Complex Pediatric Thoracolumbar Spinal Deformity: Neurosurgical Management

Surgical management of complex pediatric spinal deformity is increasingly performed by neurosurgeons. We present our experience in scoliosis (18–idiopathic, 4–neuromuscular, 1–neurofibromatosis) and severe kyphoscoliosis (2– congenital, 1–segmental spinal dysgenesis, 1–post laminectomy) and I grade IV spondylolisthesis. We prospectively evaluated the preoperative percent curve correction, operative time, blood loss, transfusion requirements, and complications. Follow–up averaged 14.3 months (7.1–27.1). All patients had their deformity corrected with anterior (Kaneda scoliosis system or Isola) or posterior (C–D Horizon) instrumentation with arthrodesis. Patients only received directed donation or autogenic blood products. Deformity correction averaged 57 percent in patients with idiopathic scoliosis, 58 percent in non–idiopathic scoliosis, and 70 percent in kyphoscoliosis. The patient with grade IV spondylolisthesis had an 87 percent kyphotic angle correction. Complications in this series include one patient with inferior hook displacement requiring revision. Another patient with King II thoracolumbar scoliosis developed progression of her lumbar curve after T1 –T12 instrumentation. Her construct was extended to L4 and since has done well. One patient developed acute hydrocephalus after his shunt became disconnected due to traction placed on it after curve correction. No case was complicated by neurological deterioration, loss of SSEPS, cardiopulmonary disease, infection, donor site complication or wound breakdown. A detailed analysis of postoperative outcomes reveals significant improvement in cosmesis and no patient with continued postoperative pain. All patients have been able to return to their preoperative activities. Compared with other major operations, segmental instrumentation for pediatric deformity is a safe procedure with minimal morbidity and low risk of allogeneic blood products.