Morbidity and mortality in the surgical treatment of six hundred five pediatric patients with isthmic or dysplastic spondylolisthesis.
METHODS
Retrospective analysis of prospectively collected database.


OBJECTIVE
To analyze the rate of complications, including neurologic deficits, associated with operative treatment of pediatric isthmic and dysplastic spondylolisthesis.


BACKGROUND
Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon dis-orders. Several prior studies have suggested a high rate of complication associated with operative intervention. How-ever, most of these studies were performed with sufficiently small sample sizes such that the presence of one complication could significantly affect the overall rate. The Scoliosis Research Society (SRS) prospectively collects morbidity and mortality (M&M) data from its members. This multicentered, multisurgeon database permits analysis of the surgical treatment of this relatively rare condition on an aggregate scale and provides surgeons with useful information for preoperative counseling.


METHODS
Patients who underwent surgical treatment for isthmic or dysplastic spondylolisthesis from 2004 to 2007 were identified from the SRS M&M database. Inclusion criteria for analysis included age ≤ 21 and a primary diagnosis of isthmic or dysplastic spondylolisthesis.


RESULTS
Of 25,432 pediatric cases reported, there were a total of 605 (2.4%) cases of pediatric dysplastic (n ∇ 62, 10%) and isthmic (n ∇ 543, 90%) spondylolisthesis, with a mean age of 15 years (range, 4-21). Approximately 50% presented with neural element compression, and less than 1% of cases were revisions. Surgical procedures included fusions in 92%, osteotomies in 39%, and reductions in 38%. The overall complication rate was 10.4%. The most common complications included postoperative neurologic deficit (n ∇ 31, 5%), dural tear (n ∇ 8, 1.3%), and wound infection (n ∇ 12, 2%). Perioperative deep venous thrombosis and pulmonary embolus were reported in 2 (0.3%) and 1 (0.2%) patients, respectively. There were no deaths in this series.


CONCLUSIONS
Pediatric isthmic and dysplastic spondylolisthesis are relatively uncommon disorders, representing only 2.4% of pediatric spine procedures in the present study. Even among experienced spine surgeons, surgical treatment of these spinal conditions is associated with a relatively high morbidity.
Fu
Kai-Ming G
KM
Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
Smith
Justin S
JS
Polly
David W
DW
Perra
Joseph H
JH
Sansur
Charles A
CA
Berven
Sigurd H
SH
Broadstone
Paul A
PA
Choma
Theodore J
TJ
Goytan
Michael J
MJ
Noordeen
Hilali H
HH
Knapp
D Raymond
DR
Hart
Robert A
RA
Donaldson
William F
WF
Boachie-Adjei
Oheneba
O
Shaffrey
Christopher I
CI
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data*; D006801:Humans; D009017:Morbidity; D009422:Nervous System Diseases / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D013168:Spondylolisthesis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult