Aug 2026· Journal of pediatric orthopedics· 0 citations· 23 references
Medicine
TL;DR
The utility of the mCDS system for grading complications of EOS casting is assessed and it is hypothesized that, with modifications, it would be a valid system for assessing these complications.
Abstract
Background
Serial casting can effectively treat early-onset scoliosis (EOS), thereby preventing or delaying the need for surgery. Reported complications range from pressure sores to cardiac arrest. The modified Clavien-Dindo-Sink (mCDS) system has high reliability for grading complications following EOS surgery, but has not previously been used to classify complications of casting. We aimed to assess the utility of the mCDS system for grading complications of EOS casting and hypothesized that, with modifications, it would be a valid system for assessing these complications.
Methods
This was a multicenter retrospective study. Patients aged 10 years or younger who underwent ≥1 cast application for EOS treatment were included. Demographics, radiographic data, casting details, complications, and unplanned procedures were collected. Two authors (E.S. and M.H.) reviewed complications and assigned a mCDS grade to each.
Results
One thousand twenty patients (5605 casts) were included. Two hundred forty-four casting-related complications in 159 patients were analyzed. 15.6% of patients (n=159) had a complication, and 47 patients (4.6%) had >1 complication. Fifteen complications were categorized as mCDS grade I (6.1%), 192 as grade II (78.7%), 5 as grade IIIa (2.0%), 28 as grade IIIb (11.5%), 4 as grade IVa (1.6%), and 0 as grade IVb or grade V (0%). The most common reason for a grade IIIb complication, which is an unplanned procedure, was early cast removal necessitating early cast re-application (25/28 patients).
Conclusions
Most casting complications in our cohort were grades II and IIIb. The mCDS system, in its current state, may not accurately describe the complications of casting. Although a grade IIIb complication after casting results in an additional procedure requiring anesthesia, an unplanned return to the operating room after surgery is likely associated with greater morbidity than an unplanned cast re-application. Using the mCDS system to compare casting with surgery risks overstating the severity of casting complications and may inadequately represent outcomes. We propose modifying the mCDS system for casting.
LEVEL OF EVIDENCE
Level III-therapeutic.
The hypothesis that the Cook and aCD grading systems would yield comparable postoperative complication rates was rejected, and a grading system with greater categorical resolution that distinguishes true complications from expected outcomes may provide a more clinically relevant assessment of postoperative risk.
Savannah K. Crowdis, Faolain Barrett, Yu-An Guan et al.· Frontiers in Veterinary Scie...· 0 citations
Despite strong correlation, CD and CM classifications are not interchangeable and the CD system may overestimate complication severity in pediatric patients due to its anesthesia-based grading criteria, whereas the CM system appears more aligned with pediatric clinical practice.
Ibrahim Topcu, Resul Çiçek, Bulut Dural et al.· Urologia internationalis· 0 citations
The standardized reporting of postoperative complications is essential for improving surgical quality and comparing outcomes. However, spinal surgery has historically lacked a universal system and has instead relied on ambiguous terms. This narrative review synthesizes the literature on the adaptation, validation, and application of the therapy-based Clavien-Dindo classification (CDC) and its modified versions in spinal surgery. It focuses on studies across various spinal procedures and patient populations. The evidence shows that adapted CDC systems demonstrate good to excellent inter- and intrarater reliability, particularly for severe complications. These systems also facilitate direct comparison of surgical techniques. Moreover, they reveal strong correlations between complication severity, prolonged hospital stay, and patient factors such as frailty. Nevertheless, key limitations include poor correlation with certain long-term patient-reported outcomes. The CDC cannot capture intraoperative events or the cumulative burden of multiple complications. Subjectivity also exists in grading milder events. Recent spine-specific modifications that improve neurologic deficit assessment have enhanced clinical relevance. Overall, the CDC provides a critical framework for standardizing complication reporting in spinal surgery. Optimal application requires awareness of its limitations. In complex scenarios, the CDC may be applied most effectively as a component within more comprehensive, spine-specific taxonomies that incorporate surgical complexity and structured neurological assessment. The CDC remains a vital tool for improving communication, benchmarking, and ultimately enhancing patient care.
Zhidi Lin, Kaiwen Chen, Chi Sun et al.· Spine Research· 0 citations
Purpose Early-onset scoliosis (EOS) presents a unique therapeutic challenge, requiring interventions that achieve deformity correction while preserving spinal and thoracic growth. This systematic review and meta-analysis aimed to synthesise current evidence on serial casting outcomes in EOS, with a primary focus on treatment-related complications and secondary evaluation of radiographic, pulmonary, and quality-of-life outcomes. Methods Comprehensive searches were performed in MEDLINE, Embase, Cochrane Library and CINAHL without date restrictions to identify eligible studies. The primary outcome was treatment-related complications; secondary outcomes included Cobb angle correction, thoracic height progression, pulmonary function, and patient-reported quality of life. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were conducted using random-effects models, and narrative synthesis was applied where quantitative pooling was not feasible. Results From 578 records, 23 studies met inclusion criteria. Sixteen studies were rated as low risk of bias, six moderate, and one high. The pooled complication rate from the single-arm meta-analysis was 17% (95% CI 9–24%), with moderate heterogeneity. Dermatological complications predominated (skin irritation, ulceration), while gastrointestinal and transient respiratory symptoms were infrequent. Comparative studies demonstrated lower complication rates with casting compared to growth rods (1/27 vs 12/27), with outcomes comparable or superior to bracing. Mean annual thoracic growth ranged from 0.8 to 3.8 cm. Cobb angle correction was generally greater in non-congenital compared to congenital scoliosis. Pulmonary function may transiently decline during casting but improves following cast removal, while long-term outcomes remained acceptable when early surgery was avoided. Quality-of-life analysis demonstrated inverse associations between residual curvature and domains including daily living, pain, and emotional wellbeing. Conclusion Serial casting remains an effective, low-risk, and growth-preserving intervention for managing early-onset scoliosis. The predominance of minor, reversible complications underscores its safety, while radiographic and functional outcomes affirm its therapeutic value. Future research should prioritise prospective evaluation of pulmonary and psychosocial outcomes to optimise patient selection and refine treatment protocols.
Unknown authors· Journal of Children's Orthop...· 0 citations
Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia
Hiatus hernias are relatively common and can be associated with adverse symptoms and serious complications. Operative repair is indicated in this patient group for symptom management and the prevention of morbidity. This study aimed to identify if Clavien–Dindo (CD) complications after a laparoscopic hiatus hernia repair and fundoplication (LHHRaF) were related to poorer 12- and 24-month modified Demeester scores.
A retrospective analysis was performed from a prospectively maintained, multicentre database of patients who underwent LHHRaF between 2014 and 2024. Revision procedures were excluded. Operative data, Clavien-Dindo, Hernia size and type, and 12- and 24-month Modified Demeester scores are analysed.
1395 patients underwent LHHRaF between 2014 and 2024. Modified Demeester scores for 12- and 24- months were 451 and 272 respectively. There were CD(1-4) complications in 70 (15%) patients, who had 12-month modified Demeester Scores. The proportion of patients with a modified Demeester score >1 in each group were; no complications 11%, CD1-11%, CD2-13%, CD3-33%, CD4-20%. 24-month data will also be presented along with the effect of hernia size and type.
With increasing CD score, patients were more likely to report a modified Demeester score >1 at 12 months follow up.
Maryann Johnson, Lynn Chong, Audree So· Diseases of the esophagus· 0 citations
OBJECTIVE
Rates of revision surgery following operative treatment for adult symptomatic lumbar scoliosis (ASLS) are high, mostly due to mechanical complications, including proximal junctional failure (PJF) and pseudarthrosis/rod fracture (RF). How these revisions impact long-term clinical outcomes remains unclear. The aim of this study was to assess revision rates for the two most common mechanical complications (PJF and RF) and the potential impact of these revisions on patient-reported outcome measures over 8 years of follow-up for operatively treated patients with ASLS.
METHODS
This retrospective review used data from a multicenter prospective ASLS study to assess operative versus nonoperative ASLS treatment. Patients were 40-80 years of age with ASLS (Cobb ≥ 30° and Oswestry Disability Index [ODI] score ≥ 20 or revised Scoliosis Research Society 22-item questionnaire [SRS-22r] score ≤ 4.0 in pain, function/activity, and/or self-image domains). Patients who underwent long-segment posterior fusion (thoracic spine to sacrum) were assessed for the impact of revision due to mechanical complications on outcomes (SRS-22r subscore and ODI score).
RESULTS
Overall, 160 patients (141 female, median age 61.31 years) met inclusion criteria. Of these, 53 (33.1%) required revision (71 revisions, 25 for PJF and 46 for RF) for mechanical complications, with 1, 2, and 3 revisions in 39, 10, and 4 patients, respectively. By 8 years of follow-up, patients had a 38% estimated risk of revision for mechanical complications. The mean time to the first and second revisions was 3.0 years (SD 2.1) and 4.8 years (SD 2.3), respectively. In unadjusted analyses, patients with ≥ 1 revision had a significant negative impact on their 8-year ODI score (mean difference 9.40, 95% CI 3.68-15.13; p = 0.0013) and SRS-22r subscore (mean difference -0.27, 95% CI -0.49 to -0.05; p = 0.0141). Patients with ≥ 2 revisions experienced the greatest impact on both their ODI score (mean difference 14.48, 95% CI 4.89-24.07; p = 0.0031) and SRS-22r subscore (mean difference -0.38, 95% CI -0.74 to -0.02; p = 0.0361), with the impact exceeding the minimum detectable measurement difference for the ODI score (7) but not the SRS-22r subscore (0.4). In adjusted analyses, these differences were attenuated for patients with ≥ 2 revisions: ODI score (mean difference 14.14, 95% CI 4.52-23.75; p = 0.0040) and SRS-22r subscore (mean difference -0.30, 95% CI -0.67 to 0.06; p = 0.1001).
CONCLUSIONS
By the 8-year follow-up, revision surgery for mechanical complications was required in an estimated 38% of operative ASLS patients. Patients who underwent ≥ 1 revision had a significant negative impact on ODI score and SRS-22r subscore, and this impact was greatest with ≥ 2 revisions. These findings emphasize the need for better techniques to reduce mechanical complications in ASLS surgery.
Justin S. Smith, Michael P. Kelly, E. Yanik et al.· Journal of Neurosurgery : Sp...· 1 citation
