Adverse events in paediatric spinal deformity surgery - 12-year review of specialist spinal deformity practice

Adverse events following paediatric spinal deformity surgery in the UK suffers from significant reporting gaps, as current data relies predominantly on voluntary incident submissions. This retrospective study aims to comprehensively assess the incidence of all surgical adverse events at a specialized paediatric spinal orthopaedic centre.

A retrospective review of prospectively collected data from January 2010 to December 2022 systematically evaluated perioperative and postoperative adverse events. Patients were analyzed by scoliosis aetiology and adverse events were stratified according to the Clavien-Dindo classification system. Adverse events were further grouped by common themes including implant-related, infection-related, and neurological events.

A total of 871 paediatric spinal deformity patients undergoing 1,020 operations with at least two years follow-up were identified. Adolescent idiopathic scoliosis was the most common primary pathology with 545 patients (62.6%). Overall, 324 patients (37.2%) experienced an adverse event. Adverse events were categorized by severity: 14.8% grade 1, 5.3% grade 2, 1.1% grade 3A, 14.6% grade 3B, 1.1% grade 4, and 0.1% grade 5. Implant-related issues were most frequent (n = 113, 13.0%), followed by curve progression (n = 33, 3.8%) and persistent pain (n = 33, 3.8%). Neurological events included four complete cord injuries (0.5%) and four incomplete cord injuries which fully recovered (0.5%). One perioperative death occurred.

In this cohort of paediatric spinal deformity surgeries, over one-third of patients experienced adverse events, predominantly of low severity requiring minimal or no further intervention. Implant-related adverse events were most frequent, while the incidence of both complete and incomplete spinal cord injury, as well as mortality, remained reassuringly low across all procedures.