• Kota Watanabe, Koki Uno, Teppei Suzuki, Noriaki Kawakami, Taichi Tsuji, Haruhisa Yanagida, Manabu Ito, Toru Hirano, Ken Yamazaki, Shohei Minami, Toshiaki Kotani, Hiroshi Taneichi, Shiro Imagama, Katsushi Takeshita, Takuya Yamamoto, and Morio Matsumoto.
• Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan.
• Spine. 2013 Apr 15;38(8):E464-8.

Study DesignA retrospective multicenter study.ObjectiveTo identify risk factors for postoperative complications associated with growing-rod (GR) surgery for early-onset scoliosis (EOS).Summary Of Background DataResults and complications of GR surgery for EOS have not been adequately studied.MethodsWe evaluated clinical and radiographical results from 88 patients with EOS who underwent GR surgery in 12 spine centers in Japan. The mean age at the time of initial surgery was 6.5 ± 2.2 years (range, 1.5-9.8 yr) and the mean follow-up period was 3.9 ± 2.6 years (range, 2.0-12.0 yr). Risk factors for postoperative complications were analyzed using binomial multiple logistic regression analysis. We considered the potential factors of sex, age, number of rod-lengthening procedures, whether a pedicle screw foundation was used, the uppermost level of the proximal foundation and lowermost level of the distal foundation, Cobb angles of the proximal thoracic, main thoracic, and lumbar curves, and the kyphosis angles in the proximal, main thoracic, thoracolumbar, and lumbar spine. Kaplan-Meier analysis was used to determine the complication-free survival rate of GR surgery as a function of the number of surgical procedures.ResultsComplications affected 50 of the patients (57%) and were associated with 119 of 538 surgical procedures, with 86 implant-related failures (72%), 19 infections (16%), 3 neurological impairments (3%), and 11 other complications. The most frequent implant-related failure was dislodged implant (71%) and 95% of the dislodgements occurred at the proximal foundation. Kaplan-Meier analysis demonstrated a linear decrease in complication-free rates as the number of rod-lengthening procedures increased. Binomial multiple logistic regression analysis found the following significant independent risk factors: 6 or more rod-lengthening procedures (odds ratio [OR], 6.534), an increase of every 20° in the proximal thoracic Cobb angle (OR, 3.091), and an increase of every 25° in the lumbar lordosis angle (OR, 2.607) in the preoperative condition.ConclusionIncreases in the upper thoracic scoliotic curve, thoracic kyphosis, and number of rod-lengthening procedures are positively associated with an increased risk of complications after GR surgery for EOS.

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