title: Complications in operative Scheuermann kyphosis: do the pitfalls differ from operative adolescent idiopathic scoliosis?
abstract: METHODS
  A prospective multicenter database of operative patients with Scheuermann kyphosis (SK) with minimum 1-year follow-up was studied for major complications compared with contemporaneous operative patients with adolescent idiopathic scoliosis (AIS) from the database.
  
  
  OBJECTIVE
  To evaluate complications associated with current surgical techniques in SK and AIS.
  
  
  BACKGROUND
  There is a paucity of literature regarding complications associated with SK surgical treatment, but prior data suggest an elevated neurological risk.
  
  
  METHODS
  Complication rates were compared using analysis of variance and Fisher exact test analyses. Major complications were those that were life-threatening, caused spinal cord, nerve root, or ocular injury or required reoperation including surgical site infections. A binary logistic regression determined the likelihood of complications based on diagnosis, levels fused, blood loss, operative time, and length of stay.
  
  
  RESULTS
  Ninety-seven patients with SK (57 males; mean age, 16.5 yr; 75.3° mean kyphosis) and 800 patients with AIS (622 females; mean age, 14.9 yr; 55.6° mean curvature) met inclusion criteria. Patients with SK had significantly more major complications than those with AIS (16.3% vs. 2.3%; P < 0.001). The SK group had more infections (10.3% vs. 0.75%) and reoperations (14.4% vs. 1.4%) (P < 0.001). Operative time was longer and more levels were fused in the SK group (P < 0.001). Surgical site infection was the most common complication. There were no significant differences in length of stay or blood loss. Patients with SK were 3.9× more likely to have a major complication than those with AIS (odds ratio: 0.26, P = 0.003). The number of levels fused was an independent predictor of major complications: each additional level fused increased the odds of a complication by 36% in both groups (odds ratio: 1.36, P = 0.034).
  
  
  CONCLUSIONS
  Major complications are 3.9× more likely to occur in operative SK than in AIS. The number of levels fused is an independent risk factor for major complications. Patients with SK are at higher risk for infections and reoperation than those with AIS.
  
  
  METHODS
  2.
authors.affiliation: *Mount Sinai Medical Center, Beth Israel Hospital, New York, NY †New York University Hospital for Joint Diseases, New York, NY ‡Alfred I. duPont Hospital for Children, Wilmington, DE §Shriners Hospital for Children, Philadelphia, PA ¶Miami Children's Hospital, Miami, FL ∥Johns Hopkins Hospital, Baltimore, MD; and **Rady Children's Hospital San Diego, San Diego, CA.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.forename: Courtney S
authors.initials: CS
authors.lastname: Toombs
authors.forename: Michael
authors.initials: M
authors.lastname: Guss
authors.forename: Brian
authors.initials: B
authors.lastname: Braaksma
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.forename: Amer
authors.initials: A
authors.lastname: Samdani
authors.forename: Harry
authors.initials: H
authors.lastname: Shufflebarger
authors.forename: Paul
authors.initials: P
authors.lastname: Sponseller
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012544:Scheuermann Disease / Q000175:diagnosis / Q000601:surgery*; D012600:Scoliosis / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome