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Poster from the 2006 SRS Annual Meeting
Study Design: We performed a retrospective review of 165 consecutive
pediatric patients who underwent spine deformity surgery. Objective: To investigate
the prevalence of superior mesenteric artery (SMA) syndrome.
Summary of Background Data: Obstruction of the third part
of the duodenum by the SMA is associated with spinal manipulation in the surgical
or conservative management of scoliosis. Methods: The study group comprised
85 patients with idiopathic scoliosis, 20 patients with neuromuscular and 18
patients with miscellaneous or syndromic scoliosis, and 42 patients with congenital
spine deformities. The medical records and imaging tests were reviewed.
Results: Posterior spine arthrodesis was performed in 94 patients,
combined anterior/posterior in 60 patients, and anterior spinal fusion in 11
patients. We identified 4 patients who developed SMA syndrome postoperatively.
These were all markedly underweight, adolescent females; 2 patients had adolescent
idiopathic scoliosis, one had neuromuscular, and one congenital scoliosis. Third
generation instrumentation systems with derotational effect were used in 3 patients.
The spine arthrodesis in the patient with neuromuscular scoliosis was performed
using bone graft followed by application of a spinal jacket. The symptoms developed
at a mean of 3.7 days post-surgery and included nausea, vomiting, increased
nasogastric aspirates, abdominal pain and distension. Conservative management
with prolonged nasojejunal feedings achieved resolution of the symptoms in all
but one patient, who required derotation of the duodenum and jejunum. There
was no evidence of recurrence of the condition in any patient.
Conclusions: The prevalence of SMA syndrome in our series
was 2.4%. This draws attention to the significance of prevention of the condition
by recognizing patients who are at a higher risk. An early diagnosis of the
syndrome will allow for application of conservative methods and will increase
the chances for a successful outcome.
Table 1. Presentation of our study population and the type of surgery
that was performed.
| Diagnosis |
No. of patients |
PSF with instrument-
ation |
PSF without instrument-
ation |
A/PSF with instrument-
ation |
A/PSF without instrument-
ation |
ASF with instrument-
ation |
| Idiopathic scoliosis |
85 |
44 |
0 |
31 (two-stage) |
0 |
10 |
| Neuromuscular scoliosis |
20 |
13 |
0 |
5 (two-stage) |
1 (two-stage) |
1 |
| Congenital spine deformity |
42 |
8 |
17 |
3 (two-stage: 2, one-stage 1) |
14 (one-stage) |
0 |
| Miscellaneous / syndromic scoliosis |
18 |
12 |
0 |
6 (two-stage) |
0 |
0 |
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