Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2021; 12(8): 584-603
Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.584
Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review
Michał Latalski, Marek Fatyga, Ireneusz Sowa, Magdalena Wojciak, Grzegorz Starobrat, Anna Danielewicz
Michał Latalski, Anna Danielewicz, Children Orthopaedic Department, Medical University of Lublin, Lublin 20-093, Poland
Marek Fatyga, Grzegorz Starobrat, Children Orthopaedic Department, University Hospital for Children, Lublin 20-093, Poland
Ireneusz Sowa, Magdalena Wojciak, Department of Analytical Chemistry, Medical University of Lublin, Lublin 20-093, Poland
Author contributions: Latalski M and Danielewicz A designed the research, performed literature research, analyzed the data, drafted, revised, and supervised the manuscript; Starobrat G and Fatyga M performed literature research, analyzed the data, drafted, revised the manuscript; Sowa I and Wojciak M analyzed the data, drafted, revised the manuscript; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Michał Latalski, MD, PhD, Professor, Children Orthopaedic Department, Medical University of Lublin, Gebali 6, Lublin 20-093, Poland. michallatalski@umlub.pl
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: March 31, 2021
Revised: April 12, 2021
Accepted: August 2, 2021
Article in press: August 2, 2021
Published online: August 18, 2021
Abstract
BACKGROUND

The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications.

AIM

To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries.

METHODS

In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed.

RESULTS

A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries.

CONCLUSION

The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

Keywords: Scoliosis, Spine, Growth-friendly implant, Surgery, Complications, Treatment

Core Tip: Early-onset scoliosis (EOS) is defined as curvature of the spine ≥ 10° with onset before 10 years of age, regardless of etiology. The treatment for EOS is still a great challenge for pediatric orthopedics, and surgery is often necessary. Repeated surgeries and complications are two major concerns in EOS management. The literature on the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Data on the incidence of complications can be underestimated, and should be interpreted with caution.