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Complications following surgical treatment of adolescent idiopathic scoliosis: a 10-year prospective follow-up study

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Abstract

Background

Accurate reporting of long-term complications of surgical treatment of adolescent idiopathic scoliosis (AIS) is critical, but incomplete. This study aimed to report on the rate of complications following surgical treatment of AIS among patients with at least 10 years of follow-up.

Methods

This was a retrospective review of prospectively collected data from a multicenter registry of patients who underwent surgical treatment for AIS with minimum 10-year follow-up. Previously published complications were defined as major if they resulted in reoperation, prolonged hospital stay/readmission, neurological deficits, or were considered life-threatening. Rates and causes of reoperations were also reviewed.

Results

Two hundred and eighty-two patients were identified with mean age at surgery of 14.6 ± 2.1 years. Mean follow-up was 10.6 (range 9.5–14) years. Eighty-seven patients had anterior spinal fusion (ASF); 195 had posterior spinal fusion (PSF). The overall major complication rate was 9.9% (n = 28) in 27 patients. Among PSF patients, the complication rate was 9.7% (n = 19) in 18 patients. The complications were surgical site infection (37%), adding-on (26%), pulmonary (16%), neurologic (11%), instrumentation (5%), and gastrointestinal (5%). In ASF patients, the complication rate was 10.3% (n = 9) among nine patients. The complications were pulmonary (44%), pseudoarthrosis (22%), neurologic (11%), adding-on (11%), and gastrointestinal (11%). The reoperation rate was 6.0% (n = 17) among 17 patients. Although most of the complications presented within the first 2 years (60.7%), surgical site infection and adding-on were also seen late into the 10-year period.

Conclusion

This is the largest prospective study with at least a 10-year follow-up of complications following spinal fusion for AIS, the overall major complication rate was 9.9% with a reoperation rate of 6.0%. Complications presented throughout the 10-year period, making long-term follow-up very important for surveillance.

Level of evidence

Therapeutic II.

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Availability of data and materials

Data are available upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

Harms Study Group Investigators: Aaron J. Buckland, MD, Royal Children’s Hospital–Melbourne Australia; Amer F. Samdani, MD, Shriners Hospitals for Children–Philadelphia; Amit Jain, MD, Johns Hopkins Hospital; Baron S. Lonner, MD, Mount Sinai Hospital; Benjamin D. Roye, MD, Columbia University; Burt Yaszay, MD, Rady Children’s Hospital; Chris Reilly, MD, BC Children’s Hospital; Daniel J. Hedequist, MD, Boston Children’s Hospital; Daniel J. Sucato, MD, Texas Scottish Rite Hospital; David H. Clements, MD, Cooper Bone & Joint Institute New Jersey; Firoz Miyanji, MD, BC Children’s Hospital; Harry L. Shufflebarger, MD, Paley Orthopedic & Spine Institute; John M. “Jack” Flynn, MD, Children’s Hospital of Philadelphia; Jahangir “John” Asghar, MD, Paley Orthopedic & Spine Institute; Jean-Marc Mac-Thiong, MD, CHU Sainte-Justine; Joshua M. Pahys, MD, Shriners Hospitals for Children–Philadelphia; Juergen Harms, MD, Klinikum Karlsbad–Langensteinbach, Karlsbad; Keith R. Bachmann, MD, University of Virginia; Lawrence G. Lenke, MD, Columbia University; Lori A. Karol, MD, Children’s Hospital, Denver Colorado; Mark F. Abel, MD, University of Virginia; Mark A. Erickson, MD, Children’s Hospital, Denver Colorado; Michael P. Glotzbecker, MD, Rainbow Children’s Hospital, Cleveland; Michael P. Kelly, MD, Washington University; Michael G. Vitale, MD, Columbia University; Michelle C. Marks, PT, MA, Setting Scoliosis Straight Foundation; Munish C. Gupta, MD, Washington University; Nicholas D. Fletcher, MD, Emory University; A. Noelle Larson, MD, Mayo Clinic Rochester Minnesota; Patrick J. Cahill, MD, Children’s Hospital of Philadelphia; Paul D. Sponseller, MD, Johns Hopkins Hospital; Peter G. Gabos, MD, Nemours Children’s Hospital, Delaware; Peter O. Newton, MD, Rady Children’s Hospital; Peter F. Sturm, MD, Cincinnati Children’s Hospital; Randal R. Betz, MD, Institute for Spine & Scoliosis; Stefan Parent, MD, CHU Sainte-Justine; Stephen G. George, MD, Nicklaus Children's Hospital; Steven W. Hwang, MD, Shriners Hospitals for Children–Philadelphia; Suken A. Shah, MD, Nemours Children’s Hospital, Delaware; Sumeet Garg, MD, Children’s Hospital, Denver Colorado; Thomas J. Errico, MD, Nicklaus Children's Hospital; Vidyadhar V. Upasani, MD, Rady Children’s Hospital.

Funding

The authors received study support from Setting Scoliosis Straight Foundation for the submitted work.

Author information

Authors and Affiliations

  1. Pediatric Orthopedics of Southwest Florida, Fort Myers, FL, USA

    Arun R. Hariharan

  2. Department of Orthopaedics, Nemours Children’s Hospital, Delaware, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Suken A. Shah

  3. Penn State College of Medicine, Hershey, PA, USA

    Joseph Petfield

  4. Nemours Children’s Hospital, Florida, Orlando, FL, USA

    Margaret Baldwin

  5. Seattle Children’s Hospital, Seattle, WA, USA

    Burt Yaszay

  6. Rady Children’s Hospital, San Diego, CA, USA

    Peter O. Newton

  7. Columbia University, New York, NY, USA

    Lawrence G. Lenke

  8. Mount Sinai Hospital, New York, NY, USA

    Baron S. Lonner

  9. BC Children’s Hospital, Vancouver, BC, Canada

    Firoz Miyanji

  10. Johns Hopkins Hospital, Baltimore, MD, USA

    Paul D. Sponseller

  11. Shriners Hospitals for Children, Philadelphia, Philadelphia, PA, USA

    Amer F. Samdani

Authors
  1. Arun R. Hariharan
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  2. Suken A. Shah
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  3. Joseph Petfield
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  4. Margaret Baldwin
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  5. Burt Yaszay
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  6. Peter O. Newton
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  7. Lawrence G. Lenke
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  8. Baron S. Lonner
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  9. Firoz Miyanji
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  10. Paul D. Sponseller
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  11. Amer F. Samdani
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Consortia

Harms Study Group

  • Aaron J Buckland
  • , Amer F Samdani
  • , Amit Jain
  • , Baron S Lonner
  • , Benjamin D Roye
  • , Burt Yaszay
  • , Chris Reilly
  • , Daniel J Hedequist
  • , Daniel J Sucato
  • , David H Clements
  • , Firoz Miyanji
  • , Harry L Shufflebarger
  • , John M. “Jack” Flynn
  • , Jahangir “John” Asghar
  • , Jean-Marc Mac-Thiong
  • , Joshua M Pahys
  • , Juergen Harms
  • , Keith R Bachmann
  • , Lawrence G Lenke
  • , Lori A Karol
  • , Mark F Abel
  • , Mark A Erickson
  • , Michael P Glotzbecker
  • , Michael P Kelly
  • , Michael G Vitale
  • , Michelle C Marks
  • , Munish C Gupta
  • , Nicholas D Fletcher
  • , A Noelle Larson
  • , Patrick J Cahill
  • , Paul D Sponseller
  • , Peter G Gabos
  • , Peter O Newton
  • , Peter F Sturm
  • , Randal R Betz
  • , Stefan Parent
  • , Stephen G George
  • , Steven W Hwang
  • , Suken A Shah
  • , Sumeet Garg
  • , Thomas J Errico
  •  & Vidyadhar V Upasani

Contributions

ARH: Conception or design of the work OR, Acquisition, analysis, or interpretation of data for the work OR, Drafting the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SAS: Conception or design of the work OR, Acquisition, analysis, or interpretation of data for the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JP: Acquisition, analysis, or interpretation of data for the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MB: Acquisition, analysis, or interpretation of data for the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BY: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PON: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LGL: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BSL: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. FM: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PDS: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AS: Conception or design of the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Harms: Conception or design of the work OR, Acquisition, analysis, or interpretation of data for the work OR, Revising the work critically for important intellectual content, Final approval of the version to be published, Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Suken A. Shah.

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Conflicts of interest

Authors ARH, JP, and MB have no relevant financial or non-financial interests to disclose. Author SAS reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and non-financial support from DePuy Synthes Spine, outside the submitted work. Author BY reports grants from Setting Scoliosis Straight, during the conduct of the study; grants and personal fees from Stryker, grants and personal fees from Nuvasive, grants and personal fees from Depuy Synthes, personal fees from Globus, personal fees from Orthopediatrics, personal fees from Medtronic, personal fees from Biogen, outside the submitted work. Author PON reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children's Specialists of San Diego, grants, personal fees and non-financial support from DePuy Synthes Spine, grants and other from Scoliosis Research Society, grants from EOS imaging, personal fees from Thieme Publishing, grants from NuVasive, other from Electrocore, other from International Pediatric Orthopedic Think Tank, grants, non-financial support and other from Orthopediatrics, grants, personal fees and non-financial support from Stryker K2M, grants and non-financial support from Alphatech, grants from Mazor Robotics, personal fees from Pacira, personal fees from Globus Medical, personal fees from Medtronic, outside the submitted work; In addition, Dr. Newton has a patent Anchoring systems and methods for correcting spinal deformities (8540754) with royalties paid to DePuy Synthes Spine, a patent Low profile spinal tethering systems (8123749) licensed to DePuy Spine, Inc., a patent posterior spinal fixation licensed to Stryker/K2M, and a patent posterior cervical fixation with royalties paid to Stryker/K2M. Author LGL reports personal fees from Medtronic, non-financial support from Broadwater, grants and non-financial support from Scoliosis Research Society, grants from EOS, grants from Setting Scoliosis Straight Foundation, other from Evans Family Donation, other from Fox Family Foundation, grants and non-financial support from AOSpine, personal fees from Abryx, personal fees from EOS Technologies, personal fees from Acuity Surgical. Author BSL reports grants from Grant from DePuy Synthes to Setting Scoliosis Straight Foundation in Support of Harms Study Group, personal fees and non-financial support from Depuy Synthes, personal fees from Zimmer Biomet, personal fees and non-financial support from ApiFix, other from Spine Search, other from Paradigm Spine, other from SRS Spine Deformity Journal, outside the submitted work. Author FM reports grants from Setting Scoliosis Straight Foundation, personal fees from Depuy Synthes Spine, personal fees from Stryker Spine, personal fees from Zimmer Biomet, personal fees from Orthopediatrics, outside the submitted work. Author PDS reports personal fees from DePuy Synthes Spine, personal fees from Globus, personal fees from Pacira, personal fees from Orthopediatrics, personal fees from JBJS, outside the submitted work. Author AFS reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from Medical Device Business Services, personal fees from Mirus, personal fees from NuVasive, personal fees from Orthofix, personal fees from Stryker, personal fees from Zimmer Biomet, outside the submitted work. Author HSG reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study: SSSF receives funding from DePuy Synthes Spine, EOS imaging, K2M, Medtronic, NuVasive, Zimmer Biomet and the FDA in support of Harms Study Group research; grants and other from Setting Scoliosis Straight Foundation: SSSF received educational grants from Orthopediatrics, Mazor Robotics, Stryker, Ellipse, Globus & SpineGuard, to support Setting Scoliosis Straight educational activities.

Ethics approval

Approval was obtained from the Nemours Institutional Review Board. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Not applicable.

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Not applicable.

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The members of the Harms Study Group are mentioned in the Acknowledgements section.

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Hariharan, A.R., Shah, S.A., Petfield, J. et al. Complications following surgical treatment of adolescent idiopathic scoliosis: a 10-year prospective follow-up study. Spine Deform 10, 1097–1105 (2022). https://doi.org/10.1007/s43390-022-00508-6

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  • DOI: https://doi.org/10.1007/s43390-022-00508-6

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