Secondary Surgery Rates After Primary Fusion for Adolescent Idiopathic Scoliosis

Abstract

Instrumented spinal fusion is the gold standard treatment for surgical magnitude adolescent idiopathic scoliosis (AIS), with the goal being stable fusion without the need for additional procedures. The purpose of this study was to define the surgical return rates of AIS at a single center with respect to various instrumentation constructs used during initial spinal fusion. A retrospective chart review was performed of all patients with AIS who underwent instrumented fusion with a minimum of 2-year follow-up. Demographic information, implant type, and surgical approach for the primary surgery and all subsequent secondary operations were recorded. Four hundred eleven patients who underwent instrumented fusion for AIS during the study period met inclusion criteria. Sixty-six secondary operations were performed in 50 patients (12.2%). Symptomatic hardware, pseudarthrosis, and infection were the most common indications for secondary surgery. Posterior pedicle screw constructs had a lower secondary surgery rate (5.8%) compared with hybrid and combined fusions ( P <.05). The all hook, hybrid, anterior only, and combined fusions had secondary surgery rates of 13.0%, 18.5%, 10.0%, and 20.8%, respectively, which were not statistically different. When specifically comparing pedicle screw with hook constructs, there was a statistically lower pseudarthrosis rate ( P =.03) favoring pedicle screw instrumentation. Patients undergoing instrumented fusion for AIS are at some risk for subsequent surgery. To lessen that risk, pedicle screw constructs should be considered, as they have shown an overall lower secondary surgery rate and in particular a lower rate of pseudarthrosis. [ Orthopedics . 2019; 42(4):235–239.]

Treatment of Scoliosis with One‐Stage Posterior Pedicle Screw System by Paraspinal Intermuscular Approach: A Minimum of Two Years of Follow‐Up

“…Posterior spine fusion (PSF) for scoliosis involves extensive muscle dissection, 36 which causes substantial blood loss (EBL) leading to 20% to 30% risk of blood transfusions 37–40 . In our study, only one NFS patient (10%) got blood transfusion during the operation.…”

“…In comparison to stable vertebra fusion, 25 this type of fusion segment selection can preserve one or two more mobile segments. Although several studies have been published regarding the selection of fusion and instrumentation levels in adolescent idiopathic scoliosis (AIS) through routine approach fusion, only a few studies have focused on correction surgery through PIA with only interarticular fusion 37 …”

“…Posterior spine fusion (PSF) for scoliosis involves extensive muscle dissection, 36 which causes substantial blood loss (EBL) leading to 20% to 30% risk of blood transfusions. [37][38][39][40] In our study, only one NFS patient (10%) got blood transfusion during the operation. This was mainly due to the protection of paraspinal muscles through PIA and only the face joint fusion was applied without extensive lamina decortication.…”

“…Although several studies have been published regarding the selection of fusion and instrumentation levels in adolescent idiopathic scoliosis (AIS) through routine approach fusion, only a few studies have focused on correction surgery through PIA with only interarticular fusion. 37 The classification systems of AIS facilitate surgical planning and comparison of postoperative results. 25,43,44 Nonetheless, the most appropriate identification of fusion levels remains a challenge in surgical planning for AIS.…”

Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity

“…To date, there have been few reports that discuss UPROR after fusion surgery for pediatric spinal deformities; most only focus on idiopathic scoliosis, and there has been only one study that described the incidence and risk factors for UPROR after fusion surgery for pediatric spinal deformity with every etiology, and the follow-up period was limited to 90 days. [12][13][14][15][16] Hence, the present study aimed to investigate, for the first time, the incidence and risk factors for UPROR, with minimum 2-year follow-up following primary definitive fusion for pediatric spinal deformity with every etiology.…”