Causes and tactics for revision of internal spinal instrumentation

English Keywords:Spinal instrumentation  Complication  Revision surgery

English Abstract:

  【Abstract】 Objectives: To analyse the causes and to find out the tactics of spinal revision surgery for internal instrumentation. Methods: A retrospective analysis was carried out for the forty-four cases suffered from a revision surgery of internal spinal instrumentation in our department from January 2004 to December 2011, with a mean follow-up of 3 years(1 to 81 months). The causes of revision surgery were divided into eight types: (1)secondary injury of the implant, 3 cases; (2)implant broken and displacement, 21 cases; (3)unsatistactory implant placement, 3 case; (4)implant lose function, 1 case; (5)residual implant, 1 case; (6)adjacent segment degeneration of the implant, 2 cases; (7)implant affect the infection control, 12 cases; (8)non-implant compression, 1 case. According to the different causes, the different tactics of changing or removing the implant were underwent. All these patients were evaluated radiologically by X-ray plain film, three-dimensional CT and magnetic resonance imaging. Among all, the cervical myelopathy patients were evaluated by the modified JOA scoring method; the lumbar degenerative patients were evaluated by the Stucki scoring method; and the patients of spine fracture and dislocation with spinal cord injury were evaluated by the ASIA injury grade. Results: There was no intraoperative complication among all the revision patients. But one complication after the surgery was found as the transitory nurological dysfunction caused by hematomaic compression, the patient received the revision surgery again with the removal of hematoma and internal fixation, and nurological function was recoverd. The JOA score of the cervical myelopathy patients before and after the revision surgery did not change significantly; according to the Stucki scoring method, 90% of the the lumbar degenerative patients were satisfied with the surgery, 90% of them were satisfied with the pain relief and recovery of ambulatory function, and 80% of them were satisfied with the lower limb strength and the balance capability; the patients of spine fracture and dislocation with spinal cord injury had no change on the ASIA injury grade after the revision surgery.　After the revision surgery, implants were in good position, fusion rate was 100%, and the infections were controlled. Conclusions: There are many causes of spinal revision surgery for internal instrumentation and appropriate tactic can achieve satisfactory result. As well, we should manage the principle of the internal spinal instrumentation and standardize the procedure to avoid revision surgery.