Overall efficacy and complications of surgical treatment of congenital spinal deformity

English Keywords:Congenital scoliosis  Surgical efficacy  Surgical complications

English Abstract:

  【Abstract】 Objectives: To evaluate the overall efficacy and complications of surgical treatment of congenital spinal deformity. Methods: 431 congenital scoliosis(CS) patients surgically treated by our team from April 2007 to January 2018 were retrospectively reviewed. All of them had complete 2-year follow-up, including 158 male patients and 273 female patients with an average age of 14.9±6.2 years old. Before the surgeries, all the patients had computed tomography and magnetic resonance imaging of the whole spine to detect the deformity in the spinal canal, and echocardiography and abdominal ultrasound examination were also performed to exclude other visceral deformities. All the patients had surgical treatment, including growth-friendly non-fusion techniques(growing rods and vertical expandable prosthetic titanium rib)(n=40), posterior hemivertebra resection and short fusion(n=48), posterior spinal fusion without grade 3 or higher osteotomy(n=89), and posterior grade 3 or higher osteotomy and spinal fusion(n=254). All the patients had follow-up at 3 months, 6 months, 1 year and 2 years after surgery. Whole-spine radiographs were performed before surgery, after surgery and at each follow-up, and the Cobb angles, sagittal vertical axis(SVA), and the C7 plumb line-center sacral vertical line(C7PL-CSVL) were measured on the radiographs. The operation time, estimated blood loss and surgical complications were also collected. Results: 351 cases of intraspinal malformations and 24 cases of other visceral malformations in 431 patients were identified. The average operation time was 412.35±150.57mins, the average blood loss was 1879.93±1727.63ml, and the average follow-up duration was 48.7±9.3 months. The average Cobb angle was 68.88°±27.55° at pre-operation, 28.86°±18.90° at post-operation, and 30.77°±19.80° at final follow-up. The average SVA was 22.15±19.37mm at pre-operation, 24.15±22.22mm at post-operation, and 19.75±16.06mm at final follow-up. The average C7PL-CSVL was 17.37±15.47mm at pre-operation, 21.95±47.29mm at post-operation, and 13.03±12.39mm at final follow-up. Both the Cobb angle and C7PL-CSVL at final follow-up had statistically significant differences compared with those before surgery, respectively(P<0.05). The complications included pulmonary complications(n=49), neurological complications(n=30), implant related complications(n=20), surgical infections(n=10) and cerebral-spinal fluid leakages(n=8). Conclusions: Surgical treatment of congenital scoliosis generally yields satisfying correction. However, the risk of surgical complications is relatively high, which is about 30.16%, especially for pulmonary and neurological complications.