Scoliosis Neurological Deficit and Death Rates | KK Women's and Children's Hospital

The department of Orthopaedic Surgery at KKH treats a wide range of musculoskeletal pathologies in children and adolescents. These include fractures, congenital conditions, paediatric tumours and sporting injuries. One of the most common conditions treated is scoliosis, of which adolescent idiopathic scoliosis is the most common. Surgery is indicated in severe cases to correct and prevent progression of the scoliotic curves.

Amongst the known complications associated with surgery for severe scoliosis, neurological complications and death remained the most serious and feared. Fortunately, these complications are relatively uncommon.

Neurological complications during and following scoliosis surgery range from mild transient neuropraxias to complete cord injuries with paralysis. The reported rate of neurologic deficits following scoliosis surgery has been reported to be 0.73%¹ overall, and 0.26-1.75%² specifically in AIS cases. All scoliosis surgeries are performed under intraoperative neuromonitoring, which remains the standard of care worldwide.

The incidence of death during or following scoliosis surgery in an otherwise healthy patient is less than 1%³. Reported causes of death in this patient group include pulmonary complications⁴ and peritonitis⁵. Within the non-idiopathic group, the most common type of scoliosis managed at KKH is neuromuscular. The post-operative 30 and 90-day mortality rate in this group has been reported to be 0% and 0.001% respectively⁶.

The incidence of neurological complications and death following scoliosis surgery remains at 0% when compared to internationally published rates and when compared to international benchmarks provided by the Scoliosis Research Society (SRS), a world-renowned international society with a commitment to research and education in the field of spinal deformities.

Conclusion

A deep appreciation of spinal anatomy, in conjunction with advanced and modern intraoperative imaging and navigation techniques are essential in reducing the incidence of neurological complications and death during spinal surgery for severe scoliosis.

References:

Hamilton DK, Smith JS, Sansur CA et al. Rates of new neurological deficit associated with spine surgery based on 108,419 procedures: A report of the Scoliosis research Society Morbidity and Mortality Committee. Spine. 2011; 36:1218-1228.
Coe JD, Arlet V. Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis research Society Morbidity and Mortality Committee. Spine. 2006; 345-349.
Bradford DS, Tay BK, Hu SS. Adult scoliosis: surgical indications, operative management, complications and outcomes. Spine. 1999; 24:2617-2627
McDonnell MF, Glassman SD, Dimar JR et al. Perioperative complications of anterior procedures on the spine. Journal of Bone and Joint Surgery 1996; 76A: 839-847.
Mielke CH, Lonstein JE, Denis F et al. Surgical treatment of AIS: A comparative analysis. Journal of Bone and Joint Surgery 1989; 71-A:1170-1177.
Matsumoto H, Fano AN, Herman ET et al. Mortality in Neuromuscular Early Onset Scoliosis Following Spinal Deformity Surgery. J Pediatr Orthop 2022; 1;42(3):e:234-e241

Orthopaedic Surgery/Spine surgery - Scoliosis Neurological Deficit and Death Rates