Complications of Growing-Rod Treatment for Early-Onset Scoliosis

• Published in: Journal of bone and joint surgery. American volume 2010, Vol.92 (15), p.2533-2543
• Main Authors: Bess, Shay, MD, Akbarnia, Behrooz A., MD, Canale, Sarah, BS, Thompson, George H., MD, Poe-Kochert, Connie, RN, CNP, Sponseller, Paul D., MD, Shah, Suken A., MD, El Sebaie, Hazem, FRCS, MD, Boachie-Adjei, Oheneba, MD, Karlin, Lawrence I., MD, Skaggs, David L., MD
• Format: Article
• Language: English
• Subjects: Orthopedics
• ISSN: 0021-9355
• DOI: 10.1016/S0021-9355(10)71565-4

Background Previous reports have indicated high complication rates associated with non-fusion surgery in patients with early-onset scoliosis. This study was performed to evaluate the clinical and radiographic complications associated with growing-rod treatment. Methods Data from the multicenter Growing Spine Study Group database were evaluated. Inclusion criteria were growing-rod treatment for early-onset scoliosis and a minimum of two years of follow-up. Patients were divided into treatment groups according to rod type (single or dual) and rod location (subcutaneous or submuscular). Complications were categorized as wound, implant, alignment, and general (surgical or medical). Surgical procedures were classified as planned and unplanned. Results Between 1987 and 2005, 140 patients met the inclusion criteria and underwent a total of 897 growing-rod procedures. The mean age at the initial surgery was six years, and the mean duration of follow-up was five years. Eighty-one (58%) of the 140 patients had a minimum of one complication. Nineteen (27%) of the seventy-one patients with a single rod had unplanned procedures because of implant complications, compared with seven (10%) of the sixty-nine patients with dual rods (p ≤ 0.05). Thirteen (26%) of the fifty-one patients with subcutaneous rod placement had wound complications compared with nine of the eighty-eight patients (10%) with submuscular rod placement (p ≤ 0.05). The patients with subcutaneous dual rods had more wound complications, more prominent implants, and more unplanned surgical procedures than did those with submuscular dual rods (p ≤ 0.05). The risk of complications occurring during the treatment period decreased by 13% for each year of increased patient age at the initiation of treatment. The complication risk increased by 24% for each additional surgical procedure performed. Conclusions Regardless of treatment modality, the management of early-onset scoliosis is prolonged; therefore, complications are frequent and should be expected. Complications can be reduced by delaying initial implantation of the growing rods if possible, using dual rods, and limiting the number of lengthening procedures. Submuscular placement reduces wound and implant-prominence complications and reduces the number of unplanned operations. Level of Evidence Therapeutic Level III . See Instructions to Authors for a complete description of levels of evidence.