Complications and outcomes of complex spine reconstructions in poliomyelitis-associated spinal deformities: a single-institution experience.
METHODS
Retrospective case series.


OBJECTIVE
To share our institutional experience with spinal reconstruction for deformity correction in patients with a history of poliomyelitis.


BACKGROUND
Polio and postpolio syndrome are not uncommonly related to a paralytic spinal deformity. Limited modern data exist regarding outcomes and complications after spinal reconstruction in this population.


METHODS
A clinical database was reviewed for patients undergoing spinal reconstruction for polio-associated spinal deformity at our institution from 1985 to 2012. Relevant demographic, medical, surgical, and postoperative information were collected from medical records and analyzed. Preoperative and last follow-up Scoliosis Research Society-22 Questionnaire scores were recorded.


RESULTS
A total of 22 patients with polio who underwent surgical deformity correction were identified. Mean age was 49 years (range, 12-74 yr), and 15 patients (68%) were female. Preoperative motor deficit was present in 14 of 22 (64%) patients. All patients underwent instrumented spinal fusion (mean, 13 vertebral levels, range, 3-18). Ten (10/22, 45%) patients developed major complications, and 4 patients (4/22, 18%) developed new postoperative neurological deficits. Neurological monitoring yielded a 13% false-negative rate. At 2-year follow-up, 20 of 22 patients maintained an average coronal correction of 25° (33%, P = 0.001) and sagittal correction of 25° (34%, P = 0.003). Minimum 2-year follow-up data were available for 11 of 22 (50%) patients. At an average of 72 months of follow-up (range, 28-134 mo), the mean Scoliosis Research Society-22 Questionnaire pain subscore improved from a mean of 2.75 to 3.6 (P = 0.012); self-image from 2.8 to 3.7 (P = 0.041); function from 3.1 to 3.8 (P = 0.036); satisfaction from 2.1 to 3.9 (P = 0.08); and mental health from 3.7 to 4.5 (P = 0.115).


CONCLUSIONS
Spine reconstruction for poliomyelitis-associated deformity was associated with high complication rates (54%) and sometimes unreliable neurological monitoring data. Despite this, patients undergoing spine reconstructions had significantly improved outcome scores. These data may help surgeons to appropriately counsel this complicated patient population.
From the Departments of *Orthopaedic Surgery and †Neurological Surgery, Washington University in St Louis, School of Medicine, St Louis, MO.
Jakub
J
Godzik
Lawrence G
LG
Lenke
Terrence
T
Holekamp
Brenda
B
Sides
Michael P
MP
Kelly
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011051:Poliomyelitis / Q000150:complications*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D011795:Surveys and Questionnaires; D055815:Young Adult