Wound-Related Complication in Growth-Friendly Spinal Surgeries for Early-Onset Scoliosis—Literature Review

Abstract

Background: The treatment for early-onset scoliosis (EOS) is one of the most challenging for pediatric orthopedics. Surgical treatment is often necessary, and wound problems and surgical site infections (SSIs) are common, with potentially severe complications in these patients. The aim of the study was to review current literature according to this complication. Methods: PubMed, Cochrane Library, and Embase were systematically searched for relevant articles by two independent reviewers in January 2022. Every step of the review was done according to PRISMA guidelines. Results: A total of 3579 articles were found. Twenty four articles were included in this systematic review after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of wound-related problems (on average, 15.5%). Conclusion: The literature concerning the definitions, collection, and interpretation of data regarding EOS wound-related complications is often difficult to interpret. This causes problems in the comparison and analysis. Additionally, this observation indicates that data on the incidence of SSI may be underestimated. Awareness of the high rate of SSI of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

Minimally Invasive Controlled Growing Rods for the Surgical Treatment of Early-Onset Scoliosis—A Surgical Technique Video

“…If there are no effects of the conservative treatment and further progression of the spinal curvature exceeding a Cobb angle of 60–65 degrees, surgical treatment should be considered [ 1 , 3 , 4 ]. We have several options to choose from, such as SGRs, MCGRs, MICGRs, and vertical expandable prosthetic titanium ribs (VEPTRs); growth guidance systems, like Shilla; the Luque trolley technique; or newer concepts, like spring distraction systems for the dynamic growth guidance of early-onset scoliosis or vertebral body tethering [ 1 , 9 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The most appropriate technique should be selected for the curve and the patient.…”

“…The most appropriate technique should be selected for the curve and the patient. According to our many years of experience, to minimize complications, the procedure should be as minimally invasive as possible and performed as late as possible, i.e., surgical treatment should be postponed as long as possible because of the complication rate [ 8 , 9 , 10 , 15 , 16 ]. Growing rods, inserted through a less-invasive incision, correct the spinal curvature by initially distracting the spine; they then maintain the resulting correction of the deformity by controlling both the spinal curvature and growth and promoting growth with further non-invasive extensions of the internal fixator.…”

“…Metallosis resulting from the use of MCGRs appears to be of significant clinical importance, and, therefore, the product registration requires the replacement of MCGR rods 2 years after the primary implantation, which is not the case with MICGRs [ 7 , 8 , 14 , 15 , 16 , 17 , 24 ]. Replacement every 2 years increases the number of surgeries that are performed, which may increase the risks of spontaneous spondylodesis and infection [ 7 , 8 , 9 , 14 , 15 , 16 , 17 , 24 ]. The use of MICGRs is a new alternative to both SGRs and MCGRs.…”

“…When the curvature continues to progress and exceeds a Cobb angle of more than 60–65 degrees, surgical treatment should be considered [ 3 , 4 , 6 ]. It is known from data in the literature that the earlier the surgical treatment is performed, the more complications one can expect during the entire treatment process [ 7 , 8 , 9 , 10 ]. The most common treatment procedure for EOS is the surgical correction of the deformity using distraction-based systems, such as standard growing rods (SGRs), and in some cases of congenital defects with additional hemivertebrae, the treatment is the resection of the hemivertebra and short fusion [ 10 , 11 ].…”

Retrospective Analysis of FED Method Treatment Results in 11–17-Year-Old Children with Idiopathic Scoliosis

“…These two examinations differ from each other but should complement each other. Carrying out diagnostic activities on various grounds results in better control of scoliotic deformation progressing to impaired quality of life or to surgery, which often causes complications, and which we would like to avoid in the treatment of patients with idiopathic scoliosis [ 26 ].…”