Paediatric Surgery

Scoliosis Neurological Deficit and Death Rates

Amongst the known complications associated with spine surgery to address severe scoliosis, neurological complications and death remained the most serious and feared. Fortunately, these complications are relatively uncommon.

Neurological complications during and following scoliosis surgery range from mild transient neuropraxias to complete cord injuries with paralysis. The reported rate of neurologic deficits following scoliosis surgery has been reported to be 0.73%1 overall, and 0.26-1.75%2 specifically in AIS cases, depending on the surgical approach used. In KKH, all scoliosis surgeries are performed under intraoperative neuromonitoring, which remains the standard of care worldwide.

The incidence of death during or following scoliosis surgery in an otherwise healthy patient is reported to be less than 1%3. Reported causes of death in this patient group include pulmonary complications4 and peritonitis5. Within the non-idiopathic group, the most common type of scoliosis managed at KKH is neuromuscular. The post-operative 30 and 90-day mortality rate in this group has been reported to be 0% and 0.001% respectively6.

The incidence of neurological complications and death following scoliosis surgery remains at 0% when compared to internationally published rates.

References

1. Hamilton DK, Smith JS, Sansur CA et al. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: A report of the Scoliosis research Society Morbidity and Mortality Committee. Spine. 2011; 36:1218-1228.
2. Coe JD, Arlet V. Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis research Society Morbidity and Mortality Committee. Spine. 2006; 345-349
3. Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications and outcomes. Spine. 1999; 24:2617-2627
4. McDonnell MF, Glassman SD, Dimar JR et al. Perioperative complications of anterior procedures on the spine. Journal of Bone and Joint Surgery 1996; 76A: 839-847.
5. Mielke CH, Lonstein JE, Denis F et al. Surgical treatment of AIS: A comparative analysis. Journal of Bone and Joint Surgery 1989; 71-A:1170-1177.
6. Matsumoto H, Fano AN, Herman ET et al. Mortality in Neuromuscular Early Onset Scoliosis Following Spinal Deformity Surgery. J Pediatr Orthop 2022; 1;42(3):e:234-e241