European Spine Journal

, Volume 15, Issue 8, pp 1230–1238 | Cite as

Surgical correction of spinal deformities after solid organ transplantation in childhood

  • Jari Peltonen
  • Ville Remes
  • Christer Holmberg
  • Hannu Jalanko
  • Ilkka Helenius
Original Article


A review of the current literature reveals no systematic analyses of the results of surgical correction of spinal deformity after pediatric organ transplantation. We therefore evaluated clinical and radiographic outcomes of spinal deformity correction after solid organ transplantation in childhood and adolescence. All 211 cases of heart, liver, and kidney transplantations performed in children in our country were reviewed. Six patients had undergone surgical correction of spinal deformity at a mean age 14.6 (range 12–17) years. Clinical data of the patients were evaluated. Radiographs of the whole spine were taken preoperatively, immediately after, at 2-year, and final follow-up visits. The Scoliosis Research Society (SRS) questionnaire was completed and a physical examination was performed at the final follow-up visit. The mean follow-up after spinal surgery was 4.9 years (range 2–7.6 years). Four patients developed scoliosis after organ transplantation without any evidence of scoliosis prior to organ transplantation. One patient with congenital scoliosis was operated on after kidney transplantation. One boy had osteoporosis and severe local kyphosis due to vertebral compression fractures. Four patients underwent anterior and posterior surgery, two posterior only. The mean preoperative Cobb angle of the thoracic curve was 54° (range 42–69°) in the patients with scoliosis. The postoperative values were 30° (26–38°) immediately after instrumentation and 39° (34–42°) at the final follow-up visit. The patient with vertebral compression fractures and progressive kyphosis had 70° curve before surgery, 23° immediately after the operation, and 60° at the final check up. The mean total score on the SRS questionnaire was 95.5 (range 90–101). There is a relatively high incidence (2.8%) of spinal deformities needing operative treatment after solid organ transplantation. Possible etiologies for spinal deformities are growth disturbance and muscle weakness due to the basic disease. The other important factors are related to immunosupressive medication, especially glucocorticoids needed after transplantation. Primary correction of these deformities was satisfactory, but during follow-up, a certain amount of recurrence of the curves was evident. Poor bone quality may explain some of the loss of correction.


Spinal deformity Solid organ transplantation Spinal surgery 


  1. 1.
    Barr SJ, Schuette AM, Emans JB (1997) Lumbar pedicle screws versus hooks. Results in double major curves in adolescent idiopathic scoliosis. Spine 22:1369–1379CrossRefPubMedGoogle Scholar
  2. 2.
    Beals RK, Kennedy KH, Lees MH (1972) Heart disease and idiopathic scoliosis. Clin Orthop 89:112–116PubMedGoogle Scholar
  3. 3.
    Belle SH, Beringer KC, Detre K (1996) An update on liver transplantation in the United States: recipient characteristics and outcome. In: Cecka JM, Terasaki PI (eds) Clinical transplants 1995. UCLA Tissue Typing Laboratory, Los Angeles, CAGoogle Scholar
  4. 4.
    Beneux J, Rigault P, Pouliquen JC, Duval-Beaupere G, Pasteyer J, Durand Y (1976) Scoliosis and congenital cardiopathies. Rev Chir Orthop Reparatrice Appar Mot 62:781–792PubMedGoogle Scholar
  5. 5.
    Benli IT, Akalin S, Aydin E, Baz A, Citak M, Kis M, Duman E (2001) Isola spinal instrumentation system for idiopathic scoliosis. Arch Orthop Trauma Surg 121:17–25CrossRefPubMedGoogle Scholar
  6. 6.
    Bitan F, Rigault P, Houfani B, Sidi D, Padovani JP, Merckx J, Durand Y (1991) Scoliosis and congenital heart diseases in children. Apropos of 44 cases. Rev Chir Orthop Reparatrice Appar Mot 77:179–188PubMedGoogle Scholar
  7. 7.
    Boode W, Semmekrot B, ter Laak H, van derv Burgt C, Draaisma J, Lommen E, Sengers R, van Wijk-Hoek J (1996) Myopathy in patients with a Noonan phenotype. Acta Neuropathol 92:597–602CrossRefPubMedGoogle Scholar
  8. 8.
    Bunnell WP (1984) An objective criterion for scoliosis screening. J Bone Joint Surg Am 66:1381–1387PubMedGoogle Scholar
  9. 9.
    Ceroni D, Beghett M, Spahr-Schopfer I, Faundez AA, Kaelin A (2001) Corrective surgery for idiopathic scoliosis after heart transplantation. Eur Spine J 10:454–457CrossRefPubMedGoogle Scholar
  10. 10.
    Cobb JR (1948) Outline for the study of scoliosis. In: Arbor A, Edwards JW (eds) Instructional course lectures. Am Acad Orthop Surg 5:261–275Google Scholar
  11. 11.
    Compston J (2003) The skeletal effects of liver transplantation in children. Liver Transpl 9:371–372CrossRefPubMedGoogle Scholar
  12. 12.
    Connolly BJ, von Schroder HP, Johnson GE, Kostuik JP (1995) Adolescent idiopathic scoliosis. Long-term effect of instrumentation extending to the lumbar spine. J Bone Joint Surg Am 77:1210–1216PubMedGoogle Scholar
  13. 13.
    Coran DL, Rodgers WB, Keane JF, Hall JE, Emasn JB (1999) Spinal fusion in patients with congenital heart disease. Predictors of outcome. Clin Orthop 364:99–107CrossRefPubMedGoogle Scholar
  14. 14.
    Dunn HK, Aiona MD (1982) Spinal instrumentation and fusion for idiopathic scoliosis in a renal transplant patient. A case report. Spine 7:177–179Google Scholar
  15. 15.
    Gazioglu K, Goldstein LA, Femi-Pearse D, Yu PN (1968) Pulmonary function in idiopathic scoliosis. J Bone Joint Surg Am 50:1391–1399Google Scholar
  16. 16.
    Haher TR, Gorup JM, Shin TM (1999) Results of the Scoliosis Research Society Instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine 24:1435–1440CrossRefPubMedGoogle Scholar
  17. 17.
    Helenius I, Remes V, Yrjönen T, Ylikoski M, Schlenzka D, Helenius M, Poussa M (2002) Comparison of long-term functional and radiologic outcomes after Harrington instrumentation and spondylodesis in adolescent idiopathic scoliosis. Spine 27:176–180CrossRefPubMedGoogle Scholar
  18. 18.
    Helenius I, Lamberg T, Österman K, Schlenzka D, Yrjönen T, Tervahartiala P, Seitsalo S, Poussa M, Remes V (2005) Scoliosis Research Society outcome questionnaire in evaluation of long-term surgical results in spondylolysis and low-grade isthmic spondylolisthesis in young patients. Spine 30:336–341CrossRefPubMedGoogle Scholar
  19. 19.
    Helenius I, Remes V, Yrjönen T, Schlenzka D, Ylikoski M, Schlenzka D, Helenius M, Poussa M (2005) Does gender affect outcome of surgery in adolescent idiopathic scoliosis? Spine 30:462–467CrossRefPubMedGoogle Scholar
  20. 20.
    Helenius I, Lamberg T, Österman K, Schlenzka D, Yrjönen T, Seitsalo S, Poussa M, Remes V (2005) Posterolateral, anterior or circumferential fusion in situ for high-grade spondylolisthesis in young patients. A long-term evaluation using Scoliosis Research Society questionnaire. Spine (in press)Google Scholar
  21. 21.
    Helenius I, Jalanko H, Remes V, Sairanen H, Salminen S, Holmberg C, Palmu P, Tervahartiala P, Valta H, Sarna S, Helenius M, Mäkitie O, Peltonen J (2005) Scoliosis after solid organ transplantation in children and adolescents. Am J Transpl (in press)Google Scholar
  22. 22.
    Hosenpud JD, Novick RJ, Bennett LE, Keck B, Fiol B, Daily OP (1996) The Registry of the International Society for Heart and Lung Transplantation: 13th Official Report—1996. J Heart Lung Transplant 15:655–674PubMedGoogle Scholar
  23. 23.
    Joshi GP, Tillmann Hein HA, Ramsay MAE, Foreman ML (1996) Hemodynamic response to anesthesia and pneumoperitoneum in orthotopic cardiac transplant recipients. Anesthesiology 85:929–932CrossRefPubMedGoogle Scholar
  24. 24.
    Liljenqvist U, Lepsien U, Hackenberg L, Niemeyer T, Halm H (2002) Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis. Eur Spine J 11:336–343CrossRefPubMedGoogle Scholar
  25. 25.
    Nissinen M, Heliövaara M, Ylikoski M, Poussa M (1993) Trunk asymmetry and screening for scoliosis: a longitudinal cohort study of pubertal schoolchildren. Acta Paediatr 82:77–82PubMedCrossRefGoogle Scholar
  26. 26.
    Pratt RK, Webb JK, Burwell RG, Cole AA (2001) Changes in surface and radiographic deformity after Universal Spine System for right thoracic adolescent idiopathic scoliosis: is rib-hump reassertion a mechanical problem of the thoracic cage rather than an effect of relative anterior spinal overgrowth? Spine 26:1778–1787CrossRefPubMedGoogle Scholar
  27. 27.
    Primiano FP, Nussbaum E, Hirschfeld SS (1983) Early echocardiographic and pulmonary function findings in idiopathic scoliosis. J Pediatr Orthop 3:475–481PubMedGoogle Scholar
  28. 28.
    Reckles LN, Peterson HA, Bianco AJ, Weidman JH (1975) The association of scoliosis and congenital heart defects. J Bone Joint Surg Am 57:449–455PubMedGoogle Scholar
  29. 29.
    Remes V, Helenius I, Peltonen J, Poussa M, Sovijarvi A (2002) Lung function in diastrophic dysplasia. Pediatr Pulmonol 33:277–282CrossRefPubMedGoogle Scholar
  30. 30.
    Remes V, Helenius I, Yrjönen T, Schlenzka D, Ylikoski M, Poussa M (2004) Cotrel–Dubousset (CD) or Universal Spine System (USS) instrumentation in adolescent idiopathic scoliosis (AIS): comparison of midterm clinical, functional, and radiologic outcomes. Spine 29:2024–2030CrossRefPubMedGoogle Scholar
  31. 31.
    Sarna S, Laine J, Sipilä I, Koistinen R, Holmberg C (1995) Differences in linear growth and cortisol production between liver and renal transplant recipients on similar immunosuppression. Transplantation 60:656–662PubMedCrossRefGoogle Scholar
  32. 32.
    Warady BA, Hebert D, Sullivan EK, Alexander ST, Tejani A (1997) Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents: the 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11:49CrossRefPubMedGoogle Scholar
  33. 33.
    Westgate HD, Moe JH (1969) Pulmonary function in kyphoscoliosis before and after correction by the Harrington instrumentation method. J Bone Joint Surg Am 51:935–946PubMedGoogle Scholar
  34. 34.
    Ylikoski M, Tallroth K (1990) Measurement variations in scoliotic angle, vertebral rotation, vertebral body height, and intervertebral disc height space. J Spinal Disord 3:387–391PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Jari Peltonen
    • 1
  • Ville Remes
    • 1
    • 2
  • Christer Holmberg
    • 1
  • Hannu Jalanko
    • 1
  • Ilkka Helenius
    • 1
  1. 1.Hospital for Children and AdolescentsHelsinki University Central HospitalHelsinkiFinland
  2. 2.Surgical HospitalHelsinki University Central HospitalHelsinkiFinland

Personalised recommendations