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Titel på arbejdetPediatric Spinal Deformity Surgery – diagnostic challenges and postoperative morbidity
NavnSidsel Fruergaard
Afdeling / StedOrthopedic Department, Spine Unit, Rigshospitalet
UniversitetCopenhagen University
  • Spine Surgery
Abstract / Summary

Pediatric spinal deformities (PSDs) are complex but can be classified according to age of onset, etiology and radiological landmarks. The deformities may be classified as either idiopathic
deformity, congenital deformity, neuromuscular deformity, syndromic deformity, spondylolisthesis or as Scheuermann’s kyphosis. Curve progression, pain, neurological deficit, and cardiopulmonary compromise are indications for corrective surgery. The surgical strategy in pediatric scoliosis has evolved with the development of all-pedicle screw constructs, growing rod technologies and increasing use of osteotomies. Compared to adult spinal surgery, the morbidity and mortality rates are relatively low after PSD surgery but is highly dependent on the underlying etiology. With the increasing number of PSD procedures, the recognition of a uniform diagnostic evaluation as well as peri- and postoperative complications is critical for optimal patient counseling and quality assurance measures.
This thesis explores the diagnostic challenges and the surgical safety in patients with pediatric spinal deformity.

Study I is a retrospective study of 381 patients referred for evaluation of adolescent idiopathic scoliosis (AIS) and enrolled in an MRI-protocol for assessment of neural axis abnormalities (NAAs). The prevalence of NAAs was 8.9%, which did not vary with curve severity or treatment modality. In addition to this, it was not possible to validate previously proposed clinical and radiographical risk factors for NAAs. The reported NAAs did not have any clinical implication, neither did the NAAs result in surgical alterations or postoperative neurological deficits.

Study II is a nationwide register study of patients aged 0–21 years undergoing primary PSD surgery within a ten-year period. Data were retrieved from the Danish National Patient Registry
(DNPR) and included length of stay, 90-day readmission and mortality. The most common reason for extended length of stay was pain and mobilization issues. Mortality and 90-day readmission risk
were low and the most common reason for readmission was infection unrelated to the surgical site.
Finally, risk factors for readmission were an etiology of neuromuscular disease, spondylolisthesis, Scheuermann’s kyphosis and extended length of stay during index admission.

Study III focused on surgical revision risk within two years following primary PSD surgery. Data were retrieved from the DNPR and all medical records were reviewed for reason for revision. The
cumulative two-year revision risk was 9.5% and differed markedly across etiologies. Risk factors for revision were an etiology of congenital deformity, spondylolisthesis and Scheuermann’s
kyphosis. The most common reason for revision was implant failure followed by implant misplacement/prominence, however, this varied markedly across etiologies.

In conclusion, this thesis provides new and valuable information to improve the diagnostic evaluation and the safety in the postoperative period. This will hopefully lead to multidisciplinary
initiatives to further improve the overall safety of PSD surgery.

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