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.

Significant, but less than "perfect" correlations were observed between the radiographic, cosmetic measures and patient-rated outcomes. Thoracic AV-CSVL, AV-T1 correction and POTSI associated significantly with SRS-30 scores. Whereas, thoracic Cobb angle, Cobb correction, and coronal balance did not correlate with any patient-rated outcome measure. It is, therefore, inferred that the patients-rated subjective outcomes are only poorly reflected by the objectively measured radiographic and cosmetic measures of deformity correction.

Radiographic indices can only minisculely (r≤0.7) reflect cosmetic deformity in Lenke 1C scoliosis, which emphasizes not only the vulnerability of overreliance on radiographic indices but also the vital importance of clinical cosmetic evaluations. In particular, cosmetic shoulder height and angle are not represented by radiographic indices. However, radiograph trunk shift was significantly associated with cosmetic trunk shift in cosmetic pictures.

The use of PVP as a therapeutic alternative for the treatment of VCFs in patients with GIOP is still controversial. As seen in our case, even when the management decisions were made in consideration of the patient's pulmonary infection, the outcome was disastrous with the cluster phenomenon of vertebral refractures. Current findings suggest a compelling need for high-quality studies investigating cement augmentation procedures in patients with VCF with GIOP.

<p class="abstract"><strong>Background:</strong> Pediatric tracheostomy has always been more challenging due to varoius factors. The present study was carried out to assess various indications, complications and outcomes of pediatric tracheostomy.</p><p class="abstract"><strong>Methods:</strong> It was a prospective observational study in a tertiary care teaching hospital conducted over four years. Observations were recorded in form of indication, any surgical challenge, complications and postoperative follow up.  </p><p class="abstract"><strong>Results:</strong> Total 29 tracheostomies done in patients less than 12 years were included in the study. Majority of cases were infants (86%). Majority of patients were tracheostomised for lower respiratory infective cause who required prolonged ventilatory support (35%) followed by neurological cause (31%), obstructive cause (24%) and head injury (10%). Two most common complications were tube blockage (10%) and peristomal granulations (10%) which were suitably addressed. There has been no tracheostomy related mortality in the present study. All the patients who were considered for decannulation underwent check endoscopy. Out of 29 patients, 6 patients were lost in follow up. Out of the remaining, decannulation was successful in 16 patients (76%).</p><p class="abstract"><strong>Conclusions:</strong> Pediatric tracheostomies with better care facilities and trained team, there are fewer complications and higher rates of decannulation. The average age of children undergoing tracheostomy has come down. There is changing trends in the indications of tracheostomies from infective causes to causes requiring prolonged ventilation. The complication rates have declined with proper decannulation protocol.</p>