Surgical management of scoliotic deformities related to spina bifida: complication rates, radiographic parameters, and quality of life

Spina bifida is a serious condition with numerous comorbidities, leading to severe scoliotic deformities. Several surgical techniques can be considered for the correction of scoliosis but may be associated with complications. Our hypothesis is that the isolated anterior approach significantly reduces the rate of infectious complications. The primary objective of our study is to define the rate of complications according to the surgical technique. Secondary objectives are radiographic results and quality of life scores.

Thirty-six patients aged less than 18 years with spina bifida who underwent spinal deformity surgery at our centre between 1996 and 2022 were included. The mean age at surgery was 12.5 ± 2.59 years (from 5 to 18). We collected all the complications that occurred during the entire follow-up period, and their treatments. Pre, postoperative and last follow-up radiological parameters were studied. The quality of life was reported by the SBSQ (Spina Bifida Spine Questionnaire). Survival analysis for surgical site infection occurrence in different surgical groups was performed with a log-rank test. A subgroup analysis of preoperative radiological parameters and postoperative correction of radiological parameters was performed with an ANOVA test. Statistical significance was set at p < 0.05.

Mean follow-up was 12 ± 7.5 years (range, 1.5 to 27). Twenty-one patients (58%) presented a complication, including 13 surgical site infections (36%). Survival analysis for the 5 subgroups (ASF, PSF, ASF + PSF, BC, ASF + BC) showed a significant difference (p = 0.03). Infection rates were significantly lower in the ASF group. No significant statistical difference between the different surgical techniques was found concerning the correction of radiological parameters. Sixteen patients answered the SBSQ questionnaire, with a mean score of 58.8/100.

Spinal deformity surgery in patients with spina bifida can lead to more than 50% complications, and particularly a third of infections. Isolated anterior arthrodesis seems to reduce infection rate while achieving a similar correction.