Thoracic and Abdominal Complications After Posterior Fusion for Adolescent Idiopathic Scoliosis: Evidence and Clinical Implications
- 12nd Clinical Department of General and Gastroenterological Surgery, Medical University of Bialystok, ul. M. Skłodowskiej-Curie 24A, 15-276 Bialystok, Poland
- 2Department of Neurosurgery, Regional Specialized Hospital, ul. Dekerta 1, 66-400 Gorzow, Poland
- 3Department of Neurosurgery, Polish-Mother’s Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Poland
Abstract
Background: Posterior spinal fusion (PSF) is an established treatment for progressive adolescent idiopathic scoliosis (AIS) requiring surgery. Thoracic and abdominal complications range from transient postoperative findings to uncommon emergencies. This narrative review examines their reported frequency, recognition, prevention, and management. Methods: Literature published between January 2000 and June 2026 was reviewed using PubMed/MEDLINE and Google Scholar, supplemented by reference-list screening. AIS-specific evidence was prioritized. Reports involving other deformities or surgical approaches and general management guidelines were used as explicitly identified contextual evidence. No pooled incidence estimates were calculated. Results: Reported frequencies depended strongly on outcome definitions, imaging protocols, surgical approach, and follow-up. Two retrospective AIS studies detected pleural effusion in 71.0% and 76.3% of patients on computed tomography approximately one week after PSF; in the latter study, all effusions were asymptomatic and required no treatment. These findings should not be equated with clinically significant pulmonary complications. Postoperative ileus was reported in 13.2% of one 318-patient AIS cohort aged 10–20 years, whereas superior mesenteric artery syndrome, chylothorax, hemothorax, and implant-related vascular injury were supported largely by small series or case reports. Enhanced recovery pathways were consistently associated with shorter hospitalization, but evidence that they prevent individual rare complications was limited. Accurate instrumentation, appropriate blood conservation, individualized nutritional assessment, opioid-sparing analgesia, and symptom-directed investigation support perioperative care. Conclusions: Thoracic and abdominal complications after PSF for AIS require separate interpretation of radiographic findings, clinically diagnosed events, and events requiring intervention. Persistent vomiting, progressive abdominal distension, respiratory deterioration, unexplained anemia, or hemodynamic instability warrant prompt reassessment. Management should follow the suspected diagnosis, patient physiology, and relevant pediatric or multidisciplinary guidance.
Related
- Blood Transfusion Rates and Predictive Factors in Posterior-Based Minimally Invasive Scoliosis Surgery for Idiopathic Scoliosis: A LASSO-Based Prediction Model
- Maternal and Antenatal Complications in Pregnancies Complicated by Fetal Intra-Abdominal Umbilical Vein Varix
- Before Sepsis Strikes: Artificial Intelligence for Early Prediction of Postoperative Sepsis and Sepsis-Related Complications After Major Abdominal Surgery—A Systematic Review
- Dance Instructors and Early Recognition of Adolescent Idiopathic Scoliosis.
- Genetic Predictors of Curve Progression and Brace Treatment Response in Adolescent Idiopathic Scoliosis: Toward Personalized Management
BibTeX
@article{grabala2026thoracic,
title = {{Thoracic and Abdominal Complications After Posterior Fusion for Adolescent Idiopathic Scoliosis: Evidence and Clinical Implications}},
author = {Michał Grabala and Piotr Kowalski and Justyna Walczak and Joanna Suszczyńska and Krzysztof Zakrzewski and Paweł Grabala},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218573},
url = {https://www.mdpi.com/2077-0383/15/21/8573},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Thoracic and Abdominal Complications After Posterior Fusion for Adolescent Idiopathic Scoliosis: Evidence and Clinical Implications
AU - Michał Grabala
AU - Piotr Kowalski
AU - Justyna Walczak
AU - Joanna Suszczyńska
AU - Krzysztof Zakrzewski
AU - Paweł Grabala
PY - 2026
DA - 2026/11/03
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218573
UR - https://www.mdpi.com/2077-0383/15/21/8573
AB - Background: Posterior spinal fusion (PSF) is an established treatment for progressive adolescent idiopathic scoliosis (AIS) requiring surgery. Thoracic and abdominal complications range from transient postoperative findings to uncommon emergencies. This narrative review examines their reported frequency, recognition, prevention, and management. Methods: Literature published between January 2000 and June 2026 was reviewed using PubMed/MEDLINE and Google Scholar, supplemented by reference-list screening. AIS-specific evidence was prioritized. Reports involving other deformities or surgical approaches and general management guidelines were used as explicitly identified contextual evidence. No pooled incidence estimates were calculated. Results: Reported frequencies depended strongly on outcome definitions, imaging protocols, surgical approach, and follow-up. Two retrospective AIS studies detected pleural effusion in 71.0% and 76.3% of patients on computed tomography approximately one week after PSF; in the latter study, all effusions were asymptomatic and required no treatment. These findings should not be equated with clinically significant pulmonary complications. Postoperative ileus was reported in 13.2% of one 318-patient AIS cohort aged 10–20 years, whereas superior mesenteric artery syndrome, chylothorax, hemothorax, and implant-related vascular injury were supported largely by small series or case reports. Enhanced recovery pathways were consistently associated with shorter hospitalization, but evidence that they prevent individual rare complications was limited. Accurate instrumentation, appropriate blood conservation, individualized nutritional assessment, opioid-sparing analgesia, and symptom-directed investigation support perioperative care. Conclusions: Thoracic and abdominal complications after PSF for AIS require separate interpretation of radiographic findings, clinically diagnosed events, and events requiring intervention. Persistent vomiting, progressive abdominal distension, respiratory deterioration, unexplained anemia, or hemodynamic instability warrant prompt reassessment. Management should follow the suspected diagnosis, patient physiology, and relevant pediatric or multidisciplinary guidance.
SN - 2077-0383
ER -