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Risk Factors for Complications Associated With Growing-Rod Surgery for Early-Onset Scoliosis

Watanabe, Kota MD*; Uno, Koki MD; Suzuki, Teppei MD; Kawakami, Noriaki MD, DMSc; Tsuji, Taichi MD; Yanagida, Haruhisa MD§; Ito, Manabu MD; Hirano, Toru MD; Yamazaki, Ken MD**; Minami, Shohei MD††; Kotani, Toshiaki MD††; Taneichi, Hiroshi MD‡‡; Imagama, Shiro MD§§; Takeshita, Katsushi MD¶¶; Yamamoto, Takuya MD‖‖; Matsumoto, Morio MD***

doi: 10.1097/BRS.0b013e318288671a

Study Design. A retrospective multicenter study.

Objective. To identify risk factors for postoperative complications associated with growing-rod (GR) surgery for early-onset scoliosis (EOS).

Summary of Background Data. Results and complications of GR surgery for EOS have not been adequately studied.

Methods. We evaluated clinical and radiographical results from 88 patients with EOS who underwent GR surgery in 12 spine centers in Japan. The mean age at the time of initial surgery was 6.5 ± 2.2 years (range, 1.5–9.8 yr) and the mean follow-up period was 3.9 ± 2.6 years (range, 2.0–12.0 yr). Risk factors for postoperative complications were analyzed using binomial multiple logistic regression analysis. We considered the potential factors of sex, age, number of rod-lengthening procedures, whether a pedicle screw foundation was used, the uppermost level of the proximal foundation and lowermost level of the distal foundation, Cobb angles of the proximal thoracic, main thoracic, and lumbar curves, and the kyphosis angles in the proximal, main thoracic, thoracolumbar, and lumbar spine. Kaplan-Meier analysis was used to determine the complication-free survival rate of GR surgery as a function of the number of surgical procedures.

Results. Complications affected 50 of the patients (57%) and were associated with 119 of 538 surgical procedures, with 86 implant-related failures (72%), 19 infections (16%), 3 neurological impairments (3%), and 11 other complications. The most frequent implant-related failure was dislodged implant (71%) and 95% of the dislodgements occurred at the proximal foundation. Kaplan-Meier analysis demonstrated a linear decrease in complication-free rates as the number of rod-lengthening procedures increased. Binomial multiple logistic regression analysis found the following significant independent risk factors: 6 or more rod-lengthening procedures (odds ratio [OR], 6.534), an increase of every 20° in the proximal thoracic Cobb angle (OR, 3.091), and an increase of every 25° in the lumbar lordosis angle (OR, 2.607) in the preoperative condition.

Conclusion. Increases in the upper thoracic scoliotic curve, thoracic kyphosis, and number of rod-lengthening procedures are positively associated with an increased risk of complications after GR surgery for EOS.

Level of Evidence: 4

Eighty-eight patients who underwent growing-rod surgery for early-onset scoliosis were evaluated for identifying independent risk factors for postoperative complications. The risk factors included an increase of every 20° in the proximal thoracic Cobb angle, an increase of every 20° in the thoracic kyphosis angle, and 6 or more rod-lengthening procedures.

*Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan

Department of Orthopedic Surgery, National Hospital Organization, Kobe Medical Center, Hyogo, Japan

Department of Orthopedic Surgery, Meijo Hospital, Nagoya, Japan

§Department of Orthopedic Surgery, Fukuoka Children's Hospital, Fukuoka, Japan

Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Hokkaido, Japan

Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan

**Department of Orthopedic Surgery, Iwate Medical University, Morioka, Japan

††Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan

‡‡Department of Orthopedic Surgery, Dokkyo Medical University School of Medicine, Tochigi, Japan

§§Department of Orthopedic Surgery, Nagoya University, Aichi, Japan

¶¶Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan

‖‖Department of Orthopedic Surgery, Kagoshima University, Kagoshima, Japan; and

***Department of Orthopedic Surgery, Keio University, Tokyo, Japan.

Address correspondence and reprint requests to Morio Matsumoto, MD, Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan; E-mail:

The legal regulatory status of the device(s)/drug(s) that is/are the subject of this manuscript is not applicable in my country.

Health and Labour Sciences Research Grant funds were received to support this work.

Relevant financial activities outside the submitted work: consultancy.

© 2013 Lippincott Williams & Wilkins, Inc.