Early Complications Associated with Endoscopic Anterior Spinal Fusion and Instrumentation and Their Treatment

PURPOSE: To evaluate the early complications following endoscopic anterior spinal fusion with instrumentation and the methods used to treat them.

METHODS: 33 patients mean 14.7 years with idiopathic scoliosis who underwent endoscopic anterior spinal fusion were retrospectively reviewed. Follow up was 13months (2months – 31 months) to evaluate early complications.

RESULTS: The average preoperative curve 48 degrees corrected to 20degrees. Levels fused ranged from T5 – L1. All disc spaces were grafted: 10 autologous iliac grafts; 17 autologous ribs; 6 cancellous allografts. There were 18 complications: rods fractured in 7 cases (2 iliac, 3 rib, 2 allograft) 5 requiring posterior fusion; screws loosened in 4 cases one requiring fusion posteriorly; 3 wound infections all treated with oral antibiotics; 2 capture screw loosening: one fused posteriorly and one explored and repositioned, 1 tension pneumothorax requiring a chest tube, 1 persistent pleural effusion treated with thoracentesis, 1 lost SSEP requiring instrumentation removal and posterior fusion.

CONCLUSIONS: Anterior spinal instrumentation with fusion has a steep learning curve and carries with it a very high early complication rate.