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In Adolescent Idiopathic Scoliosis, Do All Instrument-Related Complications Require Revision Surgery?
Stephen M Plachta1, Amer F Samdani1, Joshua M Pahys1
1Shriners Children's Philadelphia, Philadelphia, PA.
Study Design:
Retrospective cohort study using a multicenter prospectively collected database.
Objective:
To evaluate outcomes of operative versus conservative management of instrumentation-related complications.
Background:
Instrumentation-related complications following AIS surgery are well described, yet limited literature exists comparing outcomes between patients treated with revision surgery and those managed conservatively.
Materials And Methods:
AIS patients with instrumentation-related complications were grouped as having broken instrumentation (BRK), loss of fixation (LOF), prominence (PRO), or other. Patients were grouped by treatment strategy: revision surgery (RS) versus conservative (nonoperative) treatment (CT).
Results:
Of 5144 AIS patients, 141 (2.7%) developed 148 instrumentation-related complications, with 68 (46%) undergoing revision. More than half (n=77) were managed conservatively. Pain was a strong predictor of revision in both BRK and LOF cohorts ( P <0.01). At five-year follow-up, SRS-22 scores were comparable between CT and RS groups, except for the BRK-RS subgroup, which had significantly higher domain scores ( P <0.05) except for satisfaction. These scores were collected at standardized intervals and may reflect different clinical trajectories: recovery in revision patients and stability in those treated conservatively. However, among patients with BRK complications, RS patients showed improved outcomes, suggesting that symptom severity may drive treatment. In the LOF group, RS patients had higher BMI, more lumbar curves, and greater pseudarthrosis incidence (all P <0.05), yet no significant radiographic or PROM differences were observed between the RS and CT groups at follow-up. The timing of complications varied widely (mean: 21.5 mo postoperatively, SD: ±22.6 mo).
Conclusion:
In this multicenter cohort, many patients with instrumentation-related complications were successfully managed conservatively (CT), especially those without significant symptoms. Long-term PROMs (SRS-22) were comparable between groups (CT and RS), supporting a symptom guided, individualized approach to management. Revision surgery remains appropriate for symptomatic patients, and observation may be a safe and appropriate option in select asymptomatic individuals.
Level Of Evidence:
Level III.
