Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Table 1 Demographic data from the reviewed articles

	Ref.	Construct	Subject	Sex (male/female)	Age at IP	Follow up	Diagnosis	No of patient with final spinal fusion	Comments, kind of complication analyzed
1	Bess et al[15], 2010	TGR	140	71/59	6	5.0	Neuromuscular (n = 52), idiopathic (n = 40), congenital (n = 24), and other (n = 24)	50	W, I, A, M
2	Du et al[16], 2020		167	69/98	7,2	10.7	Idiopathic (n = 45), neuromuscular (n = 56), syndromic (n = 43), congenital (n = 21), other (n = 2)	167	Analyzed patients who had undergone a FF after growing-rod treatment, W, I, A, M
3	Andras et al[13], 2015		36	nd	6.1	4.3	Syndromal (n = 10), idiopathic (n = 11), congenital (n = 2), neuromuscular (n = 13)	nd	I, M
4	Myung et al[17], 2014		159	nd	5	4.7	Neuromuscular (n = 46), congenital (n = 42), idiopathic (n = 37), syndromal (n = 34)	nd	I
5	Arandi et al[18], 2014		175	78/97	5.9	5.2	Idiopathic (n = 69), syndromal (n = 62), neuromuscular (n = 44)	nd	I
6	Liang et al[19], 2015		55	16/39	6.8	38.4	Congenital (n = 28), idiopathic (n = 6), syndromal (n = 8), neuromuscular (n = 6) and miscellaneous disorders (n = 7)	10	W, I, A, M
7	Ramirez et al[20], 2020		67	32/35	6	4.1	Only non-ambulatory neuromuscular early-onset scoliosis	nd	W, I, M
8	Yamaguchi et al[21], 2014		176	nd	nd	4.7	Congenital (n = 48), neuromuscular (n = 42), syndromal (n = 37), idiopathic scoliosis (n = 32) and miscellaneous (n = 17)	nd	I
9	Poe-Kochert et al[22], 2016		100	42/58	7	4.3	Neuromuscular (n = 38), syndromic (n = 31), idiopathic (n = 22), congenital (n = 9)	100	Analyzed patients who had undergone a FF after growing-rod treatment; W, I
10	Kabirian et al[23], 2014		379	177/202	6.3	5.3	nd	nd	Only deep infection analyzed
11	Hosseini et al[24], 2018		274	114/160	6.7	6.3	Neuromuscular (n = 84), congenital (n = 43), syndromic (n = 89), idiopathic (n = 58)	nd	I
12	Johnston et al[25], 2013		27	nd	5.3	4.5	Neuromuscular (n = 6), idiopathic (n = 11), syndromic (n = 10)	6	Comparing with cast treatment, complications in total
13	Bachabi et al[11], 2020		50	nd	5.5	8.3	nd	nd	W, I, A, M
14	Luhmann et al[14], 2017		18	18	7.7	7.4	Idiopathic (n = 9), neuromuscular (n = 7), syndromic (n = 1), congenital (n = 1)	17	W, I, M
15	Akbarnia et al[10], 2014		12	5	6.5	4.1	Not given	nd	W, I, M
16	Harris et al[8], 2020		353	nd	6	6.0	Not given	nd	I, TGR -318 cases, 35 -VEPTR cases
17	Helenius et al[9], 2018		214	94/120	5.6	6.0	Neuromuscular (n = 68), congenital (n = 28), syndromic (n = 74), idiopathic (n = 44)	49	W, I, M TGR cases 198) MCGR cases 16
18	Gadepalli et al[26], 2011	VEPTR	26	16/10	7.58	7.0	Congenital or infantile scoliosis (n = 12), neuromuscular scoliosis (n = 5), unspecified structural thoracic disorder (n = 7), Jeune syndrome (n = 2)	nd	W, I, M
19	Bachabi et al[11], 2020		22	nd	4.3	7.7	nd	nd	W, I, M
20	Crews et al[27], 2018		151	16/6	7.1	3+	nd	nd	Only SSIs following VEPTR implant or revision surgeries were identified
21	Murphy et al[28], 2016		25	12/13	5.7	4.5	Congenital (n = 25)	nd	W, I, M
22	Berger-Groch et al[29], 2020		13	7/6	2.2	7.6	Congenital (n = 13)	nd	W, I, M
23	Hasler et al[30], 2010		23	8/15	6.5	3.6	Early onset idiopathic scoliosis (n = 1), neuromuscular (n = 11), post-thoracotomy scoliosis (n = 2), Sprengel deformity (n = 1), hyperkyphosis (n = 2), myopathy (n = 1), syndromic (n = 5)	nd	W, I, A, M
24	Latalski et al[31], 2011		12	nd	5.25	2.5	Congenital (n = 3), neuromuscular (n = 9)	0	W, I, A, M
25	Hell et al[32], 2005		15	8/7	6	nd	Congenital (n = 9), neuromuscular (n = 6)	0	W, I, M
26	Garg et al[33], 2014		103	57/46	5.3		Neuromuscular (n = 30), congenital (n = 44), syndromic (n = 18), idiopathic (n = 11)		Only wound complications following VEPTR implant or revision surgeries were identified
27	Waldhausen et al[34], 2016		65	nd	6.9	6.9	Congenital (n = 23), neuromuscular (n = 12), syndromic (n = 14), idiopathic (n = 2), other (n = 14)	28	W, I, M
28	Striano et al[35], 2019		166		6.81		Neuromuscular (n = 61), syndromic (n = 38), congenital (n = 64), idiopathic (n = 3)	nd	Only wound complications following VEPTR implant or revision surgeries were identified
29	Lucas et al[36], 2013		54	21/33	7	2.0	Neuromuscular (n = 19), congenital (n = 30), syndromic (n = 7), idiopathic (n = 3)	nd	W, I, A, M
30	Garg et al[37], 2016		38	22/16	5.51	4.1	Neuromuscular (n = 18), congenital (n = 13), syndromic (n = 5), idiopathic (n = 2)	nd	Only wound complications following VEPTR implant or revision surgeries were identified
31	Subramanian et al[38], 2018	MCGR	31	15/16	7.7	3.9	Neuromuscular (n = 4), syndromic (n = 19), idiopathic (n = 6), congenital (n = 2)	nd	W, I, A, M
32	Urbański et al[39], 2020		47	14/18	8.8	1-2.5	Neuromuscular (n = 10), syndromic (n = 11), idiopathic (n = 20), congenital (n = 6)	0	W, I, A, M
33	Akbarnia et al[10], 2014		12	5/7	6.8	2.5	Neuromuscular (n = 4), syndromic (n = 4), idiopathic (n = 3), congenital (n = 1)	nd	I, M
34	Studer et al[40], 2019		30	10/20	9.4	2.1	Congenital (n = 11), neuromuscular (n = 10), syndromic (n = 4), idiopathic (n = 5)	nd	W, I, A
35	Kwan et al[41], 2017		30	11/19	7.3	3.0	Syndromal (n = 8), idiopathic (n = 8), congenital (n = 6), neuromuscular (n = 8)	5	W, I, A,
36	Obid et al[42], 2020		22	4/18	9.5	4.0	Idiopathic (n = 14), neurofbromatosis (n = 2), neuromuscular and syndromic (n = 6)	9	W, I, A, M
37	Lampe et al[43], 2019		24	7/17	10.5	3.5	Syndromal (n = 4), idiopathic (n = 9), congenital (n = 1), neuromuscular (n = 10)	nd	W, I, A, M
38	Haapala et al[12], 2020		18	11/7	6.8	3.2	Neuromuscular (n = 12) II, syndromic (n = 8) EOS two NFI (n = 2)	5	I, A, M
39	Haapala et al[12], 2020	Shilla	13	8/5	6	4.0	Neuromuscular (n = 11), syndromic (n = 2)	4	W, I, M
40	Andras et al[13], 2015	Shilla	36	nd	6.1	4.6	Syndromal (n = 10), idiopathic (n = 11), congenital (n = 2), neuromuscular (n = 13)	nd	I, M
41	Nazareth et al[44], 2020	Shilla	20	10/10	5.7	5.2	Syndromic (n = 9), neuromuscular (n = 5), idiopathic (n = 3), congenital (n = 3).	7	W, I, M
42	Miękisiak et al[45], 2019	GGS	57	13/44	9.8	2+	Not given	nd	GGS – the same principle as Shilla. System made of Ti. W, I, A, M
43	McCarthy et al[46], 2014	Shilla	10	2/8	7.5	2.0	Idiopathic (n = 3), congenital scoliosis (n = 1), syndromic (n = 2), neuromuscular scoliosis (n = 4)	nd	W, I
44	Luhmann et al[14], 2017	Shilla	18	nd	7.9	6.1	Idiopathic (n = 8), neuromuscular (n = 7), syndromic (n = 3)	15 and 3 implant removals	W, I, M
45	McCarthy et al[47], 2015	Shilla	40	17/23	6.11	5.0	Idiopathic (n = 9), congenital (n = 1), neuromuscular (n = 16), syndromic (n = 14)	15 and 3 Implant removals	W, I, A

Type of complications: Wound (W), implant-related (I), alignment (A), and medical/surgical complications (M). FF: Final fusions; GGS: Growth guidance system; VEPTR: Vertical expandable prosthetic titanium ribs; TGR: Traditional growing rods; MCGR: Magnetically controlled growing rods.

Table 2 The number of planned and unplanned surgical procedures in the traditional growing rods group

Ref.	Subject	Surgical procedures (n)	Planned surgical procedures (n)	Unplanned surgical procedure		% unplanned surgeries to all surgeries	% unplanned surgery to patients with at least one complication	Ratio of planned to unplanned surgery
				n	%
Bess et al[15], 2010	140	897	823	74	52.92	8.22	91.42	11.12
Du et al[16], 2020	167	199	167	32	19.23	16.13	100.03	5.22
Andras et al[13], 2015	36	288	259	29	80.6	10.1	100.0	8.9
Myung et al[17], 2014	159	10811	10501	311	19.5	2.9	83.8	33.87
Arandi et al[18], 2014	175	12471	1190	571	32.6	4.6	71.3	20.88
Liang et al[19], 2015	55	272	263	231	41.82	8.52	100.02	11.43
Ramirez et al[20], 2020	67	4631	3961	67	100	14.5	163.4	5.91
Poe-Kochert et al[22], 2016	100	1571	1001	57	573	36.33	285.03	1.75
Kabirian e et al[23], 2014	379	2344	22741	70	18.5	3.0	166.7	32.49
Luhmann et al[14], 2017	18	167	141	26	144.4	15.6		5.42
Akbarnia et al[10], 2014	12	73	68	5	41.7	6.8	45.5	13.6
Harris et al[8], 2020	353	31411	28951	246	69.7	7.8	174.5	11.77
Helenius et al[9], 2018	214	1971	1836	133	62.1	6.7	137.1	13.8

¹Data estimated based on the mean values of duration between lengthenings.

²The values of the % of unplanned surgeries in which all four complications were analyzed in the paper.

³Corresponds to the papers in which all the patients were after the final fusion.

Table 3 The number of planned and unplanned surgical procedures in the vertical expandable prosthetic titanium ribs group

Ref.	Subject	Surgical procedures (n)	Planned surgical procedures (n)	Unplanned surgical procedure		% unplanned surgeries to all surgeries	% unplanned surgery to patients with at least one complication	Ratio of planned to unplanned surgery
				n	%
Murphy et al[28], 2016	25	232	188	40	160	17.2	266.7	4.69
Gadepalli et al[26], 2011	26	100	86	14	53.8	14.0		6.14
Berger-Groch et al[29], 2020	13	182	178	5	38.5	2.7		35.6
Hasler et al[30], 2010	23	187	172	15	65.22	8.02	166.72	11.47
Latalski et al[31], 2011	12	44	38	6	502	13.62	75.02	6.33
Striano et al[35], 2019	166	670	560	110	66.3	16.4	275.0	5.09
Lucas et al[36], 2013	54	184	152	30	55.62	16.32	83.32	5.07
Garg et al[37], 2016	38	410	3501	601	157.9	14.6		5.83

¹Data estimated based on the mean values of duration between lengthenings.

²The values of the % of unplanned surgeries in which all four complications were analyzed in the paper.

Table 4 The number of planned and unplanned surgical procedures in the magnetically controlled growing rods group

Ref.	Subject	Surgical procedures (n)	Planned surgical procedures (n)	Unplanned surgical procedure		% unplanned surgeries to all surgeries	% unplanned surgery to patients with at least one complication	Ratio of planned to unplanned surgery
				n	%
Subramanian et al[38], 2018	31	53	31	22	712	41.52	104.8	1.41
Urbański et al[39], 2020	47	60	47	13	27.72	21.72	81.3	3.62
Akbarnia et al[10], 2014	12	16	12	4	33.3	25.0	100.0	3
Studer et al[40], 2019	30	43	30	13	43.3	30.2	118.2	2.31
Kwan et al[41], 2017	30	44	30	14	46.7	31.8	100.0	2.14
Obid et al[42], 2020	22	46	19	5	22.72	10.92	41.72	3.8
Lampe et al[43], 2019	24	43	24	19	79.22	44.22	172.72	1.26

²The values of the % of unplanned surgeries in which all four complications were analyzed in the paper.

Table 5 The number of planned and unplanned surgical procedures in guided growth group – the Shilla and growth guidance system groups

Ref.	Subject	Surgical procedures (n)	Planned surgical procedures (n)	Unplanned surgical procedure		% unplanned surgeries to all surgeries	% unplanned surgeries to patients with at least one complication	Ratio of planned to unplanned surgery
				n	%
Haapala et al[12], 2020	13	19	17	2	15.4	10.5	40.0	8.5
Andras et al[13], 2015	36	101	36	65	180.6	64.4	224.1	0.55
Nazareth et al[44], 2020	20	41	20	21	105	51.2	140.0	0.95
Miękisiak et al[45], 2019	57	82	57	25	43.92	30.52		2.28
McCarthy et al[46], 2014	10	15	10	5	50	33.3	100.0	2
Luhmann et al[14], 2017	18	56	36	20	111.1			1.8
McCarthy et al[47], 2015	40	109	58	51	127.5			1.14

²The values of the % of unplanned surgeries in which all four complications were analyzed in the paper.

Table 6 Number of complications analyzed in extracted papers

Ref.	Subject	Total No. of complications	No. of patients with a minimum of one complication	% of complications in all patients	% of patients with a minimum one complication	No. of complications in complicated patients	Complication rate per surgical procedure (%)	% complications requiring surgical procedures
TGR
Bess et al[15], 2010	140	171	81	122.12	57.92	2.12	19.12	43.32
Du et al[16], 2020	167	49	32	29.32,3	19.23	1.53	nd	nd
Andras et al[13], 2015	36	47	29	130.6	80.6	1.6	16.3	61.7
Myung et al[17], 2014	159	64	37	40.3	23.3	1.7	5.9	48.4
Arandi et al[18], 2014	175	146	80	83.4	45.7	1.8	11.7	39.0
Liang et al[19], 2015	55	42	23	76.42	41.82	1.82	15.42	54.82
Ramirez et al[20], 2020	67	92	41	137.3	61.2	2.2	19.9	72.8
Yamaguchi et al[21], 2014	176	44	26	25.0	14.8	1.7
Poe-Kochert et al[22], 2016	100	30	20	30.03	20.03	1.53	19.13	190.0
Kabirian et al[23], 2014	379	70	42	18.5	11.1	1.7	3.0
Johnston et al[25], 2013	27	23	12	85.2	44.4	1.9	12.8
Bachabi et al[11], 2020	50	45	33	90.02	66.02	1.42	9.42
Luhmann et al[14], 2017	18	26		144.4	nd		15.6
Akbarnia et al[10], 2014	12	25	11	208.3	91.7	2.3	34.2
Harris et al[8], 2020	353	264	141	74.8	39.9	1.9	nd	93.2
Helenius et al[9], 2018	214	216	97	100.9	45.3	2.2	11.0	61.6
VEPTR
Bachabi et al[11], 2020	22	26	18	118.2	81.8	1.4	7.9
Crews et al[27], 2018	151	26	22	17.2	14.6	1.2	8.0
Murphy et al[28], 2016	25	41	15	164.0	60.0	2.7	17.7	97.6
Gadepalli et al[26], 2011	26	36	nd	138.5	nd	nd		38.9
Berger-Groch et al[29], 2020	13	21	nd	161.5	nd	nd	11.5	23.8
Hasler et al[30], 2010	23	31	9	134.82	39.12	3.4	16.62	48.4
Latalski et al[31], 2011	12	15	8	125.02	66.72	1.9	34.12	40.0
Hell, et al[32]. 2005	15	3	3	20.0	20.0	1.0	10.7
Garg et al[33], 2014	103	33	25	32.0	24.3	1.3	nd
Waldhausen et al[34], 2016	65	37	22	56.9	33.8	1.7
Striano et al[35], 2019	166	47	40	28.3	24.1	1.2	7.0	234.0
Lucas et al[36], 2013	54	74	36	137.02	66.72	2.12	40.22	40.5
Garg et al[37], 2016	38	86		226.3	nd			69.8
MCGR
Subramanian et al[38], 2018	31	25	21	80.62	67.72	1.22	47.22	88.0
Urbański et al[39], 2020	47	17	16	36.22	34.02	1.12	28.32	76.5
Akbarnia et al[10], 2014	12	12	4	100.0	33.3	3.0	75.0	33.3
Studer et al[40], 2019	30	12	11	40.0	36.7	1.1	27.9	108.3
Kwan et al[41], 2017	30	15	14	50.0	46.7	1.1	34.1	93.3
Obid et al[42], 2020	22	12	12	54.52	54.52	1.02	26.12	41.7
Lampe et al[43], 2019	24	20	11	83.32	45.8	1.8	46.5	95.0
Haapala et al[12], 2020	18	10	6	55.6	33.3	1.7	20.0
Shilla
Haapala et al[12], 2020	13	5	5	38.5	38.5	1.0	26.3
Andras et al[13], 2015	36	69	29	191.7	80.6	2.4	68.3
Nazareth et al[44], 2020	20	31	15	155.0	75.0	2.1	75.6
Miękisiak et al[45], 2019	57	57		100.02	0.0		69.5
McCarthy et al[46], 2014	10	5	5	50.0	50.0	1.0	33.3
Luhmann et al[14], 2017	18	20		111.1	0.0		35.7
McCarthy et al[47], 2015	40	59	38	147.5	95.0	1.6	54.1

²The values of the % of unplanned surgeries in which all four complications were analyzed in the paper.

³Corresponds to the papers in which all patients were after final fusion.

TGR: Traditional growing rods; VEPTR: Vertical expandable prosthetic titanium ribs; MCGR: Magnetically controlled growing rods.

Table 7 Total number of complications divided into wound-related, implant-related, alignment and surgical/medical related

Ref.	Total No. of complications	Wound complications total/infection		Implant complications mechanical complication		Alignment complications		Surgical or medical complications
		n	%	n	%	n	%	n	%
TGR
Bess et al[15], 2010	171	34	20	105	61	10	6	22	13
Du et al[16], 2020	49	19	39	13	27	9	18	8	16
Andras et al[13], 2015	32			24	75			8	25
Myung et al[17], 2014	64			64	100
Arandi et al[18], 2014	146			146	100
Liang et al[19], 2015	42	5	12	25	60	4	10	8	19
Ramirez et al[20], 2020	92	49	53	30	33			13	14
Yamaguchi et al[21], 2014	44			44	100
Poe-Kochert et al[22], 2016	29	16	55	13	45
Kabirian et al[23], 2014	70	70	100
Hosseini et al[24], 2018	134			134	100
Bachabi et al[11], 2020	45	7	16	28	62	2	4	8	18
Luhmann et al[14], 2017	26	9	35	11	42			6	23
Akbarnia et al[10], 2014	25	4	16	13	52			8	32
Harris et al[8], 2020	264			264	100
Helenius et al[9], 2018	216	40	19	127	59			49	23
VEPTR
Bachabi et al[11], 2020	26	9	35	15	58			2	8
Crews et al[27], 2018	26	26	100
Murphy et al[28], 2016	57	16	28	28	49			13	23
Gadepalli et al[26], 2011	25	6	24	3	12			16	64
Berger-Groch et al[29], 2020	24	1	4			2	8	21	88
Hasler et al[30], 2010	31	16	52	7	23	7	23	1	3
Latalski et al[31], 2011	15	1	7	7	47	1	7	6	40
Hell, et al[32], 2005	3	1	33	1	33			1	33
Garg et al[33], 2014	34	34	100
Waldhausen et al[34], 2016	37	12	32	21	57			4	11
Striano et al[35], 2019	47	47	100
Lucas et al[36], 2013	49	11	22	28	57	7	14	3	6
Garg et al[37], 2016	86	86	100
MCGR
Subramanian et al[38], 2018	24	6	25	16	67	1	4	1	4
Urbański et al[39], 2020	16	2	13	8	50	1	6	5	31
Akbarnia et al[10], 2014	12			8	67			4	33
Studer et al[40], 2019	12	3	25	6	50	3	25
Kwan et al[41], 2017	15	2	13	12	80	1	7
Obid et al[42], 2020	12	1	8	3	25	7	58	1	8
Lampe et al[43], 2019	20	3	15	7	35	6	30	4	20
Haapala et al[12], 2020	10			6	60	1	10	3	30
Shilla
Haapala et al[12], 2020	5	1	20	3	60			1	20
Andras et al[13], 2015	56			55	98			1	2
Nazareth et al[44], 2020	31	4	13	26	84			1	3
Miękisiak et al[45], 2019	57	3	5	34	60	10	18	10	18
McCarthy et al[46], 2014	5	2	40	3	60
Luhmann et al[14], 2017	20	6	30	13	65			1	5
McCarthy et al[47], 2015	59	6	10	42	71	11	19

TGR: Traditional growing rods; VEPTR: Vertical expandable prosthetic titanium ribs; MCGR: Magnetically controlled growing rods.

Table 8 Complication grades according to Smith

Ref.	Total No. of complications	Related to disease				Related to device
		Complication grade I	Complication grade II	Complication grade III	Complication grade IV	Complication grade I	Complication grade IIA	Complication grade IIB	Complication grade III	Complication grade IV
Ramirez et al[20], 2020	92					8	8	17	4	4
Murphy et al[28], 2016	57	5	6	2	1	13	8	3	4
Studer et al[40], 2019	12					2	7
Miękisiak et al[45], 2019	57	32	17	8	0