O1055: Surgical Treatment of Scoliosis in Patients Diagnosed with down Syndrome: A 15 Year Experience

Background:

Background: Down Syndrome (DS), or trisomy 21, is the most diagnosed chromosomal abnormality and has been associated with multiple orthopedic concerns, including scoliosis. The surgical literature on scoliosis associated with Downs syndrome is limited to two prior studies demonstrating high rates of complications for an overall total of 14 patients undergoing spinal fusion for scoliosis. These complications included implant failure, infection, junctional kyphosis, pseudarthrosis, and wound healing problems. We sought to describe the post-operative complications associated with the surgical treatment of scoliosis in patients with Down syndrome, and we hypothesized there would be a change in the type of complications experienced due to the use of more modern implant systems in the study population.

Methods:

Methods: We looked at 14 patients with DS who underwent surgical intervention for spinal deformity between 2000 and 2018. The postoperative complications were classified using the modified Clavien-Dindo-Sink (CDS) system and further categorized into specific subtypes including excess drainage, wound dehiscence, delayed wound healing, and infection. Perioperative and final follow-up radiographic data was analyzed.

Results:

Results: The mean age at surgery was 14.3 years (11-19) with a mean follow-up of 39.1 months (5-74) at the time of data collection. 7 (50%) patients had postoperative complications, all related to wound healing. 3 patients (21%) had major complications (CDS grade ≥ 3). These included 1 deep surgical site infection, 1 hematoma, and 1 seroma, all requiring surgical drainage. 4 additional patients (29%) had minor complications (CDS grade ≤2). None of the complications occurred intraoperatively.

Conclusion:

Conclusion: Surgical intervention for scoliosis in patients with DS is associated with a high complication rate despite the use of more modern instrumentation. This study doubles the number of cases of the cumulative largest series previously published and is the largest series of patients with DS and surgically treated scoliosis reported to date. Complications in this cohort primarily involved wound healing whereas previous studies described high rates of post-operative implant failure, pseudoarthrosis, and significant curve progression, none of which were experienced by the patients in this study. This may be due to the use of more modern implants allowing for improved fixation. Although the specific etiology of wound healing-related complications is unknown, awareness of this significant risk may help surgeons optimize surgical technique, post-operative monitoring, and allow appropriate counseling of families preoperatively.