Repeat Surgical Interventions Following “Definitive” Instrumentation and Fusion for Idiopathic Scoliosis

Richards, B. Stephens; Hasley, Brian P.; Casey, Virginia F.

doi:10.1097/01.brs.0000249553.22138.58

Cited by 65 publications

(30 citation statements)

References 15 publications

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“…Infection is a common problem after spinal fusion in patients with CP. Our rate of 6% deep infection contrasts to the commonly observed 1% to 2% rate for adolescent idiopathic scoliosis [1,4], but is well within the range quoted in the literature [1,7,10,11]. The data on the rate of superficial infection are less clear, but at least another 4% of our patients had superficial infection.…”

Section: Discussioncontrasting

confidence: 51%

See 1 more Smart Citation

Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Sponseller

Shah

Abel

et al. 2010

Clinical Orthopaedics &Amp; Related Research

105

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Infection is a serious complication of surgery to correct scoliosis in patients with cerebral palsy (CP). We obtained multicenter representative figures for deep and superficial infection rates, analyzed risk factors and treatment outcomes, and compared deformity correction relative to infection. We retrospectively reviewed 157 patients who had posterior spinal fusion for CP at one of eight centers. Preoperative and intraoperative variables were subjected to multivariate analysis to determine factors predictive of infection. There were 16 wound infections (10%; nine deep, seven superficial). Only two study factors predicted infection: higher preoperative white blood cell count (8.5 versus 6.4 [in those without infection] 9 10 3 ) and use of a unit rod (15% versus 5% for bent rods). Fourteen patients underwent irrigation and débridement procedures. Five infections required 2 months or longer to resolve. Two had implant removal. Final curve correction was lower for those with deep infections than those without (67% versus 53%, respectively). We noted a trend toward greater percentages of pain at last followup in those with deep infection than in those without infection (50% versus 18%, respectively) but the study was not adequately powered to confirm this point. Our infection rate in scoliosis surgery for CP was higher than that for most elective spinal deformity surgery.

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Section: Discussioncontrasting

confidence: 51%

“…In terms of outcome, the occurrence of an infection represents a major setback for the patient, with short-term and long-term implications [4]. In the short term, most of our patients (14 of 16) underwent at least one reoperation for débridement and possible closure, and five infections required at least 2 months to resolve.…”

Section: Discussionmentioning

confidence: 99%

Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Sponseller

Shah

Abel

et al. 2010

Clinical Orthopaedics &Amp; Related Research

105

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show abstract

“…1 Frequent causes of reoperation in this patient population include wound infection/breakdown, implant failure, pseudarthrosis, and removal of instrumentation because of pain. 21,25,29,30 From a patient's standpoint, the high rates of complications and reoperation associated with lumbar deformity surgery are an important factor to be considered in the initial decision to proceed with surgery.…”

mentioning

confidence: 99%

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Mazur¹,

Ravindra²,

Schmidt³

et al. 2015

SPI

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OBJECT S-2 alar-iliac (S2AI) screws are an attractive alternative to conventional fixation with iliac bolts because they are lower profile, require less muscle dissection, and have greater pullout strength. Few studies, however, compare outcomes between these techniques. METHODS The authors conducted a retrospective cohort study of consecutive adult patients at a single institution from December 2009 to March 2012 who underwent lumbopelvic fixation using S2AI screws or iliac bolts. Medical records were reviewed for patients with clinical failure, defined as an unplanned reoperation because of instrumentation failure and/or wound-related complications. Univariate, multivariate, and survival analyses were used to compare patients who required reoperation with those who did not. Method of pelvic fixation was the main predictor variable of interest, and the authors adjusted for potential confounding risk factors. RESULTS Of the 60 patients included, 23 received S2AI screws. Seventeen patients (28%) underwent an osteotomy. The mean follow-up was 22 months. A Kaplan-Meier survival model was used to evaluate the time to reoperation from the initial placement of lumbopelvic instrumentation. The failure-free rate was 96.6% at 6 months, 87.0% at 1 year, and 73.5% at 2 years. Reoperation was more common in patients with iliac bolts than in those with S2AI screws (13 vs 2; p = 0.031). Univariate analysis identified potential risk factors for unplanned reoperation, including use of iliac bolts (p = 0.031), absence of L5–S1 interbody graft (p = 0.048), previous lumbar fusion (p = 0.034), and pathology other than degenerative disease or scoliosis (p = 0.034). After adjusting for other risk factors, multivariate analysis revealed that the use of S2AI screws (OR 8.1 [1.5–73.5]; p = 0.030) was the only independent predictor for preventing unplanned reoperation. CONCLUSIONS Both S2AI screws and iliac bolts were effective at improving fusion rates at the lumbosacral junction. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for wound-related complications and instrumentation failures than the use of iliac bolts.

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“…Традиционные методы одномомент-ной радикальной коррекции грубых форм кифосколиотических дефор-маций с применением позвоночного инструментария зачастую приво-дят к возникновению неврологиче-ских осложнений, вплоть до развития в раннем послеоперационном перио-де тракционно-ишемических миело-патий [1,3,6]. Попытки же проведения нерадикальной посильной коррекции таких деформаций, из-за сохранения большей части как кифотического, так и сколиотического компонентов и, вследствие этого, нарушения био-механики, тоже часто заканчиваются неудачами, приводя к псевдоартро-зам и потере коррекции, дисбалансу туловища, к дальнейшему прогресси-рованию деформации и даже удале-нию инструментария из-за его пере-ломов и несостоятельности костных точек опоры [7,8].…”

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Surgical Treatment of Kyphoscoliosis Complicated by Neurological Disorders Using Spinal Cord Transposition

Novikov¹,

Vasyura²,

Lebedeva³

et al. 2012

Hir. pozvonoč.

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Repeat Surgical Interventions Following “Definitive” Instrumentation and Fusion for Idiopathic Scoliosis

Abstract: Repeat surgical interventions are relatively common following these supposedly definitive surgical procedures. The most common reasons for return to surgery are infection, symptomatic implant, and pseudarthrosis.

Cited by 65 publications

References 15 publications

Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Infection Rate after Spine Surgery in Cerebral Palsy is High and Impairs Results: Multicenter Analysis of Risk Factors and Treatment

Unplanned reoperation after lumbopelvic fixation with S-2 alar-iliac screws or iliac bolts

Surgical Treatment of Kyphoscoliosis Complicated by Neurological Disorders Using Spinal Cord Transposition

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