 14 retrospective studies, Etame et al [ 55 ] reported mortality rates ranging from 3.1% to 6.7% and major medical complication rates ranging from 3.1% to 44.4% in 399 cervical deformity patients. Generally, thoracolumbar deformity surgery in patients with NMDs is more likely to have higher complication rates than that in non-NMD patients [ 56 - 58 ]. Rumalla et al [ 57 ] reported an overall complication rate of 40.1% in patients undergoing fusion surgery out of 2,154 neuromuscular scoliosis patients between 2002 and 2011.…”

Neuro-vaskuläre Komplikationen bei komplexen Korrektureingriffen − Ursachen, Prävention, Systemlösungen

“…Vornehmlich Ponte-Osteotomien u. SPO, seltener PSO u. VCR 0 -3 % Coe et al [95] Lonner et al [96] Kim et al [97] Koller [98] Finocchiaro [99] Kongenitale Skoliose Dorsale und/oder ventrale Fusion, Epiphyseodesen, VCR, Hemivertebra-Resektion, PSO, Distraktionsverfahren 0 -14 % Reames et al [14] Smith et al [15] Ayvaz et al [16] Kaspiris et al [17] Neuromuskuläre Skoliose Dorsale und dorsoventrale Fusion mit/ohne Pelvis-Einschluss 1,8 -16,7 % Rumalla et al [100] Turturro et al [101] Cognetti et al [102] Toll et al [103] Degenerative rigide Deformitäten (fixierte sagittale Imbalance, degenerative Skoliose)…”