SUPERIOR MESENTERIC ARTERY SYNDROME COMPLICATING SPINAL FUSION IN CHILDREN

Abstract

Superior mesenteric artery (SMA) syndrome is a rare medical complication of scoliosis surgery. In order to delineate the clinical features, progression and treatment of duodenal obstruction due to SMA syndrome after spinal fusions and to determine the relationship between spinal deformity correction and SMA syndrome, a retrospective study of all patients developing SMA syndrome following spinal fusion was conducted at a tertiary care center.

Charts were reviewed for symptoms of SMA syndrome, type and magnitude of spinal deformity, age at surgery, radiographic correction, complications, and other medical problems. The information gathered was divided according to non-orthopaedic and orthopaedic parameters.

All patients (five female and three male) in this study had spinal fusions performed. Overall, the patients were skeletally mature with a Risser stage average of 3.6. The average correction in the coronal plane was 28.4% in the thoracic spine and 44.6% in the lumbar spine. Sagittal correction averaged 25.9 % and 27% in the thoracic and lumbar spines respectively.. BMI index average was 17.6 (i.e. under-weight individuals). Signs and symptoms of SMA syndrome such as nausea, vomiting, epigastric pain, bloating, and weight loss developed at an average of 11.6 days. Seven patients were managed conservatively, and only one patient required surgery. All patients recovered fully.

This study identified purely asthenic body habitus (low BMI) and significant coronal correction in the lumbar region as risk factors for the development of SMA syndrome after spinal fusion Prolonged nausea and vomiting after spinal fusion requires GI imaging to rule out SMA syndrome, particularly within the first seven-ten days of surgery. Clinicians should also be aware of the possible delayed onset of symptoms in some patients. Nutritional support should be started immediately to prevent further adverse outcomes.