Management of complex pediatric and adolescent spinal deformity

Object. The authors sought to analyze prospectively the outcome of surgery for complex spinal deformity in the pediatric and young adult populations. Methods. The authors evaluate all pediatric and adolescent patients undergo ing operative correction of complex spinal deformity from December 1997 thr ough July 1999. No patient was lost to follow-up review (average 21.1 month s). There were 27 consecutive pediatric and adolescent patients (3-20 years of age) who underwent 32 operations. Diagnoses included scoliosis (18 idio pathic, five nonidiopathic) and four severe kyphoscoliosis. Operative corre ction and arthrodesis were achieved via 21 posterior approaches (Cotrel-Dub ousset-Horizon), seven anterior approaches (Isola or Kaneda Scoliosis Syste m), and two combined approaches. Operative time averaged 358 minutes (range 115-620 minutes). Blood loss averaged 807 mi (range 100-2000 mi). Levels t reated averaged 9.1 (range three-16 levels). There was a 54% average Cobb a ngle correction (range 6-82%). No case was complicated by the patient's neu rological deterioration, loss of somatosensory evoked potential monitoring, cardiopulmonary disease, donor-site complication, or wound breakdown. Ther e was one case of hook failure and one progression of deformity beyond the site of surgical instrumentation that required reoperation. There were 10 m inor complications that did not significantly affect patient outcome. No pa tient received undirected banked blood products. There was a significant im provement in cosmesis, and no patient experienced continued pain postoperat ively. All patients have been able to return to their preoperative activiti es. Conclusions. Compared with other major neurosurgical operations, segmental instrumentation for pediatric and adolescent spinal deformity is a safe pro cedure with minimal morbidity and there is a low risk of needing to use all ogeneic blood products.