Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Abstract

BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications. AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries. METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed. RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries. CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

Does Implant-Related Complications Interfere with Correction in the Shilla Technique Performed to Treat Early Onset Scoliosis?

“…One of these methods, the Shilla technique is especially recommended as a method that guides growth by reducing the number of surgical interventions while facilitating the correction of the deformity [11,12]. The results and complication rates of EOS treatment have been reported in various studies [15,[20][21][22]. Reportedly, the Shilla procedure is a suitable option to treat EOS with different etiologies; however, this procedure is associated with moderate complication rates [12,20].…”

“…Children with EOS are prone to develop pulmonary complications after repeated anesthesia procedures. Difficult intubation may be observed more frequently especially in neuromuscular and snydromic cases [22]. Furthermore, the potentially harmful effects of frequent anesthesia exposure are not yet fully understood.…”

Relook into the Risk Factors of Proximal Junctional Kyphosis in Early Onset Scoliosis Patients: Does the Location of Upper Instrumented Vertebra in Relation to the Sagittal Apex Matter?

“… 3 , 4 , 5 However, the complication rate of GRs treatment is reported as high as 50%, including implant‐related complications, alignment‐related complications, and general complication. 6 , 7 , 8 , 9 …”

“…[3][4][5] However, the complication rate of GRs treatment is reported as high as 50%, including implant-related complications, alignment-related complications, and general complication. [6][7][8][9] Proximal junctional kyphosis (PJK) is the most common alignment-related complication in EOS patients after GRs treatment. Although the current definition of PJK is mainly the imaging manifestations, severe PJK may cause vertebra collapse, acute subluxation or implant failure around the upper instrumented vertebra (UIV), also known as proximal junctional failure.…”

“…In past decades, traditional growing rods (GRs) treatment has been widely applied in EOS patients because of its effectiveness in controlling the progression of spinal deformity while allowing the growth of the spine 3–5 . However, the complication rate of GRs treatment is reported as high as 50%, including implant‐related complications, alignment‐related complications, and general complication 6–9 …”