Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien-Dindo-Sink system

Lukas G Keil; Stephen M Himmelberg; Ndéye F Guissé; Alysa B Nash; Nicholas D Fletcher; Joseph D Stone

doi:10.1007/s43390-021-00468-3

Complications following posterior spinal fusion for adolescent idiopathic scoliosis: a retrospective cohort study using the modified Clavien-Dindo-Sink system

Spine Deform. 2022 May;10(3):607-614. doi: 10.1007/s43390-021-00468-3. Epub 2022 Feb 3.

Authors

Lukas G Keil¹, Stephen M Himmelberg², Ndéye F Guissé³, Alysa B Nash⁴, Nicholas D Fletcher⁵, Joseph D Stone⁴

Affiliations

¹ Department of Orthopaedic Surgery, School of Medicine, University of North Carolina, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC, 27599-7055, USA. lukas.keil@unchealth.unc.edu.
² School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
³ School of Medicine, Emory University, Atlanta, GA, USA.
⁴ Department of Orthopaedic Surgery, School of Medicine, University of North Carolina, 130 Mason Farm Road, CB# 7055, Chapel Hill, NC, 27599-7055, USA.
⁵ Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.

PMID: 35112274
DOI: 10.1007/s43390-021-00468-3

Abstract

Purpose: Published complication rates after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) range from 1 to 22%. Complications are often minor and may be underestimated in registries. This study describes complications of PSF for AIS, classifies them according to a Clavien-Dindo-Sink (CDS) system, and investigates risk factors for occurrence of a complication.

Methods: This retrospective cohort study at two academic centers included all AIS patients aged 10-18 who underwent primary PSF 4/2014-12/2019. Data included demographics, comorbidities, curve magnitude, Lenke classification, levels osteotomized/fused, implant density, 90-day emergency department visits, readmissions, reoperations, and complications as defined by Harms Study Group.

Results: Among 424 patients, mean age was 14.7, mean BMI 22, 77% were female, and 57% had no comorbidities. There were 270 complications (0.64 per patient); 198 patients (47%) had ≥ 1 complication; and 63 patients (15%) had CDS grade ≥ II complications (deviation from standard postoperative course). Complications not related to persistent pain occurred in 103 patients (24%). Ninety-three percent of complications did not require readmission or reoperation (CDS I-II). Within 90 days, 8% presented to an ED, 2% required readmission, and 2% required reoperation. Common complications were back pain > 6 weeks postoperatively (26%), surgical site complications (7%), and ileus/prolonged constipation (3%). Risk factors for experiencing any complication were BMI ≥ 34 (OR 3.44) and Lenke 6 curve (OR 1.95).

Conclusion: One in four AIS patients experiences a complication not related to persistent pain after primary PSF, higher than rates published from self-reported registries. Obesity and Lenke 6 curve may increase risk. While most do not require readmission or surgery, 15% of patients have their postoperative course altered by complications.

Level of evidence: III-retrospective cohort study.

Keywords: Adolescent idiopathic scoliosis (AIS); Clavien-Dindo-Sink (CDS); Complications; Posterior spinal fusion (PSF).

MeSH terms

Adolescent
Female
Humans
Kyphosis* / etiology
Male
Pain / etiology
Retrospective Studies
Scoliosis* / etiology
Scoliosis* / surgery
Spinal Fusion* / adverse effects
Treatment Outcome