Unanticipated Revision Surgery in Adolescent Idiopathic Scoliosis.

By London Spine

Unanticipated Revision Surgery in Adolescent Idiopathic Scoliosis.

Spine (Phila Pa 1976). 2011 Oct 27;

Authors: Campos M, Dolan L, Weinstein S

Abstract
ABSTRACT: Study Design. Retrospective case series.Objective. The objective of this study is to share our experience in the surgical treatment of AIS, specifically the rate of revision surgeries and their indications.Summary of Background Data. Minimizing adolescent idiopathic scoliosis (AIS) surgical morbidity includes prevention of short- and long-term complications that could require an unanticipated revision. There have been an increasing number of reports about revision rates and their causes in AIS. This study summarizes the experience of a large patient population treated by a single surgeon in a single institution.Methods. All patients who underwent surgical treatment for AIS between 10 and 20 years of age during 1983-2005 were reviewed. All revision surgeries performed during the same period were searched. The indications for revision and type of procedure performed were recorded.Results. A total of 502 patients with AIS underwent spinal fusion with instrumentation at an average age of 14.3 years old at initial surgery. In 485 patients the surgery consisted of posterior-only spinal fusion. A total of 24 revision surgeries were performed for 23 patients (4.9%; cumulative probability of revision = 8%). The primary indications for revision were residual rib deformity (n = 8), instrumentation dislodgement (n = 4), compensatory curve progression (n = 3), junctional kyphosis (n = 3) and symptomatic implants (n = 3). One patient had a late infection. There was one case of pseudoarthrosis. One patient requested scar revision. There were no cases of neurologic deficit.Conclusion. In this single-surgeon series, revision after the index spinal fusion was required for a relatively low proportion of patients. The main indications for revision were residual rib deformity, hook dislodgment and progression of the unfused compensatory curve.

PMID: 22037531 [PubMed – as supplied by publisher]

Multivariate Analysis of Factors Associated with Kyphosis Maintenance in Adolescent Idiopathic Scoliosis.

By London Spine

Multivariate Analysis of Factors Associated with Kyphosis Maintenance in Adolescent Idiopathic Scoliosis.

Spine (Phila Pa 1976). 2012 Jan 5;

Authors: Lonner BS, Lazar-Antman MA, Sponseller PD, Shah SA, Newton PO, Betz R, Shufflebarger HS

Abstract
STRUCTURED ABSTRACT: Study Design. Multicenter retrospective cohort study of 269 patientsObjective. The purpose of this study is to evaluate the surgical and radiographic factors in AIS surgery that significantly affect kyphosis maintenance.Summary of Background Data. Decreased kyphosis in the thoracic spine is a component of the three-dimensional deformity in adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment after spinal fusion has been identified as a possible cause of lumbar and cervical spinal degeneration and junctional malalignment. Segmental spinal instrumentation continues to evolve and while excellent coronal plane correction is readily achieved, sagittal plane thoracic hypokyphosis may be seen postoperatively..Methods. A retrospective analysis of prospectively-collected data from a multi-center AIS database was performed to evaluate factors associated with kyphosis maintenance. 526 patients were enrolled in the database and had a mean thoracic kyphosis (T5-12) of 22?. 269 patients were identified that had kyphosis of less than 22 and thus comprised the group to be included in this analysis. A complete radiographic series was obtained for each patient pre-operatively, immediately post-operatively, and at 2-years post-operatively. All operative data including the number of levels fused and implant type and density was also recorded. Multivariate and regression analysis were performed.Results. Eight variables were found to be significantly correlated with kyphosis maintenance at 2 years post-op. Anterior approach (r = 0.37, p<0.001), increased thoracic coronal curve (r = 0.20, p = 0.001), and a larger percentage of hooks in the construct (r = 0.18, p = 0.034) were associated with increased kyphosis at follow-up. A greater number of levels fused (r = -0.33, p < 0.001), pre-operative kyphosis (r = -0.39, p < 0.001), percentage of screws in the construct (r = -0.18, p = 0.03), using standard stainless steel rods (r = -0.47, p = 0.011), and percent decrease in thoracic curve (r = -0.23, p < 0.001) all were correlated with hypokyphosis at follow-up.Conclusion. Our multi-variate analysis demonstrates that in patients with AIS who have thoracic hypokyphosis as part of their deformity, certain factors must be taken into account in the pre-operative planning to prevent hypokyphosis after surgical correction.

PMID: 22228329 [PubMed – as supplied by publisher]