title: Revision surgery after primary spine fusion for idiopathic scoliosis.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  The objective of this study was to review the overall prevalence of, and indications for, reoperations after the index spine fusion for idiopathic scoliosis at our center.
  
  
  BACKGROUND
  Spine fusions for idiopathic scoliosis are expected to be the final therapeutic intervention in management. In a recent publication in 2006, reoperations after index spine fusion for idiopathic scoliosis were reported in 12.9% of patients at a single institution (n = 1046).
  
  
  METHODS
  A spinal deformity database search at our center identified all primary anterior, posterior, and circumferential spinal fusions performed for idiopathic scoliosis (1985-2003). A total of 1057 patients were identified whose mean age was 14.4 years (7-22 years) with minimum 2 year follow-up after index surgery. Study cohort consisted patients who underwent reoperation for any reason after index fusion procedure.
  
  
  RESULTS
  Of the 1057 spinal fusions for idiopathic scoliosis, 41 (3.9%) underwent reoperation. Primary surgeries were: 11 anterior spinal fusions, 25 posterior spinal fusions, and 5 circumferential spinal fusions. Mean follow-up was 5.7 years (2-10.8). Forty-seven additional procedures were performed during 46 reoperations at an average of 26 months after index procedure (1 week-73 months). Of the 47 reoperations, 20 (43%) were revision spinal fusions (for pseudarthroses, uninstrumented curve progression or junctional kyphosis), 16 (34%) because of infections (5 acute, 11 chronic), 7 (15%) for implant removals due to pain and/or prominence (4 complete, 3 partial), 2 (4%) were revision of loosened implants, and 2 (4%) were elective thoracoplasties.
  
  
  CONCLUSIONS
  This study documented a 3.9% overall reoperation rate at our medical center, a 3-fold lower reoperation rate than the previously reported 12.9%. The most common reoperations were for infections (34%), pseudarthroses (26%), and postoperative curve progression of the adjacent unfused spine (17%).
authors.affiliation: Department of Orthopaedic Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA. luhmanns@wustl.edu
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Luhmann
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000145:classification; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion; D055815:Young Adult