Severe scoliotic deformities: results of surgical treatment and complications in a multicentric series of children and young adults

Purpose: The surgical management of severe spinal deformities (> 80°) in children and young adults remains challenging despite technical advances. Large, stiff curves with a short radius present a high complication rate, also in terms of acute or chronic spinal cord injury. There is a lack of consensus regarding the perioperative management of these curves, also due to the limited evidence available. This study aimed to review the strategies used in different hospitals for the surgical management of severe spinal deformities in young subjects and, in particular, to analyze the complication rate in a large series of patients. Methods: Multicentric, retrospective study on surgically treated patients younger than 25 with a coronal or sagittal deformity measuring at least 80°. Perioperative and radiographic data were collected. The rate of mechanical, neurologic, infectious, and other complications was analyzed, along with possible risk factors. Results: Data from 161 patients were analyzed. After surgery, there was a significant improvement of the deformity both on the coronal and sagittal plane. The overall complication rate was 25%. An increased angular ratio in the first postoperative X-ray was the main risk factor for the development of complications, along with a higher correction of the spinosacral angle. Performing a 3CO was associated with a higher risk of infections but not with a higher risk of mechanical complications. The use of an anterior approach did not increase the complication rate. A higher rate of non-mechanical and non-infectious complications was observed in patients who did not wear a brace or did not undergo halo traction before surgery. Conclusion: While spinal fusion is an effective treatment for the management of severe deformities, the rate of complications is still high.