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Complications and outcomes of complex spine reconstructions in poliomyelitis-associated spinal deformities: a
Jakub Godzik1, Lawrence G Lenke, Terrence Holekamp
1From the Departments of *Orthopaedic Surgery and †Neurological Surgery, Washington University in St Louis, School of Medicine, St Louis, MO.
Study Design:
Retrospective case series.
Objective:
To share our institutional experience with spinal reconstruction for deformity correction in patients with a history of poliomyelitis.
Summary Of Background Data:
Polio and postpolio syndrome are not uncommonly related to a paralytic spinal deformity. Limited modern data exist regarding outcomes and complications after spinal reconstruction in this population.
Methods:
A clinical database was reviewed for patients undergoing spinal reconstruction for polio-associated spinal deformity at our institution from 1985 to 2012. Relevant demographic, medical, surgical, and postoperative information were collected from medical records and analyzed. Preoperative and last follow-up Scoliosis Research Society-22 Questionnaire scores were recorded.
Results:
A total of 22 patients with polio who underwent surgical deformity correction were identified. Mean age was 49 years (range, 12-74 yr), and 15 patients (68%) were female. Preoperative motor deficit was present in 14 of 22 (64%) patients. All patients underwent instrumented spinal fusion (mean, 13 vertebral levels, range, 3-18). Ten (10/22, 45%) patients developed major complications, and 4 patients (4/22, 18%) developed new postoperative neurological deficits. Neurological monitoring yielded a 13% false-negative rate. At 2-year follow-up, 20 of 22 patients maintained an average coronal correction of 25° (33%, P = 0.001) and sagittal correction of 25° (34%, P = 0.003). Minimum 2-year follow-up data were available for 11 of 22 (50%) patients. At an average of 72 months of follow-up (range, 28-134 mo), the mean Scoliosis Research Society-22 Questionnaire pain subscore improved from a mean of 2.75 to 3.6 (P = 0.012); self-image from 2.8 to 3.7 (P = 0.041); function from 3.1 to 3.8 (P = 0.036); satisfaction from 2.1 to 3.9 (P = 0.08); and mental health from 3.7 to 4.5 (P = 0.115).
Conclusion:
Spine reconstruction for poliomyelitis-associated deformity was associated with high complication rates (54%) and sometimes unreliable neurological monitoring data. Despite this, patients undergoing spine reconstructions had significantly improved outcome scores. These data may help surgeons to appropriately counsel this complicated patient population.
