Revision Surgery After Primary Spine Fusion For Idiopathic Scoliosis: Results from a Different Institution

Methods: A spinal deformity database search at our center identified all primary anterior (ASF), posterior (PSF) and circumferential (APSF) spinal fusions performed for idiopathic scoliosis (1985-2003). 1064 patients were identified (8-22 years) with minimum 2 year follow-up after index surgery. Study cohort consisted patients who underwent re-operation for any reason after index fusion procedure.

Results: Of the 1064 spinal fusions for idiopathic scoliosis, 41 (3.9%) underwent re-operation. Mean age at index procedure was 14.0 years (10-18). Primary surgeries were: 11 ASF, 25 PSF, and 5 APSF. Mean follow-up was 5.7 years (2 to 10.8). 47 additional procedures were performed at an average of 26 months after index gprocedure (1 week to 73 months). Of the 47 re-operations, 20 (43%) were revision spinal fusions (for pseudarthroses, curve progression or junctional kyphosis), 16 (34%) because of infections (5 acute, 11 chronic), 7 (15%) for implant removals due to pain a/o prominence (4 complete, 3 partial), 2 (4%) were revision of loosened implants, and 2 (4%) were elective thoracoplasties.

Conclusions: This study documented a 3.9% overall re-operation rate at our medical center, a three-fold lower re-operation rate than the previously reported 13.8%. The most common re-operations were for infections (34%), pseudarthroses (26%), and postoperative curve progression of the adjacent unfused spine (17%).

Significance: Multiple patient, surgeon, and institutional factors are likely to account for marked differences in the re-operation rates after primary spinal fusion for idiopathic scoliosis at various medical centers (3.9% vs. 13.8%).