Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years

Abstract

Purpose Our objectives were primarily to review the published literature on complications in neuromuscular scoliosis (NMS) surgery and secondarily, by means of a meta-analysis, to determine the overall pooled rates (PR) of various complications associated with NMS surgery. Methods PubMed and Embase databases were searched for studies reporting the outcomes and complications of NMS surgery, published from 1997 to May 2011. We focused on NMS as defined by the Scoliosis Research Society's classification. We measured the pooled estimate of the overall complication rates (PR) using a random effects meta-analytic model. This model considers both intra-and inter-study variation in calculating PR. Results Systematic review and meta-analysis were performed for 68 cohort and case-control studies with a total of 15,218 NMS patients. Pulmonary complications were the most reported (PR = 22.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability. In regard to surgical complications affiliated with various surgical techniques in NMS, the level of evidence of published literature ranges between 2? to 2-; the subsequent recommendations are level C. Conclusion NMS patients have diverse and high complication rates after scoliosis surgery. High PRs of complications warrant more attention from the surgical community. Although the PR of all complications are affected by heterogeneity, they nevertheless provide valuable insights into the impact of methodological settings (sample size), patient characteristics (age at surgery), and continual advances in patient care on complication rates.

Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database

“…23,29,31 The SRS M&M database has produced somewhat lower results of complications in the past when compared with other databases such as the NSQIP, but the studies that demonstrated these differences still validated the SRS M&M as a resource. 12,21,33,34,39 The differences in our results are possibly due to an underreporting of medical complications.…”

“…3,8,12,14,30,[33][34][35] One subgroup of scoliosis, neuromuscular scoliosis, has been associated with complication rates of more than 35% in recent studies, consistently higher than those of idiopathic scoliosis. 23,29,31 Neuromuscular scoliosis is an irregular spi-ABBREVIATIONS DVT = deep venous thrombosis; IONM = intraoperative neuromonitoring; M&M = Morbidity and Mortality; MRSA = methicillin-resistant Staphylococcus aureus; MSSA = methicillin-sensitive Staphylococcus aureus; NSQIP = National Surgical Quality Improvement Program; PE = pulmonary embolism; SRS = Scoliosis Research Society; SSI = surgical site infection; VTE = venous thromboembolism. …”

The management of scoliosis in children with cerebral palsy: a review

“…Complications have been reported to affect many body systems including respiratory, gastrointestinal and neurological. In a recent meta-analysis of complications following surgery for neuromuscular scoliosis, pulmonary complications were found to be most common (22.7%), followed by implant complications (12.5%) and infections (10.9%) (88). The authors suggested age at the time of surgery (<13 years) was associated with higher rates of neurological (15.1% compared to 3%) and pseudarthrosis (11.6% compared to 1.7%) (88).…”

“…In a recent meta-analysis of complications following surgery for neuromuscular scoliosis, pulmonary complications were found to be most common (22.7%), followed by implant complications (12.5%) and infections (10.9%) (88). The authors suggested age at the time of surgery (<13 years) was associated with higher rates of neurological (15.1% compared to 3%) and pseudarthrosis (11.6% compared to 1.7%) (88). No explanation of this association was offered, however younger, smaller patients may cause an increased difficulty in placement of instrumentation therefore increasing risk of neural injury and failure of fusion.…”

Neuromuscular Scoliosis in Children with Spinal Cord Injury

“…3,5,6 The secondary complications of neuromuscular scoliosis often include pelvic obliquity, skin breakdown, pulmonary compromise, and functional decline. 2 Because of the potentially devastating consequences of neuromuscular scoliosis on body functions and the high rate of complications associated with spine surgery for neuromuscular scoliosis, 7 treatment to prevent or slow the progression of neuromuscular scoliosis is a primary focus of the longitudinal care of children with SCI.…”