• Munish C Gupta, Lawrence G Lenke, Sachin Gupta, Ali S Farooqi, Jahangir K Asghar, Oheneba Boachie-Adjei, Patrick J Cahill, Mark A Erickson, Sumeet Garg, Peter O Newton, Amer F Samdani, Suken A Shah, Harry L Shufflebarger, Paul D Sponseller, Daniel J Sucato, David B Bumpass, Richard E McCarthy, Burt Yaszay, Joshua M Pahys, Jichao Ye, Michael P Kelly, and Fox Pediatric Spinal Deformity Study Group.
• Department of Orthopaedic Surgery, Washington University in St Louis, St. Louis, MO.
• Spine. 2023 Nov 1; 48 (21): 149214991492-1499.

Study DesignProspective multicenter cohort study.ObjectiveTo evaluate perioperative complications and mid-term outcomes for severe pediatric spinal deformity.Summary Of Background DataFew studies have evaluated the impact of complications on health-related quality of life (HRQoL) outcomes in severe pediatric spinal deformity.MethodsPatients from a prospective, multicenter database with severe pediatric spinal deformity (minimum of 100 degree curve in any plane or planned vertebral column resection (VCR)) with a minimum of 2-years follow-up were evaluated (n=231). SRS-22r scores were collected preoperatively and at 2-years postoperatively. Complications were categorized as intraoperative, early postoperative (within 90-days of surgery), major, or minor. Perioperative complication rate was evaluated between patients with and without VCR. Additionally, SRS-22r scores were compared between patients with and without complications.ResultsPerioperative complications occurred in 135 (58%) patients, and major complications occurred in 53 (23%) patients. Patients that underwent VCR had a higher incidence of early postoperative complications than patients without VCR (28.9% vs. 16.2%, P =0.02). Complications resolved in 126/135 (93.3%) patients with a mean time to resolution of 91.63 days. Unresolved major complications included motor deficit (n=4), spinal cord deficit (n=1), nerve root deficit (n=1), compartment syndrome (n=1), and motor weakness due to recurrent intradural tumor (n=1). Patients with complications, major complications, or multiple complications had equivalent postoperative SRS-22r scores. Patients with motor deficits had lower postoperative satisfaction subscore (4.32 vs. 4.51, P =0.03), but patients with resolved motor deficits had equivalent postoperative scores in all domains. Patients with unresolved complications had lower postoperative satisfaction subscore (3.94 vs. 4.47, P =0.03) and less postoperative improvement in self-image subscore (0.64 vs. 1.42, P =0.03) as compared to patients with resolved complications.ConclusionMost perioperative complications for severe pediatric spinal deformity resolve within 2-years postoperatively and do not result in adverse HRQoL outcomes. However, patients with unresolved complications have decreased HRQoL outcomes.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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