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Revision strategies for failed adult spinal deformity surgery

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Abstract

Purpose

The aim of this study is to analyse the results of revision surgery for failed adult spinal deformity patients and to describe the surgical strategy selection process, based on the identification of the main clinical diagnosis responsible for failure.

Methods

We retrospectively reviewed the clinical and radiological data of 77 consecutive patients treated in a 3-year time (2016–2019) for surgical revision of long fusion (more than five levels fused) for adult spinal deformity in a high-volume spine centre, divided into four groups based on the diagnosis: rod breakage (RB) group, proximal junctional failure (PJF) group, distal junctional failure (DJF) group and loss of correction (LOC) group with symptomatic sagittal or coronal malalignment (including iatrogenic flatback).

Results

Seventy-seven patients met our inclusion criteria, with a female prevalence (66 F vs. 11 M). The mean age at revision surgery was 63. Fused levels before surgery were averagely 12, and revision added averagely two levels to the preexisting fusion area. Clinical status was apparently improved in ODI scores and VAS scores, while it was slightly worsened in SF36 scores. Different diagnosis groups have been addressed with different surgical strategies, according to the different surgical goals: interbody cages and multi-rod construct to improve stiffness and favour bony fusion, “kickstand” rod and “tie” rod to correct coronal and sagittal malalignment, specific rod contouring and proximal hooks in “claw” configuration to reduce mechanical stress at the proximal junctional area. Intraoperative complications occurred in 18% of patients and perioperative complications in 39%.

Conclusion

Revision surgery in long fusions for adult spinal deformity is a challenging field. Surgical strategy should always be planned carefully. A successful treatment is a direct consequence of a correct preoperative diagnosis, and surgery should address the primary cause of failure. All the above-mentioned surgical techniques and clinical skills should be part of surgeon’s expertise when managing these patients.

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Authors and Affiliations

  1. GSpine4, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy

    Carlotta Martini, Francesco Langella & Claudio Lamartina

  2. Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy

    Luca Mazzucchelli

Authors
  1. Carlotta Martini
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  2. Francesco Langella
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  3. Luca Mazzucchelli
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  4. Claudio Lamartina
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Correspondence to Carlotta Martini.

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C Martini, F. Langella, L. Mazzucchelli and C. Lamartina declare that they have no conflict of interest.

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Martini, C., Langella, F., Mazzucchelli, L. et al. Revision strategies for failed adult spinal deformity surgery. Eur Spine J 29 (Suppl 1), 116–125 (2020). https://doi.org/10.1007/s00586-019-06283-9

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  • DOI: https://doi.org/10.1007/s00586-019-06283-9

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