Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years
- 21 October 2012
- journal article
- review article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 22 (6), 1230-1249
- https://doi.org/10.1007/s00586-012-2542-2
Abstract
Our objectives were primarily to review the published literature on complications in neuromuscular scoliosis (NMS) surgery and secondarily, by means of a meta-analysis, to determine the overall pooled rates (PR) of various complications associated with NMS surgery. PubMed and Embase databases were searched for studies reporting the outcomes and complications of NMS surgery, published from 1997 to May 2011. We focused on NMS as defined by the Scoliosis Research Society’s classification. We measured the pooled estimate of the overall complication rates (PR) using a random effects meta-analytic model. This model considers both intra- and inter-study variation in calculating PR. Systematic review and meta-analysis were performed for 68 cohort and case–control studies with a total of 15,218 NMS patients. Pulmonary complications were the most reported (PR = 22.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability. In regard to surgical complications affiliated with various surgical techniques in NMS, the level of evidence of published literature ranges between 2+ to 2−; the subsequent recommendations are level C. NMS patients have diverse and high complication rates after scoliosis surgery. High PRs of complications warrant more attention from the surgical community. Although the PR of all complications are affected by heterogeneity, they nevertheless provide valuable insights into the impact of methodological settings (sample size), patient characteristics (age at surgery), and continual advances in patient care on complication rates.Keywords
This publication has 85 references indexed in Scilit:
- Cotrel–Dubousset instrumentation in neuromuscular scoliosisEuropean Spine Journal, 2011
- Preoperative predictors of postoperative pulmonary complications in neuromuscular scoliosisJournal of Orthopaedic Science, 2011
- Treatment of scoliosis in patients affected with Prader-Willi syndrome using various techniquesScoliosis and Spinal Disorders, 2010
- Development and treatment of spinal deformity in patients with cerebral palsyIndian Journal of Orthopaedics, 2010
- Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and TreatmentClinical Orthopaedics and Related Research, 2010
- Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentationEuropean Spine Journal, 2009
- Measuring inconsistency in meta-analysesBMJ, 2003
- Spinal fusion in patients with Duchenne's muscular dystrophy and a low forced vital capacityEuropean Spine Journal, 2003
- Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operationsEuropean Spine Journal, 2002
- Complications of scoliosis surgery in children with myelomeningoceleEuropean Spine Journal, 1999