title: Fate of the adult revision spinal deformity patient: a single institution experience.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  The aim of this study was to determine the revision rates for all revision spinal deformity (SD) surgical procedures performed at a single center and to investigate the changes in measures of HRQL in these patients.
  
  
  BACKGROUND
  Reported revision rates for primary adult spinal fusion surgical procedures have been in the range of 9% to 45%, but to our knowledge, the revision rate after revision SD surgery has not been reported. The reported improvements in health-related quality of life measures after revision SD surgery have also been quite modest.
  
  
  METHODS
  Four hundred fifty-five consecutive adult revision SD surgical procedures (1995-2008) were identified and the records were reviewed to determine the reason for and timing to any additional operation(s). Scoliosis Research Society (SRS) Outcome scores were recorded at the first visit and at planned follow-up visits.
  
  
  RESULTS
  Ninety-four of 455 patients underwent further surgical procedures for a revision rate of 21%. Two-year follow-up was available for 74 (78%) of these patients (mean follow-up, 6.0 yr; range, 2.4-12.6; sex: F = 61, M = 13; mean age, 53 yr; range, 21-78). The most common causes of revision surgery were pseudarthrosis (N = 23, 31%), implant prominence/pain (N = 15, 20%), adjacent segment disease (N = 14, 19%), and infection (N = 10, 14%). Twenty-five (27%) patients underwent more than one revision procedure. SRS outcome scores were available for 50 (68%) patients, at an average follow-up of 4.9 years (range, 2-11.4). The mean improvements in the SRS outcome measures were as follows: pain, 0.74 (P < 0.001); self-image, 0.8 (P < 0.001); function, 0.5 (P < 0.001); satisfaction, 1.2 (P < 0.001); and mental health, 0.3 (P = 0.012).
  
  
  CONCLUSIONS
  The rate of revision after revision SD surgery was 21%, most commonly due to pseudarthrosis, adjacent segment disease, infection, and implant prominence/pain. However, significant improvements in SRS outcome scores were still observed in those patients requiring additional revision procedures.
authors.affiliation: From the Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, MO.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Rashmi
authors.initials: R
authors.lastname: Agarwal
authors.forename: Jakub
authors.initials: J
authors.lastname: Godzik
authors.forename: Linda
authors.initials: L
authors.lastname: Koester
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation / Q000523:psychology / Q000639:trends*; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D013123:Spinal Fusion / Q000523:psychology / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult