Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Reviews in Musculoskeletal Medicine
Published in: Current Reviews in Musculoskeletal Medicine 4/2016

01-12-2016 | Pediatric Orthopedics (B Heyworth, Section Editor)

Complications following spine fusion for adolescent idiopathic scoliosis

Authors: Robert F. Murphy, James F. Mooney III

Published in: Current Reviews in Musculoskeletal Medicine | Issue 4/2016

Login to get access

Abstract

Complications following spine fusion for adolescent idiopathic scoliosis can be characterized as either intra-operative or post-operative. The most serious and feared complication is neurologic injury, both in the intra- and post-operative period. Other intra-operative complications include dural tears and ophthalmologic or peripheral nerve deficits, which may be related to positioning. Among the most common post-operative complications are surgical site infection, venous thromboembolism, gastrointestinal complications, and implant-related complications. Significant blood loss requiring transfusion, traditionally considered a known sequelae of spine fusion, is now being recognized as a “complication” in large national databases. Pediatric spine surgeons who care for patients with AIS must be thoroughly familiar with all potential complications and their management.
Literature
1.
Rogala EJ, Drummond DS, Scoliosis GJ. incidence and natural history. A prospective epidemiological study. J Bone Joint Surg Am. 1978;60:173–6.CrossRefPubMed
2.
Soucacos PN, Soucacos PK, Zacharis KC, Beris AE, Xenakis TA. School-screening for scoliosis. A prospective epidemiological study in northwestern and central Greece. J Bone Joint Surg Am. 1997;79:1498–503.CrossRefPubMed
3.
Montgomery F, Willner S. The natural history of idiopathic scoliosis. Incidence of treatment in 15 cohorts of children born between 1963 and 1977. Spine. 1997;22:772–4.CrossRefPubMed
4.
Weinstein SL, Zavala DC, Ponseti IV. Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients. J Bone Joint Surg Am. 1981;63:702–12.CrossRefPubMed
5.
Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV. Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study. Jama. 2003;289:559–67.CrossRefPubMed
6.
Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983;65:447–55.CrossRefPubMed
7.
Coe JD, Arlet V, Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine. 2006;31:345–9.CrossRefPubMed
8.•
Vigneswaran HT, Grabel ZJ, Eberson CP, Palumbo MA, Daniels AH. Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. J Neurosurg Pediatr. 2015;16:322–8. Recent paper detailing increasing rates of fusion for AIS, as well as increasing rates of complications. Increasing complication rate likely due to reporting of blood transfusion as a complication.CrossRefPubMed
9.•
Reames DL, Smith JS, Fu KM, et al. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine. 2011;36:1484–91. Most recent SRS M&M data on complications in pediatric idiopathic scoliosis. Does not delinate between infantile, juvenile, or adolescent cases.CrossRefPubMed
10.
Carreon LY, Puno RM, Lenke LG, et al. Non-neurologic complications following surgery for adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2007;89:2427–32.PubMed
11.
Lykissas MG, Jain VV, Nathan ST, et al. Mid- to long-term outcomes in adolescent idiopathic scoliosis after instrumented posterior spinal fusion: a meta-analysis. Spine. 2013;38:E113–9.CrossRefPubMed
12.
Martin CT, Pugely AJ, Gao Y, Weinstein SL. Causes and risk factors for 30-day unplanned readmissions after pediatric spinal deformity surgery. Spine. 2015;40:238–46.CrossRefPubMed
13.
Jain A, Puvanesarajah V, Menga EN, Sponseller PD. Unplanned Hospital Readmissions and Reoperations After Pediatric Spinal Fusion Surgery. Spine. 2015;40:856–62.CrossRefPubMed
14.
MacEwen GD, Bunnell WP, Sriram K. Acute neurological complications in the treatment of scoliosis. A report of the Scoliosis Research Society. J Bone Joint Surg Am. 1975;57:404–8.CrossRefPubMed
15.
Smith JT, Johnston C, Skaggs D, Flynn J, Vitale M. A New Classification System to Report Complications in Growing Spine Surgery: A Multicenter Consensus Study. J Pediatr Orthop. 2015;35:798–803.CrossRefPubMed
16.
Wilber RG, Thompson GH, Shaffer JW, Brown RH, Nash Jr CL. Postoperative neurological deficits in segmental spinal instrumentation. A study using spinal cord monitoring. J Bone Joint Surg Am. 1984;66:1178–87.CrossRefPubMed
17.
18.
Hamilton DK, Smith JS, Sansur CA, et al. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: a report of the scoliosis research society morbidity and mortality committee. Spine. 2011;36:1218–28.CrossRefPubMed
19.
Diab M, Smith AR, Kuklo TR. Spinal Deformity Study G. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine. 2007;32:2759–63.CrossRefPubMed
20.
Qiu Y, Wang S, Wang B, Yu Y, Zhu F, Zhu Z. Incidence and risk factors of neurological deficits of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution. Spine. 2008;33:519–26.CrossRefPubMed
21.
Schwartz DM, Drummond DS, Hahn M, Ecker ML, Dormans JP. Prevention of positional brachial plexopathy during surgical correction of scoliosis. J Spinal Disord. 2000;13:178–82.CrossRefPubMed
22.
Kamel I, Barnette R. Positioning patients for spine surgery: Avoiding uncommon position-related complications. World journal of orthopedics. 2014;5:425–43.CrossRefPubMedPubMedCentral
23.
Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery. J Bone Joint Surg Am. 2007;89:2440–9.PubMed
24.
Vitale MG, Moore DW, Matsumoto H, et al. Risk factors for spinal cord injury during surgery for spinal deformity. J Bone Joint Surg Am. 2010;92:64–71.CrossRefPubMed
25.•
Michael G. Vitale M, MPH, David L. Skaggs, MD, Gregory I. Pace, BA, Margaret L. Wright, BS, Hiroko Matsumoto, MAcorrespondenceemail, Richard C.E. Anderson, MD, Douglas L. Brockmeyer, MD, John P. Dormans, MD, John B. Emans, MD, Mark A. Erickson, MD, John M. Flynn, MD, Michael P. Glotzbecker, MD, Kamal N. Ibrahim, MD, Stephen J. Lewis, MD, Scott J. Luhmann, MD, Anil Mendiratta, MD, B. Stephens Richards III, MD, James O. Sanders, MD, Suken A. Shah, MD, John T. Smith, MD, Kit M. Song, MD, Paul D. Sponseller, MD, Daniel J. Sucato, MD, MS, David P. Roye, MD, Lawrence G. Lenke, MD. Best practices in intraoperative neuromonitoring in spine deformity surgery: development of an intraoperative checklist to optimize response. Spine Deformity. 2014;2:333–9. Provides an intra-operative checklist for situations involving neuromonitoring changes.
26.•
Mooney 3rd JF, Bernstein R, Hennrikus Jr WL, MacEwen GD. Neurologic risk management in scoliosis surgery. J Pediatr Orthop. 2002;22:683–9. Expert opinion regarding management of all aspects of neurologic risk in scoliosis surgery, including preoperative evaluation, intraoperative management, and postoperative counseling.
27.
Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine. 2010;35:E465–70.CrossRefPubMed
28.
Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in spinal deformities: are they really safe? Spine. 2001;26:2049–57.CrossRefPubMed
29.
Di Silvestre M, Parisini P, Lolli F, Bakaloudis G. Complications of thoracic pedicle screws in scoliosis treatment. Spine. 2007;32:1655–61.CrossRefPubMed
30.
Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA. Visual loss as a complication of spine surgery. A review of 37 cases. Spine. 1997;22:1325–9.CrossRefPubMed
31.
Patil CG, Lad EM, Lad SP, Ho C, Boakye M. Visual loss after spine surgery: a population-based study. Spine. 2008;33:1491–6.CrossRefPubMed
32.
Mirovsky Y, Neuwirth M. Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine. 2000;25:1266–9.CrossRefPubMed
33.
Auerbach JD, Kean K, Milby AH, et al. Delayed postoperative neurologic deficits in spinal deformity surgery. Spine. 2015
34.
Chang JH, Hoernschemeyer DG, Sponseller PD. Delayed postoperative paralysis in adolescent idiopathic scoliosis: management with partial removal of hardware and staged correction. J Spinal Disord Tech. 2006;19:222–5.CrossRefPubMed
35.
Dapunt UA, Mok JM, Sharkey MS, Davis AA, Foster-Barber A, Diab M. Delayed presentation of tetraparesis following posterior thoracolumbar spinal fusion and instrumentation for adolescent idiopathic scoliosis. Spine. 2009;34:E936–41.CrossRefPubMed
36.
Croft LD, Pottinger JM, Chiang HY, Ziebold CS, Weinstein SL, Herwaldt LA. Risk factors for surgical site infections after pediatric spine operations. Spine. 2015;40:E112–9.CrossRefPubMed
37.
Mackenzie WG, Matsumoto H, Williams BA, et al. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am. 2013;95:800–6. S1-2.CrossRefPubMed
38.•
Glotzbecker MP, Riedel MD, Vitale MG, et al. What’s the evidence? Systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery. J Pediatr Orthop. 2013;33:479–87. Excellent systematic review of risk factors for infection following pediatric spine surgery.CrossRefPubMed
39.•
Subramanyam R, Schaffzin J, Cudilo EM, Rao MB, Varughese AM. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery. The spine journal : official journal of the North American Spine Society. 2015;15:1422–31. Excellent systematic review of risk factors for infection following pediatric spine surgery.CrossRef
40.
Aleissa S, Parsons D, Grant J, Harder J, Howard J. Deep wound infection following pediatric scoliosis surgery: incidence and analysis of risk factors. Canadian journal of surgery Journal canadien de chirurgie. 2011;54:263–9.CrossRefPubMedPubMedCentral
41.
Labbe AC, Demers AM, Rodrigues R, Arlet V, Tanguay K, Moore DL. Surgical-site infection following spinal fusion: a case–control study in a children’s hospital. Infect Control Hosp Epidemiol. 2003;24:591–5.CrossRefPubMed
42.•
Ho C, Skaggs DL, Weiss JM, Tolo VT. Management of infection after instrumented posterior spine fusion in pediatric scoliosis. Spine. 2007;32:2739–44. Large series of patients with postoperative infections detailing a nearly a 50 % chance that infection cannot be eradicated without the removal of implants.
43.
Rihn JA, Lee JY, Ward WT. Infection after the surgical treatment of adolescent idiopathic scoliosis: evaluation of the diagnosis, treatment, and impact on clinical outcomes. Spine. 2008;33:289–94.CrossRefPubMed
44.
Richards BR, Emara KM. Delayed infections after posterior TSRH spinal instrumentation for idiopathic scoliosis: revisited. Spine. 2001;26:1990–6.CrossRefPubMed
45.
Richards BS. Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am. 1995;77:524–9.CrossRefPubMed
46.
Ho C, Sucato DJ, Richards BS. Risk factors for the development of delayed infections following posterior spinal fusion and instrumentation in adolescent idiopathic scoliosis patients. Spine. 2007;32:2272–7.CrossRefPubMed
47.
Hedequist D, Haugen A, Hresko T, Emans J. Failure of attempted implant retention in spinal deformity delayed surgical site infections. Spine. 2009;34:60–4.CrossRefPubMed
48.
Di Silvestre M, Bakaloudis G, Lolli F, Giacomini S. Late-developing infection following posterior fusion for adolescent idiopathic scoliosis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2011;20 Suppl 1:S121–7.CrossRef
49.
Canavese F, Gupta S, Krajbich JI, Emara KM. Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis. J Bone Joint Surg. 2008;90:377–81.CrossRef
50.•
Vitale MG, Riedel MD, Glotzbecker MP, et al. Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop. 2013;33:471–8. Consensus statement from group of experience pediatric spine surgeons detailing best practices for minimizing risk of surgical site infection in high risk pediatric spine surgery.
51.
Yoshioka K, Murakami H, Demura S, Kato S, Tsuchiya H. Prevalence and risk factors for development of venous thromboembolism after degenerative spinal surgery. Spine. 2015;40:E301–6.CrossRefPubMed
52.
53.
Jain A, Karas DJ, Skolasky RL, Sponseller PD. Thromboembolic complications in children after spinal fusion surgery. Spine. 2014;39:1325–9.CrossRefPubMed
54.
55.
56.
Yuan N, Fraire JA, Margetis MM, Skaggs DL, Tolo VT, Keens TG. The effect of scoliosis surgery on lung function in the immediate postoperative period. Spine. 2005;30:2182–5.CrossRefPubMed
57.
Lam SK, Pan IW, Harris DA, Sayama CM, Luerssen TG, Jea A. Patient-, procedure-, and hospital-related risk factors of allogeneic and autologous blood transfusion in pediatric spinal fusion surgery in the United States. Spine. 2015;40:560–9.CrossRefPubMed
58.
Linam WM, Margolis PA, Staat MA, et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure. Infect Control Hosp Epidemiol. 2009;30:109–16.PubMed
59.
Ledonio CG, Polly Jr DW, Vitale MG, Wang Q, Richards BS. Pediatric pedicle screws: comparative effectiveness and safety: a systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America task force. J Bone Joint Surg Am. 2011;93:1227–34.CrossRefPubMed
60.
Botolin S, Merritt C, Erickson M. Aseptic loosening of pedicle screw as a result of metal wear debris in a pediatric patient. Spine. 2013;38:E38–42.CrossRefPubMed
61.
Soultanis K, Pyrovolou N, Karamitros A, Konstantinou V, Liveris J, Soucacos PN. Instrumentation loosening and material of implants as predisposal factors for late postoperative infections in operated idiopathic scoliosis. Stud Health Technol Inform. 2006;123:559–64.PubMed
62.
Soultanis KC, Pyrovolou N, Zahos KA, et al. Late postoperative infection following spinal instrumentation: stainless steel versus titanium implants. J Surg Orthop Adv. 2008;17:193–9.PubMed
63.
Sheehan E, McKenna J, Mulhall KJ, Marks P, McCormack D. Adhesion of Staphylococcus to orthopaedic metals, an in vivo study. J Orthop Res. 2004;22:39–43.CrossRefPubMed
64.
Crawford HA, Pillai SB, Nair AK, Upadhyay V. Gastrointestinal morbidity following spinal surgery in children. Orthopaedic Proceedings. 2005;87:B:403.
65.
Smith JT, Smith MS. Does a preoperative bowel preparation reduce bowel morbidity and length of stay after scoliosis surgery? A randomized prospective study. J Pediatr Orthop. 2013;33:e69–71.CrossRefPubMed
66.
Hooten KG, Oliveria SF, Larson SD, Pincus DW. Ogilvie’s syndrome after pediatric spinal deformity surgery: successful treatment with neostigmine. J Neurosurg Pediatr. 2014;14:255–8.CrossRefPubMed
67.
Smith BG, Hakim-Zargar M, Thomson JD. Low body mass index: a risk factor for superior mesenteric artery syndrome in adolescents undergoing spinal fusion for scoliosis. J Spinal Disord Tech. 2009;22:144–8.CrossRefPubMed
68.
Lam DJ, Lee JZ, Chua JH, Lee YT, Lim KB. Superior mesenteric artery syndrome following surgery for adolescent idiopathic scoliosis: a case series, review of the literature, and an algorithm for management. J Pediatr Orthop B. 2014;23:312–8.CrossRefPubMed
Metadata
Title
Complications following spine fusion for adolescent idiopathic scoliosis
Authors
Robert F. Murphy
James F. Mooney III
Publication date
01-12-2016
Publisher
Springer US
Published in
Current Reviews in Musculoskeletal Medicine / Issue 4/2016
Electronic ISSN: 1935-9748
DOI
https://doi.org/10.1007/s12178-016-9372-5

Other articles of this Issue 4/2016

Current Reviews in Musculoskeletal Medicine 4/2016 Go to the issue

Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Pediatric anterior cruciate ligament reconstruction outcomes

Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Sources and quality of literature addressing femoroacetabular impingement: a scoping review 2011–2015

Pediatric Orthopedics (B Heyworth, Section Editor)

Anterior cruciate ligament reconstruction in skeletally immature patients

Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Outcomes following long head of biceps tendon tenodesis

Outcomes Research in Orthopedics (O Ayeni, Section Editor)

Radiographic outcomes reporting after arthroscopic management of femoroaceabular impingement: a systematic review

Pediatric Orthopedics (B Heyworth, Section Editor)

Lower extremity growth and deformity