Scoliosis Surgery in Children With Neuromuscular Disease

Abstract

Background: Scoliosis is a frequent complication of pediatric neuromuscular disease (NMD). Scoliosis surgery in children with NMD is thought to carry greater morbidity and mortality. Objectives: To study demographics, comorbidities, outcomes, and hospitalization expenditures among children with NMD undergoing scoliosis surgery. Design: Using the Kids Inpatient Database, a large allpayer US database of hospital discharges among children and adults younger than 20 years, we studied children undergoing scoliosis surgery between January 1, 1997, and December 31, 2003. Continuous variables were compared by t test, and categorical variables were compared by Pearson product moment correlation 2 test. Setting: National database of pediatric hospital discharges. Patients: Children with and without NMD. Main Outcome Measures: Demographics, hospital length of stay, and in-hospital mortality associated with scoliosis surgery. Results: Of 17 780 reported hospitalizations owing to scoliosis surgery, 437 children (2.5%) had NMD. Compared with children undergoing scoliosis surgery for other indications, children with NMD were more likely to be younger (12.4 vs 14.2 years), male (73.5% vs 38.3%), and insured by Medicaid (35.6% vs 20.3%). Comorbidities that were more common among children with NMD included pulmonary complications (lung disease not classified, pulmonary collapse, pulmonary insufficiency, chronic respiratory failure, and ventilator requirement) and cardiovascular complications (cardiomyopathy, hypotension, and tachycardia). Scoliosis surgery in children with NMD was associated with increased hospital length of stay (10.3 vs 7.7 days) and hospitalization expenditures ($80 251 vs $62 154), and higher in-hospital mortality (1.6% vs 0.2%). Conclusion: Children with NMD have increased hospital length of stay and higher in-hospital mortality associated with scoliosis surgery, highlighting the need for further study of measures that could reduce complications and improve outcomes in this population.

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

“…Pulmonary complications are a prominent cause of morbidity and mortality in these high-risk patients [8,32], with complication rates as high as 39 % [14]. In the current review, the overall PR is 22.71 % with 97.8 % variability.…”

“…Recently, large database studies on complications of scoliosis surgery have been published [7,9,13,14]. Although these studies benefit from large patient populations, they might be prone to underreporting.…”

Patient Factors Are Associated With Poor Short-term Outcomes After Posterior Fusion for Adolescent Idiopathic Scoliosis

“…Patient BMI is calculated by height and weight and categorized according to CDC BMI-for-age charts [8]. Per CDC guidelines, pediatric patients with less than the fifth percentile BMIfor-age are categorized as underweight; patients with BMIfor-age greater than the eighty-fifth percentile are categorized as overweight; and patients with BMI-for-age greater than the ninety-fifth percentile are categorized as obese (Appendix 2) [3,4,14]. Of the comorbidities collected by the ACS NSQIP 1 , only a history of asthma occurred with sufficient frequency to be used for our analysis.…”

The feasibility and safety of using sublaminar polyester bands in hybrid spinal constructs in children and transitional adults for neuromuscular scoliosis

“…Although no cases of mortality are reported in most prior series, 4,[17][18][19][23][24][25] Barsdorf et al reported a mortality rate of 1.6% (7 of 437 cases) following surgery for neuromuscular scoliosis, based on the National Inpatient Sample between 1997 and 2003. 2 In an effort to assess for potential differences in the rates of new neurological deficit associated with type of instrumentation used, we assessed these rates in cases that used only a single type of instrumentation, specifically pedicle screws, anterior screws, hooks, or wires. Pedicle screw-only and hook-only constructs had comparable overall rates of new neurological deficits.…”