{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T05:05:47Z","timestamp":1784955947159,"version":"3.55.0"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nVarious complications have been reported in the treatment of pediatric spinal deformities. Among these, instrument-related complications could be critical concerns and risks of reoperation. This study aimed to identify the incidence and causes of complications after primary definitive fusion for pediatric spine deformities.<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nThe authors retrospectively collected data from 14 institutions about patients who underwent primary definitive fusion between 2015 and 2017. There were 1490 eligible patients (1184 female and 306 male), with a mean age of 13.9 years. The incidence, causes, and reoperation rates were analyzed according to 4 etiologies of pediatric spine deformity (congenital, neuromuscular, syndromic, idiopathic). The complications were also categorized as screw-, hook-, or rod-related complications, implant loosening or backout, and junctional problems.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nThe incidence of overall instrument-related complications was 5.6% (84 cases). Regarding etiology, the incidence rates were 4.3% (idiopathic), 6.8% (syndromic), 7.9% (congenital), and 10.4% (neuromuscular) (p < 0.05). The most common causes were pedicle screw malposition (60.7%), followed by implant backout or loosening (15.4%), junctional problems (13.1%), rod breakage (4.8%), and other complications (6.0%). Univariate analysis showed that etiology, type of deformity (kyphosis), surgical procedure, operation time, and estimated blood loss were significant factors. Multivariate analysis revealed that etiology (neuromuscular), surgical procedure (combined approach), and operation time (> 5 hours) remained as significant risk factors. Among all patients with instrument-related complications, 45% (38\/84) required revision surgery. Of these cases, > 50% were related to pedicle screw malposition. Medial breach was the most common complication regardless of location, from upper thoracic to lumbar spine.<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nPedicle screw malposition was the primary cause of overall complications and subsequent reoperation. In addition to more precise screw insertion techniques, meticulous confirmation of pedicle screw placement, especially of medial breach, may reduce the overall instrument-related complications and revision rates.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.8.spine22729","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T09:08:58Z","timestamp":1664528938000},"page":"192-198","source":"Crossref","is-referenced-by-count":9,"title":["Incidence and causes of instrument-related complications after primary definitive fusion for pediatric spine deformity"],"prefix":"10.3171","volume":"38","author":[{"given":"Satoru","family":"Demura","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Ohara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Meijo Hospital, Nagoya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoji","family":"Tauchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Meijo Hospital, Nagoya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosuke","family":"Takimura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Meijo Hospital, Nagoya;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kota","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keio University, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keio University, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Uno","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teppei","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhisa","family":"Yanagida","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuoka Children\u2019s Hospital, Fukuoka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Fukuoka Children\u2019s Hospital, Fukuoka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Kotani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keita","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Niigata University, Niigata;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Yokogawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norihiro","family":"Oku","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Tsuchiya","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kagoshima Red Cross Hospital, Kagoshima;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Kagoshima University, Kagoshima;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The University of Tokyo, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsushi","family":"Takeshita","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Jichi Medical University, Tochigi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Jichi Medical University, Tochigi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ichiro","family":"Kikkawa","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Jichi Children\u2019s Medical Center, Tochigi;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Juntendo University School of Medicine, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Osaka Medical and Pharmaceutical University, Osaka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsutomu","family":"Akazawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Iwate Medical University, Iwate; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriaki","family":"Kawakami","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, 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Spine (Phila Pa 1976). 2013;38(21):1842\u20131847."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/38\/2\/article-p192.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/38\/2\/article-p192.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/38\/2\/article-p192.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:11:12Z","timestamp":1733490672000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/38\/2\/article-p192.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":14,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2022.8.spine22729","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2023,2,1]]}}}