1
|
Dong Y, Wang S, Tang N, Zhao H, Yu B, Zhang J. Revision Surgery After Spinal Fusion in Adolescent Idiopathic Scoliosis. Global Spine J 2024; 14:603-609. [PMID: 35862230 PMCID: PMC10802548 DOI: 10.1177/21925682221117130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective Aanalysis of a Large Cohort of Cases. OBJECTIVES To explore the rate and cause of revision surgery after spinal fusion in adolescent idiopathic scoliosis(AIS). METHODS The patients diagnosed with AIS who underwent spinal fusion surgery in a single center from 2002 to 2018 were retrospectively analyzed. All the patients were followed up at least 2 years. The causes of revision surgery were analyzed and the incidence of revision surgery was counted. RESULTS A total of 1816 AIS patients were included in the study. After an average of 8.5 years (range 3-18 years) follow-up, a total of 51 patients underwent 54 revision operations. The overall revision rate is 2.8%. The revision rate of combined approach (anterior and posterior) and anterior approach was 6.6% (8/122), and the revision rate of posterior approach was 2.5% (43/1694). The most common causes of revision were malposition of implants/implants failure (37%), followed by poor wound healing/ infection (23%). Spinal decompensation, adding on and proximal junctional kyphosis (PJK) accounted for 20%. The compensatory curve continued to worsen after selective fusion accounted for 14% and finally the discomfort with the implants accounted for 6%. CONCLUSIONS The overall revision rate of spinal fusion for AIS is 2.8%. The implants and incision problems were the most common causes of revision surgeries.
Collapse
Affiliation(s)
- Yulei Dong
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Ning Tang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Hong Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bin Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
2
|
Tse CB, Mandler SI, Crawford HA, Field AJF. Risk factors for distal construct failure in posterior spinal instrumented fusion for adolescent idiopathic scoliosis: a retrospective cohort study. Spine Deform 2023; 11:1169-1176. [PMID: 37178413 DOI: 10.1007/s43390-023-00700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate risk factors for distal construct failure (DCF) in posterior spinal instrumented fusion (PSIF) in adolescent idiopathic scoliosis (AIS). We hypothesise increased inferior angulation of the pedicle screw in the lowest instrumented vertebra (LIV) predisposes to failure and aim to find the critical angle that predisposes to failure. METHODS A retrospective cohort study was performed on all patients who underwent PSIF for AIS at our institution from 2010 to 2020. On lateral radiographs, the angle between the superior endplate of the LIV was measured against its pedicle screw trajectory. Data on demographics, Cobb angle, Lenke classification, instrumentation density, rod protrusion from the most inferior screw, implants and reasons for revision were collected. RESULTS Of 256 patients, 9 patients had DCF with 3 further failures post-revision, giving 12 cases to analyse. The DCF rate was 4.6%. The mean trajectory angle of DCF patients compared to non-DCF was 13.3° (95% CI 9.2° to 17.4°) vs. 7.6° (7.0° to 8.2°), p = 0.0002. The critical angle is less than 11° (p = 0.0076), OR 5.15. Lenke 5 and C curves, lower preoperative Cobb angle, titanium only rod constructs and one surgeon had higher failure rates. 9.6% of rods protruding less than 3 mm from its distal screw disengaged. CONCLUSION Increased inferior trajectory of the LIV screw increases the rate of DCF; inferior trajectory greater than 11° predisposes to failure. Rod protrusion less than 3 mm from the distal screw increases rate of disengagement. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Cheuk Bun Tse
- Paediatric Orthopaedics, Starship Hospital, Auckland, New Zealand.
| | | | | | | |
Collapse
|
3
|
Song Q, Leng J, Qu Z, Zhuang X, Wang Y, Liu Y, Wang Z. Treatment of Scoliosis with One‐Stage Posterior Pedicle Screw System by Paraspinal Intermuscular Approach: A Minimum of Two Years of Follow‐Up. Orthop Surg 2022; 14:3100-3110. [PMID: 36106388 PMCID: PMC9627071 DOI: 10.1111/os.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the clinical efficacy of the treatment of scoliosis with a pedicle screw system through paraspinal intermuscular approach (PIA). Methods This is a retrospective case series study. A total of 10 patients diagnosed with scoliosis had surgical indications and treated with a pedicle screw system in one‐stage posterior surgery by PIA from March 2013 to April 2015 at the First Hospital of Jilin University were enrolled in this study. The average age of the patients was 14.9 years, including one male and nine females. The operative information and surgical results, including Cobb angle correction, correction loss, global balance (including Frontal Plane Balance [FPB] and Sagittal Plane Balance [SPB]), and fusion rate were reviewed. Functional outcomes including visual analog scale (VAS) back pain score, leg pain score, and Scoliosis Research Society‐22 questionnaire (SRS‐22) were used to evaluate the quality of life of patients preoperatively and at last follow‐up. Results Each patient was followed up at least six times. The average follow‐up time was 43.2 months. Mean scoliosis and kyphosis improved from 68.5° ± 18.1°to 18.7° ± 11.8° and from 34.4° ± 17.9°to 24.0° ± 6.7°, respectively (p < 0.05); at last follow‐up, it was 20.1° and 24.7°, respectively (p > 0.05). During the follow‐up, mean coronal and sagittal correction loss was 1.4° ± 1.2°and 0.7° ± 0.8°, respectively (p > 0.05). Mean FPB improved from 32.7 to 11.7 mm (p < 0.05); Mean SPB changed from 0.3 to −0.7 mm (p > 0.05). No dural tears were observed during the corrective surgery or wound infection or implant‐related complications. No pseudoarthrosis was identified according to the last follow‐up three‐dimensional (3D) CT scan. All the domains in SRS‐22 questionnaire show statistically significant improvement at the last follow‐up (p < 0.05). The VAS back pain scores improved from a mean preoperative score of 1.7 to a mean postoperative score of 0.2 (p < 0.05). Conclusion This original one‐stage posterior PIA is safe and effective in the treatment of scoliosis, which is characterized with less blood loss, shorter operation time, and satisfactory bony fusion.
Collapse
Affiliation(s)
- Qingxu Song
- Department of Spinal Surgery the First Hospital of Jilin University ChangChun City China
| | - Jiali Leng
- Department of Hospice the First Hospital of Jilin University ChangChun City China
| | - Zhigang Qu
- Department of Spinal Surgery the First Hospital of Jilin University ChangChun City China
| | - Xinming Zhuang
- Department of Spinal Surgery the First Hospital of Jilin University ChangChun City China
| | - Yujian Wang
- Department of Spinal Surgery the First Hospital of Jilin University ChangChun City China
| | - Yi Liu
- Department of Spinal Surgery the First Hospital of Jilin University ChangChun City China
| | - Zhenyu Wang
- Department of Spinal Surgery the First Hospital of Jilin University ChangChun City China
| |
Collapse
|
4
|
Taniguchi Y, Ohara T, Suzuki S, Watanabe K, Suzuki T, Uno K, Yamaguchi T, Yanagida H, Nakayama K, Kotani T, Watanabe K, Hirano T, Yamamoto T, Kawamura I, Sugawara R, Takeshita K, Demura S, Oku N, Sato T, Fujiwara K, Akazawa T, Murakami H, Kakutani K, Matsubayashi Y, Kawakami N. Incidence and Risk Factors for Unplanned Return to the Operating Room Following Primary Definitive Fusion for Pediatric Spinal Deformity: A Multicenter Study with Minimum 2-year Follow-Up. Spine (Phila Pa 1976) 2021; 46:E498-E504. [PMID: 33186273 DOI: 10.1097/brs.0000000000003822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective multicenter cohort study. OBJECTIVE The aim of this study was to identify the incidence and risk factors for UPROR within minimum 2-year follow-up in primary definitive fusion for pediatric spinal deformity. SUMMARY OF BACKGROUND DATA Several previous reports have elucidated the incidence of complications after pediatric scoliosis surgery; however, there has been no study that described the incidence and risk factors for unplanned return to the operating room (UPROR) with long-term follow-up in surgery for pediatric scoliosis with every etiology. METHODS We retrospectively extracted data of patients aged <19 years, from 14 institutes in Japan, who underwent primary definitive fusion surgery for spinal deformity between January 1, 2015 and December 31, 2017. The primary outcomes were the incidence of UPROR within the minimum 2-year follow-up period for any reason. Univariate and multivariate logistical analyses were conducted to identify potential risk factors associated with UPROR. RESULTS We identified 1417 eligible patients (287 males and 1130 females) with a mean age of 13.9 years. UPROR for any reason within minimum 2-year follow-up was identified in 68 patients (4.8%). The most frequent cause for UPROR was implant failure found in 29 patients, followed by surgical site infection in 14 patients, junctional problems in 10 patients, and neurological complications in six patients. The multivariate logistic regression analysis revealed that a diagnosis of kyphosis (odds ratio [OR], 2.65; 95% confidence interval [CI] 1.16-6.04), etiology of congenital or structural type (OR 2.21; 95% CI 1.08-4.53), etiology of syndromic type (OR 2.67; 95% CI 1.27-5.64), and increased operation time of ≥300 minutes (OR 1.81; 95% CI 1.07-3.07) were the risk factors for the incidence of UPROR. CONCLUSION The present multicenter study identified for the first time the incidence and risk factors for UPROR with minimum 2-year follow-up after primary definitive fusion surgery for pediatric spinal deformity with every etiology.Level of Evidence: 3.
Collapse
Affiliation(s)
- Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Koki Uno
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Yamaguchi
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Haruhisa Yanagida
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Keita Nakayama
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Toru Hirano
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Japanese Red Cross Kagoshima Hospital, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Kagoshima University, Kagoshima, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Ryo Sugawara
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Katsushi Takeshita
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Norihiro Oku
- Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tatsuya Sato
- Department of Orthopedic Surgery, School of Medicine, Juntendo University, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenta Fujiwara
- Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, School of Medicine, Iwate Medical University, Morioka, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| | - Noriaki Kawakami
- Department of Orthopedics and Spine Surgery, Meijo Hospital , Nagoya, Japan
- Devision of Spine Surgery, Department of Orthopedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya, Japan
- Japan Spinal Deformity Institute (JSDI), Japan
| |
Collapse
|
5
|
Garcia EB, Garcia LF, Garcia Júnior EB, Sá AD, Matos VDO, Camarinha JG, Camarinha MF, Gonçalves RG, Garcia EB, Giesbrecht ST. COMPARATIVE STUDY OF THE TYPES OF FIXATION IN ADOLESCENT IDIOPATHIC SCOLIOSIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212001232530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To conduct a comparative study of the results obtained in the treatment of adolescent idiopathic scoliosis (AIS) with different types of fixations (traditional, selective and multiple), and to evaluate the correction of angular deformity in the frontal plane by the Cobb and sacral clavicular angle (SCA) methods. Methods: A study of a group of 278 patients with AIS who underwent selective, traditional, and multiple fixation surgeries. Results: Significant corrections of both the Cobb angle and the SCA were observed. Conclusions: In the multiple fixation surgeries there was a 100% correction between the preoperative and postoperative SCA values and a 50% correction in the traditional and selective fixations, a difference considered significant. Regarding the Cobb angle, the three fixations presented corrections between preop and postop with significant differences. Level of evidence III; Retrospective Study.
Collapse
Affiliation(s)
- Enguer Beraldo Garcia
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil; Sociedade Brasileira de Coluna, Brazil; Universidade Federal de Minas Gerais, Brazil
| | - Liliane Faria Garcia
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil
| | | | | | | | | | | | | | - Eduardo Beraldo Garcia
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil
| | - Saulo Terror Giesbrecht
- Santa Casa de Belo Horizonte, Brazil; Instituto da Coluna Vertebral de Belo Horizonte, Brazil
| |
Collapse
|