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Repeat Surgical Interventions Following Definitive Instrumentation and Fusion for Idiopathic Scoliosis: Five-Year Update on a Previously Published Cohort

Ramo, Brandon A. MD; Richards, B. Stephens MD

doi: 10.1097/BRS.0b013e31824b6b05
Deformity

Study Design. A retrospective case series.

Objective. To identify the overall reoperation rate and factors contributing to reoperation in a recent 5-year cohort of patients (2003–2007) undergoing spinal deformity surgery. These patients were compared with a previously published 15-year cohort of consecutive patients (1988–2002) from the same institution to assess for any significant differences in reoperation rates.

Summary of Background Data. In a previously published report from this institution, the reoperation rate for patients with idiopathic scoliosis treated during a 15-year period (1988–2002) was 12.9%. That group was predominantly treated with first-generation TSRH (Medtronic, Memphis, TN) implants and CD implants. Lower profile, more rigid implant systems are now used along with refined techniques for correction of scoliosis deformity. We hypothesized that these factors would lead to lower rates of reoperation.

Methods. The medical records of 452 consecutive patients (older than 9 yr) surgically treated for idiopathic scoliosis at one institution during 5 years (2003–2007) were reviewed to identify those who required reoperation.

Results. The reoperation rate for this cohort was 7.5% (34 of 452 patients). Compared with the prior cohort, significant decreases were noted with regard to total reoperation rate as well as reoperation due to infection and pseudarthrosis. Trends were noted toward decreased rates of reoperation due to prominent implants, dislodged implants, and implant proximity to vital structures. Within the newer cohort, a trend toward decreased reoperation rate was also noted for lower profile implant systems compared with first-generation TSRH implants.

Conclusion. With the evolution of newer lower profile segmental implant systems that provide more rigid fixation and with the advancements in techniques for deformity correction, the repeat surgical intervention rate for idiopathic scoliosis has decreased.

The reoperation rate for idiopathic scoliosis in a previous 15-year cohort of patients from our institution (1988–2002) was 12.9%. The most current 5-year cohort of patients (2003–2007) had a reoperation rate of 7.5%. Significant decreases in infection and pseudarthrosis rates have contributed to the declining rate of reoperation.

From the Texas Scottish Rite Hospital for Children, Dallas, TX.

Address correspondence and reprint requests to B. Stephens Richards, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219; E-mail: Steve.richards@tsrh.org

Acknowledgment date: November 25, 2011. First revision date: October 25, 2011. Acceptance date: November 25, 2011.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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