Objective: To evaluate the surgical efficacy of repeated vertebral column resection (Re-VCR) after instrumentation removal in congenital scoliosis (CS) patients previously undergoing primary posterior spinal correction with VCR, and to analyze complications pertinent to revision surgery.
Methods: In this retrospective cross-sectional study, a total of 16 CS patients who underwent Re-VCR following instrumentation removal between February 2013 and February 2022 were reviewed. Radiographic parameters were assessed pre- and post-primary operation, pre-removal, pre- and post-revision and at the last follow-up. Clinical data were also analyzed and recorded for each patient.
Results: The indications for instrumentation removal were infection, implant failure, patient and family request, and persistent pain. The Cobb angle of the main curve, global kyphosis (GK), coronal balance (CB) and sagittal vertical axis (SVA) significantly progressed after instrumentation removal. The average progression rates of scoliosis and kyphosis were 5.3° ± 4.0°/year and 10.0° ± 7.2°/year. Following revision surgery, the Cobb angle of the main curve, GK, CB showed significant improvement (t = 10.694, p < 0.001; Z = −3.516, p < 0.001; Z = −2.664, p = 0.008). For Re-VCR, the average extension of the fusion level was 2.9 ± 1.4 vertebrae proximally, 3.0 (2.0, 3.0) vertebrae distally and 5.4 ± 1.6 vertebrae in total. The average correction rates of the Cobb angle of the main curve and GK were 59.5% ± 23.4% and 53.7% ± 18.3% with no significant correction loss during follow-up (p > 0.05). Compared with pre-revision, the mean scores of pain, satisfaction, mental health and self-image on the Scoliosis Research Society-22 (SRS-22) questionnaire improved at different levels. Intra-revision complications included alert of neurophysiological monitoring and dural tear, while breakage of the distal L5 pedicle screw occurred in 1 (6.3%) patient 2 years after revision.
Conclusions: Severe progression of deformity and trunk imbalance was frequently observed following instrumentation removal. The removal of instrumentation is not routinely recommended, and revision surgery employing Re-VCR frequently necessitates an extension of the fusion level. Satisfactory radiographic and clinical outcomes following Re-VCR were effectively maintained throughout the follow-up period, but great caution should be exercised during Re-VCR.
| [1] |
D. W. Polly,, M. K. Rosner, W. Monacci, et al., “Thoracic Hemivertebra Excision in Adults via a Posterior-Only Approach Report of Two Cases,” Neurosurgical Focus 14, no. 2 (2003): e9.
|
| [2] |
Q. Zhuang, J. Zhang, S. Li, S. Wang, J. Guo, and G. Qiu, “One-Stage Posterior-Only Lumbosacral Hemivertebra Resection With Short Segmental Fusion: A More Than 2-Year Follow-Up,” European Spine Journal 25, no. 5 (2016): 1567–1574.
|
| [3] |
F. Hahn, R. Zbinden, and K. Min, “Late Implant Infections Caused by Propionibacterium acnes in Scoliosis Surgery,” European Spine Journal 14, no. 8 (2005): 783–788.
|
| [4] |
J. A. Rihn, J. Y. Lee, and W. T. Ward, “Infection After the Surgical Treatment of Adolescent Idiopathic Scoliosis: Evaluation of the Diagnosis, Treatment, and Impact on Clinical Outcomes,” Spine 33, no. 3 (2008): 289–294.
|
| [5] |
L. N. Wang, B. W. Hu, X. Yang, et al., “Loss of Correction After Removal of Spinal Implants in Congenital Scoliosis,” World Neurosurgery 144 (2020): e916–e925.
|
| [6] |
Y. Oshima, L. G. Lenke, L. Koester, and K. Takeshita, “Revision Versus Primary Patients Undergoing Vertebral Column Resection for Severe Spinal Deformities,” Spine Deformity 2, no. 5 (2014): 350–357.
|
| [7] |
H. W. Alpert, F. A. Farley, M. S. Caird, R. N. Hensinger, Y. Li, and K. L. Vanderhave, “Outcomes Following Removal of Instrumentation After Posterior Spinal Fusion,” Journal of Pediatric Orthopedics 34, no. 6 (2014): 613–617.
|
| [8] |
K. Rathjen, M. Wood, A. McClung, and Z. Vest, “Clinical and Radiographic Results After Implant Removal in Idiopathic Scoliosis,” Spine 32, no. 20 (2007): 2184–2188.
|
| [9] |
M. V. Abola, C. K. Hardesty, D. M. Knapik, C. Poe-Kochert, J. P. Son-Hing, and G. H. Thompson, “Incidence of Complete Spinal Instrumentation Removal Following Surgery for Spinal Deformity: A 22-Year Single Institution Study,” Journal of Pediatric Orthopaedics: Part B 28, no. 4 (2019): 380–384.
|
| [10] |
M. Muschik, W. Luck, and D. Schlenzka, “Implant Removal for Late-Developing Infection After Instrumented Posterior Spinal Fusion for Scoliosis: Reinstrumentation Reduces Loss of Correction. A Retrospective Analysis of 45 Cases,” European Spine Journal 13, no. 7 (2004): 645–651.
|
| [11] |
W. J. Gaine, S. M. Andrew, P. Chadwick, E. Cooke, and J. B. Williamson, “Late Operative Site Pain With Isola Posterior Instrumentation Requiring Implant Removal: Infection or Metal Reaction?,” Spine 26, no. 5 (2001): 583–587.
|
| [12] |
G. Benes, H. L. Shufflebarger, S. A. Shah, et al., “Late Infection After Spinal Fusion for Adolescent Idiopathic Scoliosis: Implant Exchange Versus Removal,” Journal of Pediatric Orthopedics 43, no. 7 (2023): e525–e530.
|
| [13] |
B. K. Potter, K. L. Kirk, S. A. Shah, and T. R. Kuklo, “Loss of Coronal Correction Following Instrumentation Removal in Adolescent Idiopathic Scoliosis,” Spine 31, no. 1 (2006): 67–72.
|
| [14] |
M. Farshad, C. Sdzuy, and K. Min, “Late Implant Removal After Posterior Correction of AIS With Pedicle Screw Instrumentation-A Matched Case Control Study With 10-Year Follow-Up,” Spine Deformity 1, no. 1 (2013): 68–71.
|
| [15] |
T. Kotani, T. Akazawa, J. M. Lumawig, T. Sakuma, and S. Minami, “Reinstrumentation for Rapid Curve Progression After Implant Removal Following Posterior Instrumented Fusion in Adolescent Idiopathic Scoliosis: A Case Report,” Scoliosis 8 (2013): 15.
|
| [16] |
A. Toga, K. Fukuda, M. Ozaki, T. Fujii, and Y. Yonezawa, “Reinstrumentation for Progressive Hyper-Kyphotic Deformity After Implant Removal Despite Obtaining Physiological Alignment by Posterior Corrective Surgery for Adolescent Idiopathic Scoliosis With Flat Back: A Case Report,” Journal of Surgical Case Reports 2023, no. 10 (2023): rjad547.
|
| [17] |
Z. Z. Zhu, X. Chen, Y. Qiu, et al., “Adding Satellite Rods to Standard Two-Rod Construct With the Use of Duet Screws: An Effective Technique to Improve Surgical Outcomes and Preventing Proximal Junctional Kyphosis in Posterior-Only Correction of Scheuermann Kyphosis,” Spine 43, no. 13 (2018): E758–E765.
|
| [18] |
T. Wang, H. Liu, Z. Zheng, et al., “Biomechanical Effect of 4-Rod Technique on Lumbosacral Fixation: An In Vitro Human Cadaveric Investigation,” Spine 38, no. 15 (2013): E925–E929.
|
| [19] |
S. J. Luhmann, L. G. Lenke, K. H. Bridwell, and M. Schootman, “Revision Surgery After Primary Spine Fusion for Idiopathic Scoliosis,” Spine 34, no. 20 (2009): 2191–2197.
|
| [20] |
B. L. Shi, Y. Li, Z. Z. Zhu, et al., “Failed Primary Surgery in Congenital Scoliosis Caused by a Single Hemivertebra: Reasons and Revision Strategies,” Orthopaedic Surgery 14, no. 2 (2022): 349–355.
|
| [21] |
S. Iyer, V. M. Nemani, and H. J. Kim, “A Review of Complications and Outcomes Following Vertebral Column Resection in Adults,” Asian Spine Journal 10, no. 3 (2016): 601–609.
|
| [22] |
L. G. Lenke, P. O. Newton, D. J. Sucato, et al., “Complications After 147 Consecutive Vertebral Column Resections for Severe Pediatric Spinal Deformity: A Multicenter Analysis,” Spine 38, no. 2 (2013): 119–132.
|
| [23] |
L. G. Lenke, B. A. Sides, L. A. Koester, M. Hensley, and K. M. Blanke, “Vertebral Column Resection for the Treatment of Severe Spinal Deformity,” Clinical Orthopaedics and Related Research 468, no. 3 (2010): 687–699.
|
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