Revision Surgery After Spinal Fusion in Adolescent Idiopathic Scoliosis

Abstract

Study design Retrospective Aanalysis of a Large Cohort of Cases. Objectives To explore the rate and cause of revision surgery after spinal fusion in adolescent idiopathic scoliosis(AIS). Methods The patients diagnosed with AIS who underwent spinal fusion surgery in a single center from 2002 to 2018 were retrospectively analyzed. All the patients were followed up at least 2 years. The causes of revision surgery were analyzed and the incidence of revision surgery was counted. Results A total of 1816 AIS patients were included in the study. After an average of 8.5 years (range 3-18 years) follow-up, a total of 51 patients underwent 54 revision operations. The overall revision rate is 2.8%. The revision rate of combined approach (anterior and posterior) and anterior approach was 6.6% (8/122), and the revision rate of posterior approach was 2.5% (43/1694). The most common causes of revision were malposition of implants/implants failure (37%), followed by poor wound healing/ infection (23%). Spinal decompensation, adding on and proximal junctional kyphosis (PJK) accounted for 20%. The compensatory curve continued to worsen after selective fusion accounted for 14% and finally the discomfort with the implants accounted for 6%. Conclusions The overall revision rate of spinal fusion for AIS is 2.8%. The implants and incision problems were the most common causes of revision surgeries.

Revision of Surgery for Adolescent Idiopathic Scoliosis: Reasons, Treatments, and Clinical Management with Case Examples

“…Regarding postoperative infection, deep infection occurred in 31.4% (11 of 35 cases), while superficial infection occurred in 25.7% (9 of 35 cases) [11]. The most common longer term postoperative complications are pseudarthrosis, curve progression, and proximal junctional kyphosis [15]. Among these, postoperative infection, pseudarthrosis, and curve progression are the most frequent causes of revision surgery, accounting for 34%, 26%, and 17% of reoperations, respectively [16].…”

“…Revisions due to decompensation, adding on, and junctional kyphosis occur mainly 2-5 years after the primary operation, while revisions due to wound and instrumentationrelated complications, such as infection and malposition, mainly occur less than 2 years after operation [15]. A study by El Rachkidi et al [27] reported that patients were never re-operated on before 3 months postoperative to allow for spontaneous correction.…”