Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
Spine (Phila Pa 1976). 2011 Aug 15;36(18):1484-91. doi: 10.1097/BRS.0b013e3181f3a326.
Retrospective review of a multicenter database.
To determine the complication rates associated with surgical treatment of pediatric scoliosis and to assess variables associated with increased complication rates.
Wide variability is reported for complications associated with the operative treatment of pediatric scoliosis. Limited number of patients, surgeons, and diagnoses occur in most reports. The Scoliosis Research Society Morbidity and Mortality (M&M) database aggregates deidentified data, permitting determination of complication rates from large numbers of patients and surgeons.
Cases of pediatric scoliosis (age ≤18 years), entered into the Scoliosis Research Society M&M database between 2004 and 2007, were analyzed. Age, scoliosis type, type of instrumentation used, and complications were assessed.
A total of 19,360 cases fulfilled inclusion criteria. Of these, complications occurred in 1971 (10.2%) cases. Overall complication rates differed significantly among idiopathic, congenital, and neuromuscular cases (P < 0.001). Neuromuscular scoliosis had the highest rate of complications (17.9%), followed by congenital scoliosis (10.6%) and idiopathic scoliosis (6.3%). Rates of neurologic deficit also differed significantly based on the etiology of scoliosis (P < 0.001), with the highest rate among congenital cases (2.0%), followed by neuromuscular types (1.1%) and idiopathic scoliosis (0.8%). Neur-omuscular scoliosis and congenital scoliosis had the highest rates of mortality (0.3% each), followed by idiopathic scoliosis (0.02%). Higher rates of new neurologic deficits were associated with revision procedures (P < 0.001) and with the use of corrective osteotomies (P < 0.001). The rates of new neurologic deficit were significantly higher for procedures using anterior screw-only constructs (2.0%) or wire-only constructs (1.7%), compared with pedicle screw-only constructs (0.7%) (P < 0.001).
In this review of a large multicenter database of surgically treated pediatric scoliosis, neuromuscular scoliosis had the highest morbidity, but relatively high complication rates occurred in all groups. These data may be useful for preoperative counseling and surgical decision-making in the treatment of pediatric scoliosis.
回顾性多中心数据库研究。
确定与小儿脊柱侧凸手术治疗相关的并发症发生率，并评估与较高并发症发生率相关的变量。
目前报道的与小儿脊柱侧凸手术治疗相关的并发症发生率差异较大。大多数报告中患者、外科医生和诊断的数量有限。脊柱侧凸研究协会发病率和死亡率（M&M）数据库汇总了去识别数据，允许从大量患者和外科医生中确定并发症发生率。
分析了 2004 年至 2007 年期间进入脊柱侧凸研究协会 M&M 数据库的小儿脊柱侧凸（年龄≤18 岁）病例。评估了年龄、脊柱侧凸类型、使用的器械类型以及并发症。
共有 19360 例符合纳入标准。其中，1971 例（10.2%）发生并发症。特发性、先天性和神经肌肉性病例的总体并发症发生率差异有统计学意义（P<0.001）。神经肌肉性脊柱侧凸的并发症发生率最高（17.9%），其次是先天性脊柱侧凸（10.6%）和特发性脊柱侧凸（6.3%）。基于脊柱侧凸的病因，神经功能缺损的发生率也有显著差异（P<0.001），先天性病例发生率最高（2.0%），其次是神经肌肉型（1.1%）和特发性脊柱侧凸（0.8%）。神经肌肉性脊柱侧凸和先天性脊柱侧凸的死亡率最高（各 0.3%），其次是特发性脊柱侧凸（0.02%）。翻修手术（P<0.001）和使用矫正性截骨术（P<0.001）与新的神经功能缺损发生率较高相关。与单纯使用椎弓根螺钉的手术（0.7%）相比，仅使用前路螺钉的手术（2.0%）或仅使用钢丝的手术（1.7%）发生新的神经功能缺损的风险更高（P<0.001）。
在对接受手术治疗的小儿脊柱侧凸的大型多中心数据库进行回顾性分析中，神经肌肉性脊柱侧凸的发病率最高，但所有组的并发症发生率相对较高。这些数据可能有助于小儿脊柱侧凸的术前咨询和手术决策。
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