Zhu Feng, Bao Hongda, Liu Zhen, Bentley Mark, Zhu Zezhang, Ding Yitao, Qiu Yong
*Spinal Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China and †Sir Charles Gairdner Hospital, Perth, Australia.
Spine (Phila Pa 1976). 2014 Dec 15;39(26 Spec No.):B36-44. doi: 10.1097/BRS.0000000000000463.
Retrospective case series.
This study reviewed the overall prevalence and indications of revision surgical procedures for adult scoliosis in a single institution. In this largest single-institution series, revision surgery in adult scoliosis was required for a relatively low proportion of cases (7.61%). The main indications were implant breakage, deformity progression, and infection.
Spine fusion is considered as the final therapeutic intervention in the management of adult scoliosis. However, reports on the repeat surgical intervention of adult scoliosis predate the use of advanced instrumentation systems.
The scoliosis database of our center was searched, and all cases with index spinal fusion surgical procedures performed for adult scoliosis from 1998 to 2011 with the follow-up period of more than 2 years were identified. The clinical data and radiographs of patients were reviewed to provide information on the indication of initial operation and any subsequent revision surgery. A total of 815 patients were identified, with a mean age of 30.49 years (range, 20-76 yr). The mean follow-up periods were 6.4 years (range, 2-15 yr) for the entire cohort and 7.6 years (range, 2.5-12 yr) for the subset of the cohort requiring revision.
The patients exhibiting multiple reasons for revision were classified under primary reason and subjected to subsequent analysis. Among the 815 patients, 62 (7.61%) underwent at least 1 revision surgery. The most common reasons for revision were implant breakage (23/62; 37.1%), deformity progression (10/62; 16.1%), and infection (9/62; 14.5%). The other indications were pseudarthrosis (n = 8), implant dislodgement (n = 6), junctional kyphosis (n = 5), and neurological deficit (n = 1). Revision rate was significantly higher in patients older than 40 years (15.23% vs. 5.87%), in patients with degenerative or congenital scoliosis (15.12% vs. 12.82%), or in patients with hybrid constructs (12.12% vs. 5.82%).
In this largest single-institution series, revision surgery after index spinal fusion in patients with adult scoliosis was required for a relatively low proportion of surgical cases (7.61%). The main indications for revision were implant breakage, deformity progression, and infection.
回顾性病例系列。
本研究回顾了单一机构中成人脊柱侧凸翻修手术的总体患病率及手术指征。在这个最大的单一机构系列研究中，成人脊柱侧凸需要进行翻修手术的病例比例相对较低（7.61%）。主要指征为内植物断裂、畸形进展和感染。
脊柱融合术被认为是成人脊柱侧凸治疗的最终干预手段。然而，关于成人脊柱侧凸再次手术干预的报道早于先进内固定系统的使用。
检索了本中心的脊柱侧凸数据库，确定了1998年至2011年期间因成人脊柱侧凸接受初次脊柱融合手术且随访时间超过2年的所有病例。回顾患者的临床资料和X线片，以提供初次手术指征及任何后续翻修手术的信息。共确定了815例患者，平均年龄30.49岁（范围20 - 76岁）。整个队列的平均随访时间为6.4年（范围2 - 15年），需要翻修的队列子集的平均随访时间为7.6年（范围2.5 - 12年）。
将有多种翻修原因的患者按主要原因分类并进行后续分析。在815例患者中，62例（7.61%）接受了至少1次翻修手术。最常见的翻修原因是内植物断裂（23/62；37.1%）、畸形进展（10/62；16.1%）和感染（9/62；14.5%）。其他指征包括假关节形成（n = 8）、内植物移位（n = 6）、交界性后凸（n = 5）和神经功能缺损（n = 1）。40岁以上患者（15.23%对5.87%）、患有退行性或先天性脊柱侧凸的患者（15.12%对12.82%）或采用混合结构的患者（12.12%对5.82%）的翻修率显著更高。
在这个最大的单一机构系列研究中，成人脊柱侧凸患者初次脊柱融合术后需要进行翻修手术的手术病例比例相对较低（7.61%）。翻修的主要指征是内植物断裂、畸形进展和感染。
