Effects and complications of revision surgery for severe coronal imbalance after scoliosis correction

English Keywords:Scoliosis  Coronal imbalance  Revision surgery  Asymmetric osteotomy

English Abstract:

  【Abstract】 Objectives: To observe the effects and complications of revision for severe coronal imbalance after scoliosis correction surgery. Methods: A retrospective analysis was performed on the clinical data of 7 patients with severe coronal imbalance after scoliosis correction surgery who underwent reoperation and revision at our hospital from January 2013 to August 2021, including 3 males and 4 females, aged 21.3±7.5 years (14-32 years). The follow-up period was 16.3±4.2 months, ranging from 12 to 25 months. The age of the first operation, number of previous operations, operative time of this revision surgery, amount of intraoperative blood loss, osteotomy method, and fixed segment were collected. The Cobb angles of the main thoracic and lumbar curves, tilt angle of the lowest instrumented vertebra, coronal balance distance(CBD), and coronal pelvic tilt angle were measured on the anteroposterior and lateral full-spine X-rays preoperatively, immediately postoperatively, and at the last follow-up, and the correction rate of CBD was calculated. The 36-Item Short Form Health Survey(SF-36) was used to score all the patients before operation, immediately after operation, and at final follow-up to assess their improvements in the quality of life. The complications of this reoperation and their outcomes were recorded. Results: The age of the first operation of the patients was 8.86±4.14 years (3-15 years), the number of previous operations was 5.29±3.55(2-13), the operative time of this revision was 346.14±64.65min, and the intraoperative blood loss was 1342.86±687.65ml. Asymmetric pedical subtraction osteotomy(PSO) was performed in 6 patients, and multi-segment Ponte osteotomy with internal fixation fusion segment extended was performed in the remaining 1 patient. The CBD was improved to 36.11±15.14mm immediately after surgery from the preoperative 77.23±33.28mm significantly(P<0.05), with a correction rate of (53±3)%, and it was 35.91±14.45mm at final follow-up, with no significant difference from that immediately after surgery(P>0.05). The main thoracic curve, the lowest instrumented vertebra inclination angle, and the coronal pelvic inclination angle were significantly reduced immediately after surgery(P<0.05), and no significant differences were found between those at final follow-up and immediately after surgery, respectively(P>0.05). The lumbar curve was 21.29°±17.77° at preoperation and 30.14°±8.86° at immediately after surgery, the changes were significantly different(P<0.05), and it was 30.14°±8.13° at the last follow-up, not significantly changed from that after surgery(P>0.05). The SF-36 comprehensive score before surgery was 27.29±1.98 points, which improved to 36.86±2.27 points immediately after surgery(P<0.05) and 50.14±3.24 points at final follow-up(P<0.05). Five patients developed postoperative complications such as pleural effusion, cerebrospinal fluid leakage, and lower extremity neuralgia, all of which were completely cured during hospitalization. Conclusions: Revision osteotomy can obtain good correction for patients with severe coronal imbalance after multiple operations for scoliosis, but the surgical risk is high, and perioperative complications need to be closely monitored.