Complications in ambulatory pediatric patients with nonidiopathic spinal deformity undergoing fusion to the pelvis using the sacral-alar-iliac technique within 2 years of surgery

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  • Department of Orthopedics, Columbia University Medical Center/NewYork-Presbyterian, The Och Spine Hospital, New York, New York
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OBJECTIVE

Significant investigation in the adult population has generated a body of research regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following long fusions to the sacrum and pelvis. However, much less is known regarding early complications, including PJK and PJF, in the ambulatory pediatric patient. As such, the objective of this study was to address the minimal literature on early complications after ambulatory pediatric patients underwent fusion to the sacrum with instrumentation to the pelvis in the era of sacral-alar-iliac (S2AI) instrumentation.

METHODS

The authors performed a retrospective review of pediatric patients with nonidiopathic spinal deformity < 18 years of age with ambulatory capacity who underwent fusion to the pelvis at a multisurgeon pediatric academic spine practice from 2016 to 2018. All surgeries were posterior-only approaches with S2AI screws as the primary technique for sacropelvic fixation. Descriptive, outcome, and radiographic data were obtained. The definition of PJF included symptomatic PJK presenting as fracture, screw pullout, or disruption of the posterior osseoligamentous complex.

RESULTS

Twenty-five patients were included in this study. Nine patients (36.0%) had 15 complications for an overall complication rate of 60.0%. Unplanned return to the operating room occurred 8 times in 6 patients (24.0%). Four patients (16.0%) had wound issues (3 with deep wound infection and 1 with wound breakdown) requiring reoperation. Three patients (12.0%) had PJF, all requiring reoperation. A 16-year-old female patient with syndromic scoliosis underwent extension of fusion due to posterior tension band failure at 6 months. A 17-year-old male patient with neuromuscular scoliosis underwent extension of fusion due to proximal screw pullout at 5 months. A 10-year-old female patient with congenital scoliosis underwent extension for PJF at 5 months following posterior tension band failure. One patient had pseudarthrosis requiring reoperation 20 months postoperatively.

CONCLUSIONS

Fixation to the pelvis enables significant deformity correction, but with rather high rates of complications and unexpected returns to the operating room. Considerations of sagittal plane dynamics for PJK and PJF should be strongly analyzed when performing fixation to the pelvis in ambulatory pediatric patients.

ABBREVIATIONS AIS = adolescent idiopathic scoliosis; DWI = deep wound infection; PJF = proximal junctional failure; PJK = proximal junctional kyphosis; S2AI = sacral-alar-iliac; UIV = upper instrumented vertebra.

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Contributor Notes

Correspondence Meghan Cerpa: Columbia University Medical Center, The Spine Hospital, New York, NY. mc4338@cumc.colmubia.edu.

INCLUDE WHEN CITING Published online April 30, 2021; DOI: 10.3171/2020.11.PEDS19641.

Disclosures Dr. Vitale: royalties from Biomet Spine and Stryker Spine, and consultant for Biomet Spine. Dr. Lenke: consultant for Medtronic, EOS Technologies, Acuity Surgical, and Abryx; royalties from Medtronic and Quality Medical Publishing; reimbursement for airfare/hotel from Broadwater, Seattle Science Foundation, Stryker Spine, The Spine Research Foundation, Scoliosis Research Society (SRS), and AO Spine; grant support from SRS, EOS, Setting Scoliosis Straight Foundation, and AO Spine; fellowship support to institution from AO Spine; expert witness in patent infringement case from Fox Rothschild; and philanthropic research funding from grateful patient/family from Evans Family Donation and Fox Family Foundation.

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