title: Reinstrumentation for rapid curve progression after implant removal following posterior instrumented fusion in adolescent idiopathic scoliosis: a case report.
abstract: BACKGROUND
  Spinal implants are occasionally removed due to infection or soft tissue irritation secondary to prominence. Several studies have reported loss of scoliotic curve correction after implant removal. However, further review of the literature reveals no similar cases of rapid curve progression following implant removal in patients with adolescent idiopathic scoliosis (AIS) necessitating repeat posterior instrumented fusion.
  
  
  OBJECTIVE
  To describe a 15-year-old female AIS patient treated by posterior instrumented fusion, who developed unusual rapid coronal and sagittal curve progression after implant removal.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Retrospective case report.
  
  
  RESULTS
  A 15-year-old female with Lenke type 1A AIS underwent a successful posterior spinal fusion with instrumentation. She initially had no complications after surgery, but three years after instrumentation, her implants were removed due to pain secondary to implant prominence. Fifteen months after removal, the main thoracic curve increased, compared with radiographs taken before removal, from 29° to 57°. This development required the patient to undergo additional surgery, which involved multiple osteotomies and posterior reinstrumentation.
  
  
  CONCLUSIONS
  We must acknowledge that a remarkable amount of progression can occur rapidly following implant removal in scoliotic patients. Taking this into consideration,we need to carefully explain to patients that removal of their implants entails a risk of progressive deformity and that they need to follow-up with their physician after implant removal.
authors.affiliation: Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-shi, Chiba 285-8765, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kotani
authors.affiliation: Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-shi, Chiba 285-8765, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Akazawa
authors.affiliation: Department of Orthopedic Surgery, The Medical City, Ortigas Avenue, Pasig City, Metro Manila 1605, Philippines.
authors.forename: Jose Mt
authors.initials: JM
authors.lastname: Lumawig
authors.affiliation: Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-shi, Chiba 285-8765, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sakuma
authors.affiliation: Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, 2-36-2 Ebaradai Sakura-shi, Chiba 285-8765, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Minami
keywords: Adolescent idiopathic scoliosis; Implant removal; Posterior spinal fusion