Spinal Fusion, Post-Op, Adolescent Idiopathic Scoliosis (AIS) — Post-Operative Complications — Clinical Pathway: Inpatient

Inpatient Clinical Pathway for Adolescent Idiopathic Scoliosis (AIS) Spinal Fusion Rapid Recovery — Inpatient

Complications Following Posterior Spinal Fusion for AIS

Perioperative
Intra-operative to 7 days post-operative
  • Visceral injury
  • Excessive bleeding (> 1500 mL)
  • Technical
    • Rod breakage, etc.
  • Respiratory
    • Pleural effusion
    • Respiratory distress
    • Pneumonia
    • Pneumothorax
    • Prolonged intubation
  • Urinary
    • UTI
  • Gastrointestinal
    • Ileus
  • Superior mesenteric artery syndrome
  • Neurologic (0.32-0.69%)
    • Thecal penetration
    • Nerve root injury
    • Spinal cord injury
    • Blindness
Early Post-operative
8-30 days post-operative
  • Acute pain
  • Wound infection (0-9.7%; meta 3.6%)
  • Wound complications
    • Hematoma
    • Seroma or dehiscence
  • Respiratory
    • Pleural effusion
    • Respiratory distress
    • Pneumonia
  • Urinary
    • UTI
  • Gastrointestinal
    • Ileus
    • Nausea and vomiting
  • Superior mesenteric artery syndrome
Late Post-operative
30+ days post-operative
  • Persistent or long-term pain
  • Wound infection (0-9.7%; meta 3.6%)
  • Implant failure
  • Pseudarthrosis (meta 1.9%)
  • Failure of fusion
  • Curve progression (1.1%)
  • Reoperation (3.9-26% overall)

Common themes amongst those with neural complications include significant curve correction-producing neural stretch and using sublaminar wires. Most often, neural injuries are not permanent (e.g., thecal penetrations, neuropraxia). A few factors that significantly increase the rate of complications include a history of renal disease, increased operative blood loss, prolonged posterior surgery time, and prolonged anesthesia time.

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