ANALYSIS OF RISK FACTORS OF LATE COMPLICATIONS AFTER SPINE RECONSTRUCTION SURGERY FOR NON-TRAUMATIC PATHOLOGY IN CHILDREN

Abstract

Objective. To analyze the structure and frequency of complications after surgical treatment of non-traumatic spinal disorders in children and to identify factors affecting the development of the disorders. Material and Methods . The study included follow-up data of 218 children who underwent no less than 2-level reconstructions of the spine for infectious and neoplastic destruction, as well as for congenital malformations of the spine in 2005–2015. The average period of long-term follow-up was 5 years 4 months. Sixteen patients developed complications requiring repeated surgical treatment in the long-term period (at least 12 months). Clinical and X-ray factors that influenced the risk of developing long-term complications were studied. Results . Four groups of complications were identified: recurrence (progression) of primary pathology (n = 5), pseudoarthrosis in the interface between bone graft and recipient vertebra (n = 6), proximal junctional kyphosis (n = 4), and bone graft resorption (n = 1). The influence of thoracic lesions on the risk of pathology recurrence (p = 0.039) and of lumbar spine surgery on earlier complication development (p = 0.016) and pseudoarthrosis formation (p = 0.047), as well as on earlier appearance of secondary deformities as compared to other complications (p = 0.035) was statistically proved. The predictor value of such factors as etiology, age, gender and material used for anterior fusion (bone alone or titanium mesh with bone autograft) was not confirmed. Conclusion . The frequency of late complications after 360° vertebral reconstruction in children is 7.3 %, with most of them developing several years after surgery. Increase in surgical activity, number of operated patients and length of follow-up will possibly prove the presence of new predictors of complication development.