title: Unanticipated revision surgery in adult spinal deformity: an experience with 815 cases at one institution.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  This study reviewed the overall prevalence and indications of revision surgical procedures for adult scoliosis in a single institution. In this largest single-institution series, revision surgery in adult scoliosis was required for a relatively low proportion of cases (7.61%). The main indications were implant breakage, deformity progression, and infection.
  
  
  BACKGROUND
  Spine fusion is considered as the final therapeutic intervention in the management of adult scoliosis. However, reports on the repeat surgical intervention of adult scoliosis predate the use of advanced instrumentation systems.
  
  
  METHODS
  The scoliosis database of our center was searched, and all cases with index spinal fusion surgical procedures performed for adult scoliosis from 1998 to 2011 with the follow-up period of more than 2 years were identified. The clinical data and radiographs of patients were reviewed to provide information on the indication of initial operation and any subsequent revision surgery. A total of 815 patients were identified, with a mean age of 30.49 years (range, 20-76 yr). The mean follow-up periods were 6.4 years (range, 2-15 yr) for the entire cohort and 7.6 years (range, 2.5-12 yr) for the subset of the cohort requiring revision.
  
  
  RESULTS
  The patients exhibiting multiple reasons for revision were classified under primary reason and subjected to subsequent analysis. Among the 815 patients, 62 (7.61%) underwent at least 1 revision surgery. The most common reasons for revision were implant breakage (23/62; 37.1%), deformity progression (10/62; 16.1%), and infection (9/62; 14.5%). The other indications were pseudarthrosis (n = 8), implant dislodgement (n = 6), junctional kyphosis (n = 5), and neurological deficit (n = 1). Revision rate was significantly higher in patients older than 40 years (15.23% vs. 5.87%), in patients with degenerative or congenital scoliosis (15.12% vs. 12.82%), or in patients with hybrid constructs (12.12% vs. 5.82%).
  
  
  CONCLUSIONS
  In this largest single-institution series, revision surgery after index spinal fusion in patients with adult scoliosis was required for a relatively low proportion of surgical cases (7.61%). The main indications for revision were implant breakage, deformity progression, and infection.
authors: *Spinal Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, China and †Sir Charles Gairdner Hospital, Perth, Australia.
authors: Feng
authors: F
authors: Zhu
authors: Hongda
authors: H
authors: Bao
authors: Zhen
authors: Z
authors: Liu
authors: Mark
authors: M
authors: Bentley
authors: Zezhang
authors: Z
authors: Zhu
authors: Yitao
authors: Y
authors: Ding
authors: Yong
authors: Y
authors: Qiu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011542:Pseudarthrosis / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult