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Complications and Outcomes of Complex Spine Reconstructions in Poliomyelitis-Associated Spinal Deformities: A Single-Institution Experience

Godzik, Jakub BA*; Lenke, Lawrence G. MD*; Holekamp, Terrence MD, PhD; Sides, Brenda BS*; Kelly, Michael P. MD*

doi: 10.1097/BRS.0000000000000375
Deformity

Study Design. Retrospective case series.

Objective. To share our institutional experience with spinal reconstruction for deformity correction in patients with a history of poliomyelitis.

Summary of Background Data. Polio and postpolio syndrome are not uncommonly related to a paralytic spinal deformity. Limited modern data exist regarding outcomes and complications after spinal reconstruction in this population.

Methods. A clinical database was reviewed for patients undergoing spinal reconstruction for polio-associated spinal deformity at our institution from 1985 to 2012. Relevant demographic, medical, surgical, and postoperative information were collected from medical records and analyzed. Preoperative and last follow-up Scoliosis Research Society-22 Questionnaire scores were recorded.

Results. A total of 22 patients with polio who underwent surgical deformity correction were identified. Mean age was 49 years (range, 12–74 yr), and 15 patients (68%) were female. Preoperative motor deficit was present in 14 of 22 (64%) patients. All patients underwent instrumented spinal fusion (mean, 13 vertebral levels, range, 3–18). Ten (10/22, 45%) patients developed major complications, and 4 patients (4/22, 18%) developed new postoperative neurological deficits. Neurological monitoring yielded a 13% false-negative rate. At 2-year follow-up, 20 of 22 patients maintained an average coronal correction of 25° (33%, P = 0.001) and sagittal correction of 25° (34%, P = 0.003). Minimum 2-year follow-up data were available for 11 of 22 (50%) patients. At an average of 72 months of follow-up (range, 28–134 mo), the mean Scoliosis Research Society-22 Questionnaire pain subscore improved from a mean of 2.75 to 3.6 (P = 0.012); self-image from 2.8 to 3.7 (P = 0.041); function from 3.1 to 3.8 (P = 0.036); satisfaction from 2.1 to 3.9 (P = 0.08); and mental health from 3.7 to 4.5 (P = 0.115).

Conclusion. Spine reconstruction for poliomyelitis-associated deformity was associated with high complication rates (54%) and sometimes unreliable neurological monitoring data. Despite this, patients undergoing spine reconstructions had significantly improved outcome scores. These data may help surgeons to appropriately counsel this complicated patient population.

The authors present a retrospective case series of 22 patients with poliomyelitis undergoing spinal fusion for spinal deformity correction. Patients demonstrated improved subjective outcome scores and radiographical correction, despite a 54% complication rate.

From the Departments of *Orthopaedic Surgery and

Neurological Surgery, Washington University in St Louis, School of Medicine, St Louis, MO.

Address correspondence and reprint requests to Michael P. Kelly, MD, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave, Box 8233, St Louis, MO 63110; E-mail: kellymi@wudosis.wustl.edu

Acknowledgment date: August 8, 2013. First revision date: March 10, 2014. Acceptance date: April 4, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and TL1 TR000449 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, grants, royalties, travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins