Treatment of Early-Onset Spinal Deformities, Complications

Abstract

Introduction: Complications in the treatment of patients with early-onset deformities is a very common situation. When the surgeon assumes the treatment of this disease, he should try to gain control of the spinal deformity and obtain proper growth of thorax. The main goal of the treatment is to achieve these two aspects, with the lowest incidence of complications for the patient. Patients and Methods: This is a retrospective study case series and the level of evidence is IV. We evaluated 13 patients treated with surgical techniques and growth distraction without fusion (MMC 5p, 2p idiopathic infantile scoliosis, spinal dysplasia 1p, 1p SCIWORA, Marfan syndrome 1p, 1p Escobar syndrome, Neurofibromatosis Type I 1p, 1p Thoracogenic scoliosis). The average age at the time of surgery was 4.10 years. The average preoperative angular value was 83.7 degrees (range, 50–135 degrees). We analyzed the following: (1) Risk factors preoperative; (2) Type of mounting; (3) Sequence of distractions; (4) Complications. Results: Overall, 13 patients underwent 27 procedures of distraction. Analyzing each case, in particular, we have seen that the frequency of distractions averaged was a procedure each 11 months (range, 7–17 months), and 23% of these patients currently reached last surgery (spinal fusion) after 3.5 years of treatment with distractions (range, 2.10–3.10). In 13 patients, we observed complications in 69% during treatment. Our complications were as follows: (1) superficial infections 6.6%, (2) deep infections 10%, (3) rib fractures 10%, (4) spontaneous fusion 3.3%, and (5) prosthetic loosening. Conclusions: In treatment of early onset deformities, the spinal surgeon should be prepared to deal different complications during treatment. On the basis of our experience, we consider it a high-risk pathology.