Repeat Surgical Interventions Following "Definitive" Instrumentation and Fusion for Idiopathic Scoliosis - Revisited

Purpose: Spinal instrumentation and fusion should represent the definitive intervention needed in the management of idiopathic scoliosis. This study was undertaken to determine 1) the percentage of patients who underwent unplanned additional surgery related to their scoliosis and 2) the factors responsible for these necessary re-operations.

Methods: Surgical records at a single institution from Jan 1988 through Dec 2002 were reviewed. Primary spinal instrumentation (anterior or posterior) with fusion was performed on 1050 idiopathic scoliosis patients (ages 8-17 years). Most were teenagers. All are a minimum 2 years postoperative. Those who required one or more re-operations related to their idiopathic scoliosis were identified. The reasons for, and the number of, re-operations were examined. For those with infections, repeated I/Ds over the course of 2-6 days were considered as one further intervention (re-operation).

Results: 136 patients (13.0%) underwent additional surgery. 108 pts had one reoperation, 23 had two re-operations (3 months apart if related to repeat infection), 4 had three re-operations, and 1 had four reoperations. Of the 170 re-operations in these 136 patients, 44 (26%) were because of infection (acute 12, delayed 32); 44 (26%) included reinstrumentation +/- osteotomy because of pseudarthrosis, curve progression, or fracture; 40 (24%) represented implant removal because of pain (14 partial, 26 complete);15 (9%) were for revision of loosened implants; 7 (4%) were for elective thoracoplasties; 6 (4%) were for anterior screw malposition; 2 (1%) were for progressive spondylolisthesis at L5-S1; and 12 (7%) were for minor procedures (repeated wound closure, thoracic duct ligation, chest tube re-insertions, and scar revisions).

Conclusions: Re-operations following spinal instrumentation and fusion were needed in 13% of idiopathic scoliosis patients. Most were necessary because of pain over the implants, pseudarthroses, or infection.

Significance: Patients undergoing spinal instrumentation and fusion for idiopathic scoliosis should be advised of these potential future re-interventions.