Abstract
Purpose: To determine frequency of reoperations after definitive spinal fusion in patients with AIS and identify factors responsible
Methods and results: We undertook a retrospective review of surgical logs of patients with AIS who underwent surgical fixation during 1994–2004 and detailed case notes review of patients who required > 1 operation after definitive fusion. Results were compared according to approach used during primary operation.
We reviewed surgical logs of 310 patients who underwent instrumented spinal fusion for AIS. Approach at primary operation was anterior 101, posterior 109 and combined 100. Of these, 33 patients underwent 58 reoperations (10.6 %) after definitive fusion. Median age was 14.7 years; median follow up 5.4 years. Amongst these, primary operation was Anterior in 5 patients (7 reoperations, 5%), Posterior 13 patients (25 re-ops, 11.9%) and Combined 15 patients (26 re-ops, 15%). 12 patients required more than 1 reoperation.
Common indications were infection (9), failure of fixation either due to curve progression (10), junctional kyphosis (7) or pseudoarthrosis (3). 16 revisions were undertaken due to implant related symptoms. 5 patients with posterior instrumentation requested removal of implant. Only 1 patient had a neurological deficit that required removal of implant. 13 patients required secondary costoplasty.
Discussion: Risk of reoperation after definitive fusion in AIS is 10.6 % in our institution. Reoperation rates were maximal with combined approach and least with anterior approach (15% v 5%). Common indication with posterior instrumentation was implant related and in anterior surgery due to curve progression (wrong level fixation).
Ethics approval: Audit/service standard in trust number: 1236
Interest Statement: None
Correspondence should be addressed to BSS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
