Reconstructive surgery in the adult for failed scoliosis fusion

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients. The two-stage procedure consisted of exposure of the spine and multiple osteotomies, followed by two weeks of halofemoral traction to obtain correction. The spine fusion was then extended, using Harrington instrumentation to maintain correction. At an average follow-up of 3.3 years there was reduction of pain in 67 per cent of the patients and a solid fusion in all but two. The complication rate was high (71 per cent), the most important complications being pseudarthrosis, wound infection, urinary tract infection, loss of lumbar lordosis, and pressure sores. The mortality rate was 3.4 per cent. No patient became paraplegic following operation. An adequate length of fusion at the initial surgical procedure and early recognition and treatment of pseudarthrosis will reduce the number of patients requiring this salvage operation.