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A New Classification System to Report Complications in Growing Spine Surgery: A Multicenter Consensus Study.
John T Smith1, Charles Johnston, David Skaggs
1*University of Utah School of Medicine, Salt Lake City, UT †Texas Scottish Rite Hospital, Dallas, TX ‡Children's Hospital of Los Angeles, Los Angeles, CA §Children's Hospital of Philadelphia, Philadelphia, PA ∥Morgan Stanley Children's Hospital, New York City, NY.
A new classification system for complications in pediatric growing spine surgery was developed. While complications are frequent, most are minor and do not alter the treatment plan, enabling better comparison of surgical techniques.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Biomedical Engineering
Background:
- Growth-sparing instrumentation in pediatric spinal deformity surgery has a high rate of adverse events.
- Current methods for reporting complications lack consistency, hindering comparisons between techniques.
- A standardized classification system is needed to accurately report complications.
Purpose of the Study:
- To develop a consensus-based classification system for reporting complications in pediatric growing spine surgery.
- To establish a standardized method for evaluating adverse events associated with growth-sparing spinal instrumentation.
- To facilitate meaningful comparisons of different surgical strategies and techniques.
Main Methods:
- A collaborative effort among lead surgeons from 5 major pediatric spine centers.
- Development and testing of a new classification system for complications.
- Retrospective review of a minimum of 10 patients per center with at least 2-year follow-up after implantation of growing instrumentation.
- Inclusion criteria focused on surgical treatment of early-onset scoliosis, excluding non-surgical interventions.
Main Results:
- A total of 65 patients were analyzed, with 56 experiencing at least one complication.
- Common complications included instrumentation migration (60), infection (31), pneumonia (21), and failure (23).
- The majority of complications were classified as Grade I (57) or Grade IIA (79), indicating minor or manageable events.
Conclusions:
- Standardized reporting of complications, classified by severity and impact, is crucial for comparative research in growing spine surgery.
- The developed classification system provides a consistent method for reporting adverse events.
- Although complications are common, only a small percentage (9%) were severe enough to significantly alter the treatment course.
