Revision of scoliosis surgery
- VernacularTitle:脊柱侧凸翻修术
- Author:
Yong HAI
;
Xiaoming CHEN
;
Zhiming CHEN
- Publication Type:Journal Article
- Keywords:
Scoliosis;
Spinal fusion;
Reoperation
- From:
Chinese Journal of Orthopaedics
1996;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective Patients with previous failed scoliosis surgery were managed by revision surgery,the reasons, methods and results of revision surgery were evaluated and analyzed. Methods Thir-ty-six patients with previous failed scoliosis surgery underwent revision surgery between June 1996 and Au-gust 2002. There were 15 males and 21 females with an average age of 16.8 years. The patients had 1.57 operations on average (1 for 27 cases, 2 for 8 cases and 3 for 1 case). The reasons for revision surgery were failure of previous instrumentation (6 cases), deterioration of the deformity (18 cases), and unsatisfactory re-sults with previous surgery (12 cases). Thorough radiographic evaluations including plain X-ray, CT scan and MRI were taken for each patient pre-operatively. The preoperative average Cobb angle for scoliosis was 76.2?(52?-108?)?Of 36 patients, there were 11 with kyphosis and the preoperative average Cobb angle was 53?(36?-79?). The involved spines in the deformity were 10.1 on average (8-13 levels). The surgical proce-dures included removal of previous instrumentation in 21 cases, staged trans-thoracic anterior release in 5 cases with rigid curve, and osteotomy passing through articular joints and laminae on previous fusion mass in 18 cases. All patients underwent trans-pedicular fixation and fusion as well. The clinical and radiographic results were evaluated post-operatively. Results All patients underwent surgery safely. The average opera-tive time was 3.8 hours (2.8-5.1 h) and the average blood loss was 817 ml(630-1 800 ml). There were no serious complications such as neurological injury. The average correction was 48? (22?-64?, 56%) for scolio-sis, and 47? (17?-52?, 72%) for kyphosis respectively. All patients were followed up at least 12 months (12-76 months). There was no loss of correction found during follow up and all patients achieved solid fu-sion. At the last follow up, 33 patients (91.7%) were satisfied with the results of revision surgery. Conclusion Revision surgery for failed scoliosis surgery is challenging because of technical difficulties for the procedure and higher risk for neurological injury. Extreme caution must be taken for each patient during pre-operative examination and evaluation. If appropriate surgical procedure including staged anterior re-lease, posterior osteotomy and trans-pedicular fixation is properly selected according individual deformity, the satisfactory results can be achieved.
