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Morbidity and Mortality in the Surgical Treatment of Six Hundred Five Pediatric Patients With Isthmic or Dysplastic Spondylolisthesis

Fu, Kai-Ming G., MD, PhD*; Smith, Justin S., MD, PhD*; Polly, David W. Jr., MD; Perra, Joseph H., MD; Sansur, Charles A., MD§; Berven, Sigurd H., MD; Broadstone, Paul A., MD; Choma, Theodore J., MD**; Goytan, Michael J., MD††; Noordeen, Hilali H., MD‡‡,§§; Knapp, D. Raymond Jr., MD¶¶; Hart, Robert A., MD∥∥; Donaldson, William F. III, MD***; Boachie-Adjei, Oheneba, MD†††; Shaffrey, Christopher I., MD*

doi: 10.1097/BRS.0b013e3181cf3a1d
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Study Design. Retrospective analysis of prospectively collected database.

Objective. To analyze the rate of complications, includ­ing neurologic deficits, associated with operative treatment of pediatric isthmic and dysplastic spondylolisthesis.

Summary of Background Data. Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon dis­orders. Several prior studies have suggested a high rate of complication associated with operative intervention. How­ever, most of these studies were performed with sufficiently small sample sizes such that the presence of one complica­tion could significantly affect the overall rate. The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. This multicentered, multisurgeon database permits analysis of the surgi­cal treatment of this relatively rare condition on an aggre­gate scale and provides surgeons with useful information for preoperative counseling.

Methods. Patients who underwent surgical treatment for isthmic or dysplastic spondylolisthesis from 2004 to 2007 were identified from the SRS M&M database. Inclu­sion criteria for analysis included age ≤21 and a primary diagnosis of isthmic or dysplastic spondylolisthesis.

Results. Of 25,432 pediatric cases reported, there were a total of 605 (2.4%) cases of pediatric dysplastic (n ∇ 62, 10%) and isthmic (n ∇ 543, 90%) spondylolisthesis, with a mean age of 15 years (range, 4-21). Approximately 50% presented with neural element compression, and less than 1% of cases were revisions. Surgical procedures included fusions in 92%, osteotomies in 39%, and reduc­tions in 38%. The overall complication rate was 10.4%. The most common complications included postoperative neurologic deficit (n ∇ 31, 5%), dural tear (n ∇ 8, 1.3%), and wound infection (n ∇ 12, 2%). Perioperative deep venous thrombosis and pulmonary embolus were re­ported in 2 (0.3%) and 1 (0.2%) patients, respectively. There were no deaths in this series.

Conclusion. Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders, repre­senting only 2.4% of pediatric spine procedures in the present study. Even among experienced spine surgeons, surgical treatment of these spinal conditions is associated with a relatively high morbidity.

The authors analyzed the Scoliosis Research Society morbidity and mortality database for the 4 most recent years, with the purpose of quantifying the morbidity and mortality of operative intervention for pediatric isthmic and dysplastic spondylolisthesis. The present study fi nds a relatively high rate of overall complications. Patients undergoing reduction and/or with high grades of spondylolisthesis were more likely to suff er new neurologic defi cit after surgery.

From the *Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

Departments of Orthopedic Surgery and Neurosurgery, University of Minnesota, Minneapolis, MN

Twin Cities Spine Center, Minneapolis, MN

§Department of Neurosurgery, Univer­sity of Maryland Medical Center, Baltimore, MD

Department of Ortho­pedic Surgery, University of California—San Francisco, San Francisco, CA

Spine Surgery Associates, Chattanooga, TN

**Department of Or­thopedic Surgery, University of Missouri; Columbia, MO

††Health Sci­ences Centre, Winnipeg, Canada

‡‡The Royal National Orthopedic Hos­pital, London, United Kingdom

§§The Great Ormond Street Children's Hospital, London, United Kingdom

¶¶Arnold Palmer Children's Hospital, Orlando, FL

∥∥Department of Orthopedic Surgery, Oregon Health and Science University, Portland, OR

***Department of Orthopedic Sur­gery, University of Pittsburgh Physicians, Pittsburgh, PA

†††Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY

Address correspondence and reprint requests to Christopher I. Shaffrey, MD, Department of Neurosurgery, University of Virginia, PO Box 800212, Charlottesville, VA 22908; E-mail: CIS8Z@hscmail.mcc.virginia.edu

Acknowledgment date: October 15, 2009. Revision date: November 30, 2009. Acceptance date: December 1, 2009.

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

No funds were received in support of this work. One or more of the author(s) has/have received or will receive benefits for personal or pro­fessional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision making position.

© 2011 by Lippincott Williams & Wilkins