Loss of Correction After Removal of Spinal Implants in Congenital Scoliosis

• Published in: World neurosurgery 2020-12, Vol.144, p.e916-e925
• Main Authors: Wang, Lin-nan, Hu, Bo-wen, Yang, Xi, Wang, Lei, Xiu, Peng, Zhou, Chun-guang, Liu, Li-min, Song, Yue-ming
• Format: Article
• Language: English
• Subjects: Congenital scoliosis; Fusion; Implant removal; Loss of correction; Revision surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.09.110

Previous studies have reported the progression of deformity in patients with adolescent idiopathic scoliosis after implant removal. However, for patients with congenital scoliosis, few studies have investigated the prognosis after implant removal. We observed 24 patients with congenital scoliosis, who underwent implant removal, for at least 3 years. Radiographic parameters and demographic data were compared to evaluate whether implant removal would lead to deformity progression. Four of the 24 patients (16.7%) suffered correction loss and underwent revision surgery (RS). All correction losses occurred within 12 months of implant removal. The average curve of fixed segments (9.84° ± 7.22° to 16.42° ± 16.79°; P = 0.017) and kyphosis of fixed segments (10.46° ± 13.42° to 18.98° ± 25.99°; P = 0.03) increased significantly throughout the follow-up. After excluding patients who underwent RS, the changes in curve of fixed segments (9.10°–11.58°) and kyphosis of fixed segments (8.50°–9.24°) were all within the measurement error. The coronal and sagittal balance maintained during the follow-up. Through comparison, we thought that the younger age and lower Risser’s grade with larger scoliosis might be risk factors for correction loss. Implant removal after fusion surgery for congenital scoliosis may present loss of correction and require RS, thus preserving implants is recommended. When removal of instrumentation is inevitable, parents and patients should be counseled for potential loss of correction and RS, and patients should be monitored for the progression of deformity.