Complications
In patients with adolescent idiopathic scoliosis (AIS), this complication is exceedingly rare. These patients do not generally develop cardiopulmonary difficulties that can be linked to the degree of curvature, although those with thoracic curvatures of >50° have been shown to demonstrate abnormalities on pulmonary function testing (PFTs) consistent with a pattern of restrictive lung disease. These abnormalities are rarely clinically significant.[55][81][82][83][84][85][87]
Some experts believe that only juvenile (or early onset) scoliosis has the potential for development of severe thoracic deformity leading to cardiopulmonary complications.[50][88]
The development of a postoperative wound infection following scoliosis surgery is relatively rare.
While the estimated incidence of infection after all spinal deformity surgery combined is approximately 2%, infection after surgery for AIS is believed to be much less than 1%.[2]
Routine radiographs are obtained at each follow-up visit to evaluate for pseudarthrosis and other postoperative complications that may develop.
With the use of modern surgical techniques and instrumentation, as well as the implementation of intraoperative neurological monitoring, the incidence of neurological injury during scoliosis surgery is very low.
Data from the SRS morbidity and mortality database estimate the rate of neurological injury for all patients undergoing spinal deformity correction, specifically for adolescent idiopathic scoliosis as 0.26% to 1.75 %, depending on surgical approach.[89]
Postoperative neurological deficit may be caused by traction injuries from correction of the deformity, direct injury during vertebral instrumentation, or hypoperfusion injury due to hypotensive anaesthetic techniques used to decrease the amount of intraoperative blood loss.
Routine radiographs are obtained at each follow-up visit to evaluate for pseudarthrosis and other postoperative complications that may develop.
The rate of pseudarthrosis, or failure of fusion, following surgical spinal arthrodesis varies, depending on the surgical approach, the type of instrumentation used, and other patient factors such as the presence of medical comorbidities, errors in bone metabolism, or the use of glucocorticoids.
Additionally, the reported incidence of this complication varies widely when comparing results of similar surgical techniques from different surgical centres and surgeons. Not all patients with a pseudarthrosis will develop symptoms; in a 5-year follow-up study on the treatment of main thoracic scoliosis with anterior thoracoscopic instrumentation, investigators identified radiographic evidence of fusion at 151 of 155 (97%) instrumented motion segments. Each of these 4 pseudarthroses occurred at a single level in 4 of the 25 patients who were included in the study. Therefore, the incidence of this particular complication in this patient group was 4 in 25, or 16%. Hardware failure with rod breakage was identified in 3 of these 4 patients. These 3 patients all had revision surgery with posterior instrumentation and fusion. The fourth patient remained asymptomatic and was managed by observation without activity modification.[90]
In a published review of 114 patients who underwent posterior spinal fusion with pedicle screw-only instrumentation for adolescent idiopathic scoliosis, investigators reported the identification of only one patient with a single-level pseudarthrosis.[91] While these data do follow a trend within the literature that this complication is more common with anterior fusion procedures, it is difficult to objectively compare the data given the number of uncontrolled variables between the two patient groups.
Fusion rates following surgery for AIS are much higher than those after adult spinal surgery.
Routine radiographs are obtained at each follow-up visit to evaluate for pseudarthrosis and other postoperative complications that may develop.
This complication is believed to be secondary to increased stress and mechanical load on vertebral segments adjacent to the area of fusion.
In severe cases, the kyphosis can lead to neurological deficits secondary to cord impingement at the level of the deformity.
It can be prevented or minimised by the careful selection of levels to incorporate into the fusion during the procedure.
Routine radiographs are obtained at each follow-up visit to evaluate for pseudarthrosis and other postoperative complications that may develop.
This phenomenon involves the progressive development of spinal deformity secondary to continued anterior vertebral growth following posterior spinal fusion and instrumentation in the immature spine.[28]
It can be prevented by performing an anterior spinal fusion (intervertebral) in conjunction with the posterior spinal fusion and instrumentation in at-risk patients, such as younger patients with a significant amount of remaining growth potential at the time of surgical arthrodesis.
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