Mortality and morbidity in early-onset scoliosis surgery

Retrospective chart review.

To accurately determine complication rates, particularly mortality rates, in surgically treated early-onset scoliosis.

The advent of modern segmental instrumentation for spinal fusion surgery in adolescent scoliosis has allowed for application of similar nonsegmental unfused techniques aimed at controlling scoliosis in the very young child. The dismal prognosis for these children without repeated spinal lengthening procedures is unquestioned, although no controlled trials exist. Many, if not most, of these children need surgery; however, the surgical complication rate is very high.

During the study period, all surgically treated children with early-onset scoliosis seen at our institution were identified. Any patient who presented to our clinic with early-onset scoliosis that was surgically managed was included. The total number of procedures, type of implants, number and type of complications, geographic origin of the cases, and final outcomes were all assessed.

A total of 165 surgical procedures on 28 patients accrued during the study time period, including index implantation of instrumentation, lengthening, and definitive fusion, as well as operations performed for complications such as wound debridement and revision of failed implants. Clinical diagnoses included congenital scoliosis, syndromic and chromosomal abnormalities, cerebral palsy, and spinal muscular atrophy. There was a complication rate of 84% overall with a mortality rate of almost 18%. The only patients with no complications were those whose entire surgical course had been at our institution only. The mortality rate was equal in patients whose treatment was performed elsewhere versus exclusively in our center.

This study underlines the grave severity of these scolioses particularly in syndromic children. The high mortality rate is alarming, suggesting that further study is needed in this area.