The reasons and risk factors for revision surgery in degenerative scoliosis

English Keywords:Degenerative  Scoliosis  Revision  Surgery

English Abstract:

  【Abstract】 Objectives: To investigate the revision rate and the risk factors for revision surgery in degenerative scoliosis. Methods: 132 cases with degenerative scoliosis who underwent single posterior spinal fusion longer than 5 vertebrae and more than 2 years follow-up were studied retrospectively. There were 49 males and 83 females, the mean age was 61.8±15 years(40-78 years). The fusion segments were 5-14 vertebrae(average, 7.9±1.8 vertebrae). The mean follow-up was 3.7±1.2 years(2-5 years). The clinical data and spinopelvic parameters were reviewed to identify the causes of revision surgery. Results: Revision surgeries were performed in 15 patients with 17 incidences of complications, with revision rate of 11.4%. There were 5 males and 10 females, the average age was 59±17 years(41-75 years). The main reasons of revision surgery were proximal junctional complication(29.4%, 5/17), pseudarthrosis or implant breakage(23.5%, 4/17), and spinal coronal or sagittal imbalance(11.8% respectively). There was no significant correlation between revision rate and age or gender(χ2=0.104, P=0.747, χ2=0.151, P=0.698). There was also no significant correlation between revision rate of proximal junctional complication and upper instrumented vertebra(χ2=0.063, P=0.802). However, the revision rate of proximal junctional complication with fusion to S1 group was more than that fusion to L5 group(χ2=2.033, P=0.041). Moreover, there was a significant difference between three column osteotomy and non-three column osteotomy in terms of implant breakage and coronal imbalance(χ2=5.214，P=0.022). Conclusions: The revision rate of degenerative scoliosis is 11.4%, and the main reasons are proximal junctional complication, pseudarthrosis or implant breakage and spinal imbalance. Three column osteotomy can cause implant breakage and coronal imbalance. Fusion to S1 can increase revision rate of proximal junctional complications.