223. Surgery for severe pediatric spinal deformity has a significant rate of revision: a prospective multicenter cohort study

Abstract

BACKGROUND CONTEXT Surgical treatment of severe pediatric deformity can be extremely challenging due to difficulties with instrumentation placement in small patients, stress on implants due to correction of severe deformities, and use of three column osteotomies. We investigated the instrumentation and fusion related complications in these complex spine deformity surgical cases. PURPOSE The purpose of this study was to evaluate the frequency and timing of revisions related to instrumentation or fusion in patients with severe pediatric deformity. STUDY DESIGN/SETTING Prospective observational multicenter cohort of severe pediatric deformity patients treated surgically. PATIENT SAMPLE Patients with a minimum spinal deformity curve of 100° or who were scheduled for a VCR procedure were prospectively enrolled at 17 sites. Patient who had reached a minimum of 2 years postoperative were included for analysis. OUTCOME MEASURES Postoperative complications associated with instrumentation and/or fusion, time of revisions and complications from index surgery METHODS Patients with severe spinal deformity (>100° or planned VCR) were included with a min. Two year f/u from 17 centers. Complications with or without revision due to pseudoarthrosis, instrumentation failure, infection requiring instrumentation removal and progression of deformity were all analyzed. RESULTS A total of 228 of 312 patients had a min of 2 yrs f/u. Of these, 29 pts (13%) had complications associated with instrumentation or fusion. A total of 22 patients (10%) had 27 revisions. The average time for all revisions was 16 mos (0-36) after index surgery; 3 patients were revised 2x and 1 pt 3x. The 27 revisions included 5 patients with loss of fixation, revised an ave. of 21 mos po (1-35). Four patients with pseudarthrosis were revised an average of 21 mos po (13-28). One patient was revised for prominent instrumentation at 27 mos po, and 5 patients for deep infection between 1-27 mos, average 15 mos. Eight patients had revisions for deformity progression at an ave of 13 mos (1-36). One patient was revised for a malpositioned screw a few days po, and 1 at 12 mos po for implant/instrumentation failure. Eight patients had complications that did not require revision. These included 1 with prominent implants, 1 with a malpositioned screw in the disc space, 3 had progressive deformity including PJK , 1 patient for implant prominence, 1 for loss of fixation, and 2 implant failures . CONCLUSIONS Pediatric patients with severe spinal deformity are at significant risk for revision surgery at a rate of 13% within 2 years. The average time for revision surgery was 16 mos po but was necessary as long 36 months after index surgery. Long term follow-up is necessary to evaluate failures in this patient population. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.