title: The superior mesenteric artery syndrome in patients with spinal deformity.
abstract: METHODS
  A retrospective review.
  
  
  OBJECTIVE
  To determine the incidence of the superior mesenteric artery syndrome (SMAS) after surgical correction for scoliosis and if it is influenced by newer derotation/translation surgical systems.
  
  
  BACKGROUND
  The SMAS is a known complication after surgery.
  
  
  METHODS
  Of 2939 charts reviewed, 17 patients between 1960 and 2002 matched inclusion criteria.
  
  
  RESULTS
  Our incidence of the SMAS was 0.5%. Onset of symptoms was 7.2 days. Several scoliosis diagnoses were included in the study group. Instrumentation that was used included: nondistraction systems (n = 14), Harrington rod with body cast (n = 1), Luque rod with sublaminar wires (n = 1), and casted in situ posterior spinal fusion (n = 1). Before surgery, 10 of 17 patients weighed less than the 50th percentile. Mean preoperative BMI was 18.6 kg/cm/cm. Postoperative height gain averaged 3.175 cm, and weight loss at onset of symptoms averaged 4.5 kg. There were 14 patients who required nasogastric suction for an average duration of 10.2 days, 11 required hyperalimentation, and 5 concurrently received hyperalimentation with enteric feeding. The SMAS recurred in 2 patients.
  
  
  CONCLUSIONS
  Postoperative weight loss appears to be more important for the development of the SMAS than asthenic body type. Newer derotation/translation corrective techniques have not eliminated the SMAS. Gastrointestinal imaging is indicated when nausea and vomiting occur 6-12 days after surgery, associated with early satiety and normal bowel sounds. Decompression and nutritional support remain the mainstays of treatment.
authors.affiliation: Department of Orthopaedic Surgery, Shriners Hospitals for Children, Chicago, IL, USA.
authors.forename: Haluk
authors.initials: H
authors.lastname: Altiok
authors.forename: John P
authors.initials: JP
authors.lastname: Lubicky
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: DeWald
authors.forename: Jean E
authors.initials: JE
authors.lastname: Herman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D016268:Internal Fixators / Q000009:adverse effects; D007441:Intubation, Gastrointestinal; D008297:Male; D018529:Nutritional Support; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013008:Somatotypes; D013396:Suction; D013478:Superior Mesenteric Artery Syndrome / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D015431:Weight Loss