Pediatric patients with arthrogryposis have increased early complications and long-term reoperation risk following posterior spinal fusion.

purposeArthrogryposis multiplex congenita (AMC) is a rare syndrome characterized by congenital joint contractures involving at least two different body areas. AMC patients often develop scoliosis and may undergo posterior spinal fusion (PSF). However, such procedures can be challenging due to a spectrum of underlying differences in body structure and comorbidities. The present study aimed to investigate odds of postoperative adverse events and reoperation in patients with AMC following PSF relative to matched controls with idiopathic scoliosis (IS).

methodsPediatric AMC and IS patients undergoing primary PSF were identified from 2010-2023Q1 PearlDiver dataset. Those with versus without AMC were matched 1:4 based on age, sex, and number of spinal segments fused. Ninety-day adverse events were assessed using multivariable logistic regression, and 5-year reoperation risk was compared with log-rank test (P < 0.05).

resultsAmong 4,600 patients undergoing PSF for deformity, AMC was noted for 115 (2.5%). After matching, 84 patients with AMC were found to have greater odds of experiencing any, severe, and minor 90-day adverse events. In addition, reoperation analysis showed patients with AMC were at a significantly higher odds undergoing 5-year reoperations following PSF (21.4% versus 5.8%, P < 0.001). DISCUSSION: PSF patients with AMC were found to be at significantly greater odds of complications and reoperations compared to matched patients with idiopathic scoliosis. These findings highlight the importance of such considerations in surgical planning and suggest that further research is needed to mitigate these risks. LEVEL OF EVIDENCE: III.