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Perioperative complications after posterior spinal fusion versus minimally invasive fusionless surgery in neuromuscular scoliosis: a comparative study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Early-onset scoliosis is a common deformity in neuromuscular disease. When conservative treatment becomes ineffective, several surgical options can be proposed. The most common technique is posterior spinal fusion (PSF) consisting of performing a multiple segmental instrumentation with pedicular screws on the full spine associated with decortication and bone graft. Minimally invasive fusionless surgery (MIFS) is an alternative to correct and fix definitively the spine without graft. The objective of this study was to compare early surgical inpatient period between PSF and MIFS in neuromuscular scoliosis.

Material and methods

140 NMS operated by PSF or MIFS between 2012 and 2017 was retrospectively reviewed. The following data were compared between groups: general characteristics (age, sex, etiology), preoperative preparation (halo traction, noninvasive ventilation or tracheostomy), Cobb angle and pelvic obliquity correction, use of drugs (vasopressor and/or inotropes, expansion fluids, transfusion and volumes), postoperative complications, and need of noninvasive ventilation.

Results

75 patients were managed by PSF with a mean age of 14.3 ± 2.3y and 65 by MIFS with a mean age of 11.8 ± 3y. Average pelvic obliquity and major curve correction were similar postoperatively. Intraoperative blood transfusion was significantly more common in PSF group (OR, 14; 95% CI [6.3–33.0]). Vasopressors were used non-significantly more often in the PSF group and expansion fluids similar in the two groups. PSF group had more overall complications (OR, 4.6; 95% CI [2.3–9.8]), more infections (OR, 3.6; 95% CI [1.5–9.3]) and more hemodynamic complications (OR, 4.1; 95% CI [1.4–15.1]). Average intubation duration was 5 days in the PSF and 4 days in MIFS (p = 0.05).

Conclusion

In this series of neuromuscular patients, the complication rate was reduced in MIFS comparatively to PSF, with lower blood transfusion and less infections.

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Data availability

The data underlying this study are available on request.

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Pediatric Orthopedic Surgery Department, Necker University Hospital, APHP, 149 Rue de Sevres, 75015, Paris, France

    Mathilde Gaume, Christophe Glorion & Lotfi Miladi

  2. University of Paris, Paris, France

    Mathilde Gaume, Gilles Orliaguet, Christophe Glorion & Lotfi Miladi

  3. Pediatric Intensive Care, Raymond Poincaré University Hospital, APHP, Garches, France

    Josiane Njiki, Aben Essid, Blaise Mbieleu, Justine Zini, Isabelle Desguerre & Jean Bergounioux

  4. INSERM CIC1429, Raymond Poincaré University Hospital, APHP, Garches, France

    Isabelle Vaugier

  5. Pediatric Anesthesiology Department, Necker University Hospital, APHP, Paris, France

    Gilles Orliaguet

  6. Pediatric Neurology, Physical Medicine, and Rehabilitation Department, Raymond Poincaré University Hospital, APHP, Garches, France

    Delphine Verollet & Susana Quijano-Roy

  7. Pediatric Neurology and ICU, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, 92380, Garches, France

    Abdallah Fayssoile

  8. Versailles Saint Quentin en Yvelines University, Versailles, France

    Abdallah Fayssoile, Susana Quijano-Roy & Jean Bergounioux

  9. Pediatric Neurology Departments, Necker University Hospital, APHP, Paris, France

    Isabelle Desguerre

Authors
  1. Mathilde Gaume
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  2. Josiane Njiki
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  3. Isabelle Vaugier
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  8. Blaise Mbieleu
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  9. Justine Zini
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  10. Abdallah Fayssoile
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  12. Isabelle Desguerre
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  13. Lotfi Miladi
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  14. Jean Bergounioux
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Contributions

MG: contribution: manuscript drafting, data acquisition and interpretation, revision for important intellectual content, approval of the version to be published. JN: contribution: manuscript drafting data acquisition and interpretation, revision for important intellectual content, approval of the version to be published. GO: contribution: approval of the version to be published. DV: contribution: approval of the version to be published. CG: contribution: data acquisition, approval of the version to be published. AE: contribution: data acquisition, approval of the version to be published. BM: contribution: data acquisition, approval of the version to be published. JZ: contribution: data acquisition, approval of the version to be published. AF: contribution: data acquisition, approval of the version to be published. SQR: contribution: data acquisition, approval of the version to be published. ID: contribution: data acquisition, approval of the version to be published. LM: contribution: revision for important intellectual content, approval of the version to be published. JB: contribution: manuscript drafting data acquisition and interpretation, revision for important intellectual content, approval of the version to be published.

Corresponding author

Correspondence to Mathilde Gaume.

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No conflict of interest to declare.

Ethical approval

All the procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration. Informed consent was obtained from all the individual participants included in the study. Ethical approval: CPP, ID-EUDRACT # 2014 A019043 44.

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Gaume, M., Njiki, J., Vaugier, I. et al. Perioperative complications after posterior spinal fusion versus minimally invasive fusionless surgery in neuromuscular scoliosis: a comparative study. Arch Orthop Trauma Surg 143, 4605–4612 (2023). https://doi.org/10.1007/s00402-022-04727-4

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