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Risk Factors for Major Complications After Surgery for Neuromuscular Scoliosis

Master, Daniel L. MD; Son-Hing, Jochen P. MD, FRCS (C); Poe-Kochert, Connie RN, CNP; Armstrong, Douglas G. MD, FRCS (C); Thompson, George H. MD

doi: 10.1097/BRS.0b013e3181e193e9

Study Design. Retrospective, case series.

Objective. To determine the prevalence of major complications and to identify factors that increase the risk of complications in patients undergoing surgery for neuromuscular scoliosis.

Summary of Background Data. Complications after surgery for neuromuscular scoliosis are more prevalent than in idiopathic scoliosis. However, the associated risk factors have not been statistically significant.

Methods. Our computerized Pediatric Orthopedic Spine Database identified 131 consecutive patients with neuromuscular scoliosis, excluding those with myelodysplasia, who underwent surgery and had a minimum of 2 years of follow-up. Preoperative, intraoperative, and postoperative factors were analyzed for any association with major complications and length of stay using stepwise logistic and multiple regression analyses. Odds ratios were calculated for significant dichotomous variables, and receiver operator characteristic curves were created for significant continuous variables.

Results. There were 81 male and 50 female patients with a mean age at surgery of 13.4 years (range, 6–21 years). The majority of patients (n = 75) had cerebral palsy. Eighty-eight patients (67%) underwent posterior spinal fusion and segmental spinal instrumentation (only), whereas 43 patients (33%) underwent an anterior spinal fusion followed by a posterior spinal fusion with segmental spinal instrumentation. Seventy-seven patients (59%) were fused to the pelvis using the Galveston technique. The mean follow-up was 3.9 years (range, 2–16.9 years). There were 46 major complications in 37 patients (28% prevalence), including 2 deaths.

Nonambulatory status (P < 0.05) and preoperative curve magnitude (P < 0.01) were associated with an increased prevalence of major complications. Nonambulatory patients (n = 94) were almost 4 times more likely to have a major complication (odds ratio of 3.8, P < 0.05) in comparison with ambulatory patients. A preoperative major curve magnitude of ≥60° (P < 0.01) was the most accurate indicator for an increased risk for a major complication.

Conclusion. Nonambulatory status and a preoperative curve magnitude (≥60°) are directly associated with an increased risk for major complications and indirectly associated with increased length of stay. As such, we recommend operative intervention in neuromuscular scoliosis before curve progression to ≥60°. Level of Evidence. Level III.

Major complications associated with surgery for neuromuscular scoliosis occurred in 37 of 131 patients (28% prevalence). Factors associated with major complications included nonambulatory status and major curve magnitude of [mtequ]60[deg]. We recommend surgery before the deformity reaching this magnitude.

From the Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.

Address correspondence and reprint requests to George H. Thompson, MD, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106; E-mail:

Acknowledgment date: November 17, 2009. Revision date: March 2, 2010. Acceptance date: March 12, 2010.

The device(s)/drug(s) is/are FDA-approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.