OBJECTIVES :

Scoliosis is a spinal deformity that can be treated by complex spine surgery. The objective of this systematic literature review was to assess the perioperative complications associated with scoliosis surgery, their associated costs, and their management in France.

METHODS :

A search was performed in Embase and Medline from 2014 to 2018. Adult and pediatric patients with a scoliosis pathology and/or a Scheuermann’s kyphosis that were undergoing ≥4 level spine surgery in France were included. Variables extracted from the studies and analyzed included: age, underlying indication for surgery, number of spine levels operated, operative time and length of stay, peri-operative blood loss and transfusions, complications, costs and management strategies.

RESULTS :

Out of 733 articles identified, 8 full-text articles were included for evaluation: 2 prospective studies and 6 retrospective studies. The number of patients included was comprised between 40 and 524. Seven studies included pediatric patients. Five studies included patients suffering from adolescent idiopathic scoliosis. The number of spine levels operated was between 4.3 and 13. The follow-up period was between 1 month and 7 years. The complications reported were postoperative infections (N=7), complications associated with spinal implants (N=3), proximal junction kyphosis (N=2), adding-on (N=1), blood transfusions (N=1), neurological complications (N=1), reoperation (N=1). The length of stay was reported in one study (3.5 days) and the operative time was reported in three studies (mean: 212 minutes). Postoperative pain was assessed in three studies using a visual analogical scale (VAS) or the Scoliosis Research Society SRS-22 questionnaires. Quality of life and functional outcomes were reported in two studies using the SRS-22.

CONCLUSIONS :

Management strategies and associated costs of complications associated with scoliosis surgery were not or little reported in the selected studies. A board of experts should be conducted to identify the management strategies and their costs in France.