Risk Factors for Major Complications After Surgery for Neuromuscular Scoliosis

Master, Daniel L.; Son-Hing, Jochen P.; Poe-Kochert, Connie; Armstrong, Douglas G.; Thompson, George H.

doi:10.1097/brs.0b013e3181e193e9

Cited by 121 publications

(96 citation statements)

References 22 publications

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“…The high risk of complications arises because of concurrent risk factors from disease pathology and its associated co-morbidities [7,11]. Patients with NMS have significantly higher rates of morbidity and mortality compared to other scoliosis etiologies [7].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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Section: Discussionmentioning

confidence: 99%

“…5,8 Master et al reported 46 major complications in 37 patients with neuromuscular scoliosis (28% prevalence), including 2 deaths, and concluded that a preoperative curve magnitude is directly associated with an increased risk for major complications. 8 Liang et al also found that preoperative Cobb angle correlated with postoperative pulmonary complications in patients with scoliosis with moderate or severe pulmonary dysfunction. 5 Consistent with the studies of Master et al and Liang et al, our study demonstrated that a preoperative major curve magnitude ≥ 80° was the most accurate predictor of an increased risk for a major complication, suggesting spinal fusion should be carefully considered in patients with scoliosis and surgically corrected CCMs whose preoperative major curve magnitude is greater than 80°.…”

Section: Discussionmentioning

confidence: 99%

Safety of surgical treatment for patients with scoliosis and surgically corrected congenital cardiac malformations: a comparison with patients with scoliosis and normal hearts

Liang

Ding

Chua

et al. 2013

PED

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Object The safety of spinal fusion has been poorly studied in children with surgically corrected congenital cardiac malformations (CCMs). The objective of this study was to evaluate the safety of spinal fusion in patients with CCMs following cardiac surgery. Methods A retrospective study was conducted on 32 patients with scoliosis who received surgical treatment for their CCMs (CCM group). Sixty-four age- and sex-matched patients with scoliosis and normal hearts who received spinal fusion served as the control group. These 2 groups were compared for demographic distribution, blood loss, transfusion requirements, and incidence of postoperative complications. Results The ages, curve pattern distributions, and number of levels fused were similar between the 2 groups before spinal fusion. Overall, a total of 7 patients in the CCM group (21.9%) and 5 (7.8%) in the control group had documented postoperative complications. The perioperative allogenic blood transfusion rate and mean red blood cell transfusion requirement in the CCM group were significantly higher than those found in patients in the control group (68.7% vs 28.1%, respectively, p = 0.000; and 2.68 ± 2.76 units/patient vs 0.76 ± 1.07 units/patient, respectively, p = 0.011). In the CCM group, a preoperative major curve magnitude ≥ 80° was the most accurate indicator of an increased risk for a major complication (p = 0.019), whereas no statistically significant correlation was noted between postoperative complications and age, type of congenital heart disease, operative duration, and estimated blood loss during the operation and transfusion. Conclusions Spinal fusion subsequent to prior cardiac surgery is relatively safe and effective in correcting the spinal deformity for patients with scoliosis and surgically corrected CCMs. A preoperative major curve magnitude ≥ 80° may be a risk factor in predicting postoperative complications in scoliotic patients with surgically corrected CCMs.

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“…Complications can include pseudarthrosis, deformity progression, hardware failure, wound breakdown, neurological deterioration, respiratory decompensation, and death. 8 The evolution of our technique for iliac screw placement, from direct palpation to an image-guided approach, was motivated by a desire to avoid extensive soft tissue dissection, decrease operative time, and decrease blood loss. The exclusive use of minimally invasive approaches for the placement of iliac screws engenders significant difficulties in connecting the iliac instrumentation to complex 3D constructs beneath the fascia.…”

Section: Discussionmentioning

confidence: 99%

Iliac screw placement in neuromuscular scoliosis using anatomical landmarks and uniplanar anteroposterior fluoroscopic imaging with postoperative CT confirmation

Gressot

Patel

Hwang

et al. 2014

PED

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Object Neuromuscular scoliosis is a challenging pathology to treat. Surgical correction can involve long fusion constructs extending to the pelvis. The deformity inherent in these patients makes it difficult to obtain adequate lateral intraoperative radiographs for traditional image-guided placement of iliac screws. Methods A clinical and radiographic assessment of 14 patients with neuromuscular spinal deformity was conducted. From 2007 to 2013, 12 of these patients (mean age 14.25 years, range 10–20 years) underwent long spinal instrumentation (mean 15 levels, range 10–18 levels) and fusion to the pelvis, and 2 underwent placement of a growing rod construct with iliac screw placement at a single institution. The average length of follow-up was 33.7 months (range 6–64 months). Iliac screws were placed after identifying the posterior superior iliac spine and using only anteroposterior fluoroscopy (view of the inlet of the pelvis), rather than the technique of direct palpation of the sciatic notch. The accuracy of iliac screw placement was assessed with routine postoperative CT. Results A total of 12 patients had 24 screws placed as part of a long-segment fusion to the pelvis, and 2 patients had two iliac screws placed as part of a growing rod construct for neuromuscular scoliosis. There were no iliac screw misplacements, and no complications directly related to the technique of iliac screw placement. For cases of definitive fusion (n = 12), the average coronal Cobb angle of patients with neuromuscular spinal deformity measured 62° before surgery and 44.3° immediately after surgery. The average preoperative thoracic kyphosis and lumbar sagittal lordosis measured 37.3° and 60.7°, respectively. Immediately after surgery, the thoracic and lumbar angles measured 30° and 41.1°, respectively. At last follow-up, the average coronal Cobb angle was maintained at 45.1°, and the thoracic and lumbar sagittal angles were maintained at 32.8° and 45.3°, respectively. Conclusions A less invasive technique for iliac screw placement can be performed safely with a low likelihood of screw misplacement. This technique offers the biomechanical advantages of iliac fixation without the soft tissue exposure typically needed for safe screw insertion. The technique relies on identification of the posterior superior iliac spine and high quality anteroposterior fluoroscopic imaging for a view of the pelvic inlet.

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Risk Factors for Major Complications After Surgery for Neuromuscular Scoliosis

Cited by 121 publications

References 22 publications

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

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

Safety of surgical treatment for patients with scoliosis and surgically corrected congenital cardiac malformations: a comparison with patients with scoliosis and normal hearts

Iliac screw placement in neuromuscular scoliosis using anatomical landmarks and uniplanar anteroposterior fluoroscopic imaging with postoperative CT confirmation

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