The Journal of Bone and Joint Surgery (American). 2007;89:2427-2432.
doi:10.2106/JBJS.F.00995
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Non-Neurologic Complications Following Surgery for Adolescent Idiopathic Scoliosis

Leah Y. Carreon, MD, MSc1, Rolando M. Puno, MD1, Lawrence G. Lenke, MD2, B. Stephen Richards, MD3, Daniel J. Sucato, MD, MS3, John B. Emans, MD4 and Mark A. Erickson, MD5

1 Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40202. E-mail address for L.Y. Carreon: lcarreon{at}spinemds.com
2 Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110
3 UT Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390
4 Department of Orthopaedic Surgery, Children's Hospital Boston, 300 Longwood Avenue, Fegan 2, Boston, MA 02115
5 Children's Hospital, 1056 East 19th Avenue, Denver, CO 80218

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Medtronic Sofamor Danek. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 (Medtronic Sofamor Danek) and less than $10,000 (Synthes) or a commitment or agreement to provide such benefits from these commercial entities. Also, a commercial entity (Medtronic Sofamor Danek) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated

Background: The reported prevalence of non-neurologic complications following corrective surgery for adolescent idiopathic scoliosis ranges from 0% to 10%. However, most studies were retrospective evaluations of treatment techniques and did not focus solely on complications. The purpose of this study was to determine the prevalence of non-neurologic complications following surgery for adolescent idiopathic scoliosis and to identify preoperative and operative factors that can increase this risk.

Methods: The demographic data, medical and surgical histories, and prevalence of non-neurologic complications were reviewed in a prospective cohort of 702 patients who had undergone corrective surgery for adolescent idiopathic scoliosis and were consecutively enrolled in a multicenter database.

Results: There were 556 female and 146 male patients. The mean age at the time of surgery was 14.25 years (range, eight to eighteen years). Five hundred and twenty-three patients had only posterior spinal surgery, 105 had only anterior spinal surgery, and seventy-four had a combined anterior and posterior procedure. There was a total of 108 complications in eighty-one patients, for an overall prevalence of 15.4%. There were ten respiratory complications (1.42%), six cases of excessive bleeding (0.85%), five wound infections (0.71%), and five cases of wound hematoma, seroma, or dehiscence (0.71%). Five patients, two with an early infection and three with late failure of the implant, required a reoperation.

Factors that did not correlate with an increased prevalence of complications were age, body mass index, presence of cardiac or respiratory disease, previous surgery, pulmonary function, surgical approach, number of levels fused, graft material, use of a diaphragmatic incision, Lenke curve type, or region of the major curve. Although the number of patients with renal disease was small, these patients were 7.90 times more likely to have a non-neurologic complication. Increased blood loss as well as prolonged operative and anesthesia times were associated with a higher prevalence of non-neurologic complications.

Conclusions: The prevalence of non-neurologic postoperative complications following surgery for correction of adolescent idiopathic scoliosis in this study was 15.4%. The few factors noted to significantly increase the rate of complications include a history of renal disease, increased operative blood loss, prolonged posterior surgery time, and prolonged anesthesia time.

Level of Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.


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