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Reduced complication rate with simultaneous detethering and spinal deformity correction surgery compared to staged surgeries in patients with early onset scoliosis

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Abstract

Purpose

In patients with early onset scoliosis (EOS) and intraspinal anomalies, surgery may be necessary for both the tethered spinal cord (TSC) and spinal deformity. The purpose of this study was to determine if there is a difference in complications when TSC release and surgery for spinal deformity correction (SDC) are performed separately compared simultaneously.

Methods

EOS patients with TSC who underwent detethering and SDC surgeries were identified through a multicenter registry. Patients were stratified into two groups. The simultaneous cohort consisted of patients receiving both detethering and SDC surgeries in a single anesthetic event on the same day, and the staged cohort consisted of patients undergoing detethering and SDC on two separate occasions. Postoperative complications up to 180 days for either surgery were assessed.

Results

Twenty five (65.8%) patients were staged and 13 (34.2%) underwent a simultaneous approach. Percent curve correction following SDC surgery did not significantly differ between the groups (p = 0.36). Within 90 days postoperatively, 16 complications in 11 patients (44.0%) occurred in the staged group, whereas no complications occurred in the simultaneous cohort (p = 0.006). From 90-days to 180-days postoperatively, 4 additional complications in 3 patients (12.0%) occurred in the staged group, with no complications reported in the same timeframe for the simultaneous cohort.

Conclusion

To our knowledge, this is the largest multicenter comparative study to date, and it suggests that a simultaneous approach can be performed safely for EOS patients undergoing detethering and SDC surgeries, with a potentially lower risk profile than the traditional staged approach to these pathologies.

Level of Evidence: Level III.

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Data availability

The data that support the findings of this study are available from the corresponding author, TQ, upon reasonable request.

Code availability

Not applicable.

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Funding

This work was conducted without the support of additional funding.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA

    Jennifer Kunes, Theodore Quan, Adam N. Fano, Hiroko Matsumoto & Michael G. Vitale

  2. Department of Neurosurgery, Intermountain Primary Children’s Hospital, University of Utah, Salt Lake City, UT, 84113, USA

    Rajiv Iyer

  3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    Hiroko Matsumoto

  4. Department of Orthopaedics, Children’s Hospital Colorado, Aurora, CO, 80045, USA

    Mark Erickson

  5. Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR, 72205, USA

    Richard McCarthy

  6. Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84113, USA

    Douglas Brockmeyer

  7. New York University, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, 10016, USA

    Richard C. E. Anderson

  8. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA

    Michael G. Vitale

Authors
  1. Jennifer Kunes
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  2. Theodore Quan
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  3. Rajiv Iyer
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  4. Adam N. Fano
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Consortia

Pediatric Spine Study Group

Contributions

JK, TQ, RI, ANF, HM, ME, RM, DB, RCEA, MGV, Pediatric Spine Study Group, made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data. Drafted the work or revised it critically for important intellectual content. Approved of the version to be published. Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Theodore Quan.

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Conflict of interest

Dr. Brockmeyer reports personal fees from Occipitocervical plate outside the submitted work. Dr. Matsumoto reports personal fees from Pediatric Spine Foundation, grants from Scoliosis Research Society, grants from Pediatric Orthopaedic of North America outside the submitted work. Dr. Erickson reports personal fees from Medtronic and Nuvasive outside the submitted work. Dr. McCarthy reports personal fees from Medtronic and OrthoPediatrics outside the submitted work. Dr. Vitale reports non-financial support from Pediatric Spine Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation, grants and other from Children’s Spine Foundation, grants from Orthopaedic Scientific Research Foundation, grants and other from POSNA, other from OMeGA, personal fees from Stryker, personal fees from Biomet, personal fees from Nuvasive outside of the submitted work. Pediatric Spine Study Group reports support from Zimmer Biomet, DePuy Synthes Spine, Pediatric Spine Foundation, OrthoPediatrics, Nuvasive, Medtronic, Globus Medical Inc., and Stryker during the conduct of the study. The other authors have no conflicts of interest to disclose.

Ethics approval

This study was approved by the Columbia University Institutional Review Board under protocol AAAB5378. It was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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All patient information is deidentified. Not applicable.

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Kunes, J., Quan, T., Iyer, R. et al. Reduced complication rate with simultaneous detethering and spinal deformity correction surgery compared to staged surgeries in patients with early onset scoliosis. Spine Deform 10, 1473–1480 (2022). https://doi.org/10.1007/s43390-022-00550-4

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