Many patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts (VSs) for hydrocephalus and baclofen pumps (BPs) for spastic cerebral palsy. Recent studies have discussed a possible increase in implant complication rates following spinal fusion, but published data are inconclusive. The authors therefore, sought to investigate: 1) the rate of implant complications following fusion, 2) possible causes of these complications, and 3) factors that place patients at higher risk for implant-related complications.
Cases involving pediatric patients with a preexisting VS or BP who underwent spinal fusion for scoliosis correction between 2005 and 2016 at a single tertiary children’s hospital were retrospectively analyzed. Patient demographics, implant characteristics, spinal fusion details, neurosurgical follow-up, and implant complications in the 180 days following fusion were recorded and analyzed.
Overall, 75 patients who underwent scoliosis correction had preexisting implants: 39 had BPs, 31 VSs, and 5 both. The patients’ mean age at fusion was 13.49 ± 2.78 years (range 3.62–18.81 years), and the mean time from the most recent previous implant surgery to fusion was 5.70 ± 4.65 years (range 0.10–17.3 years). The mean preoperative and postoperative Cobb angles were 62.4° ± 18.9° degrees (range 20.9°–109.0°) and 23.5° ± 13.3° degrees (range 2.00°–67.3°), respectively. No VS complications were identified. Two patients with BPs were found to have complications (unintentional cutting of their BP catheter during posterior spinal fusion) within 180 days postfusion. There were no recorded neurosurgical implant infections, failures, fractures, or dislodgements. Although 10 patients required at least 1 surgical procedure for irrigation and debridement of the spine wound following fusion, there were no abdominal or cranial implant wound infections requiring revision, and no implants required removal.
The results of this study suggest that spinal fusion for scoliosis correction does not increase the rates of complications involving previously placed neurosurgical implants. A large-scale, prospective, multicenter study is needed to fully explore and confirm this finding.
ABBREVIATIONSBP = baclofen pump; I&D = irrigation and debridement; IV = intravenous; OR = operating room; VS = ventricular shunt; VUMC = Vanderbilt University Medical Center.
Correspondence Christopher M. Bonfield: Vanderbilt University Medical Center, Nashville, TN. firstname.lastname@example.org.INCLUDE WHEN CITING Published online May 4, 2018; DOI: 10.3171/2018.2.PEDS17713.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
BensonER, ThomsonJD, SmithBG, BantaJV: Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. 23:2308–2317, discussion 2318, 199810.1097/00007632-199811010-00012)| false
CairdMSPalancaAAGartonHHensingerRNAyyangarRNDrongowskiA: Outcomes of posterior spinal fusion and instrumentation in patients with continuous intrathecal baclofen infusion pumps. Spine (Phila Pa 1976)33:E94–E992008
CairdMS, PalancaAA, GartonH, HensingerRN, AyyangarRN, DrongowskiA, : Outcomes of posterior spinal fusion and instrumentation in patients with continuous intrathecal baclofen infusion pumps. 33:E94–E99, 2008)| false
CognettiDKeenyHMSamdaniAFPahysJMHansonDSBlankeK: Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database. Neurosurg Focus43(4):E102017
CognettiD, KeenyHM, SamdaniAF, PahysJM, HansonDS, BlankeK, : Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database. 43(4):E10, 20172896544810.3171/2017.7.FOCUS17384)| false
KulkarniAVRiva-CambrinJButlerJBrowdSRDrakeJMHolubkovR: Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls: clinical article. J Neurosurg Pediatr12:334–3382013