Yamauchi Ippei, Nakashima Hiroaki, Ito Sadayuki, Segi Naoki, Ouchida Jun, Morita Yoshinori, Ode Yukihito, Nagatani Yasuhiro, Okada Yuya, Tauchi Ryoji, Ohara Tetsuya, Kawakami Noriaki, Imagama Shiro
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
Yotsuya Orthopedic and Rehabilitation Clinic, Nagoya, Japan.
Eur Spine J. 2025 Feb;34(2):635-642. doi: 10.1007/s00586-024-08519-9. Epub 2024 Dec 10.
To evaluate the complications and postoperative outcomes of implant removal after posterior fixation in adolescent idiopathic scoliosis.
We retrospectively reviewed the data of patients who underwent implant removal after posterior corrective fixation for adolescent idiopathic scoliosis between 2002 and 2014. Complications were evaluated in the 116 patients who underwent implant removal at their choice. Radiological evaluations were performed and analyzed in 71 patients who were followed up for > 2 years after implant removal. Moreover, the patients were divided into two groups: those with increased thoracic kyphosis after implant removal and those without.
Overall, 14 of the 116 patients had complications. Two of the three patients with fractures required reoperation. Radiological examination revealed no significant difference in the scoliosis curvature in the coronal plane after implant removal. In the sagittal plane, the lowest instrumented vertebral tilt, cervical lordosis, T1 slope, T1-12 kyphosis angle, and T5-12 kyphosis angle were significantly increased. Moreover, patients with an increased T5-12 kyphosis angle after implant removal had greater pelvic incidence (PI) and sacral slope (SS) before implant removal.
The prevalence of complications after implant removal in adolescent idiopathic scoliosis was 12.1%. Spinal alignment is more variable in the sagittal plane than in the coronal plane, and patients with increased thoracic kyphosis after implant removal have greater preoperative PI and SS. Sufficient preoperative explanation is necessary if a patient wishes to undergo implant removal.
评估青少年特发性脊柱侧凸后路固定术后内植物取出的并发症及术后结果。
我们回顾性分析了2002年至2014年间因青少年特发性脊柱侧凸接受后路矫正固定术后行内植物取出患者的数据。对116例自主选择行内植物取出的患者的并发症进行了评估。对71例在取出内植物后随访超过2年的患者进行了影像学评估并分析。此外，将患者分为两组：取出内植物后胸椎后凸增加的患者和未增加的患者。
总体而言，116例患者中有14例出现并发症。3例骨折患者中有2例需要再次手术。影像学检查显示取出内植物后脊柱侧凸在冠状面的弯曲度无显著差异。在矢状面，最低固定椎体倾斜度、颈椎前凸、T1斜率、T1-12后凸角和T5-12后凸角均显著增加。此外，取出内植物后T5-12后凸角增加的患者在取出内植物前骨盆倾斜度（PI）和骶骨斜率（SS）更大。
青少年特发性脊柱侧凸内植物取出术后并发症的发生率为12.1%。脊柱矢状面的排列比冠状面更具变异性，取出内植物后胸椎后凸增加的患者术前PI和SS更大。如果患者希望进行内植物取出，术前进行充分的解释是必要的。
