New scoliosis surgery long-term follow up paper indicates that the Harrington rod replacer, the Cotrel-Dubousset had unexpectedly high revision rate and complications are common. All proponents for scoliosis surgery were hoping that the new spinal implants would have fewer issues than Harrington rods. Unfortunately that doesn’t seem to be the case.

Here is a list of all Complication that occurred due to the scoliosis surgery

There was no direct or indirect operative mortality. Furthermore, there was no permanent
neurological complication. In one case, surgical correction was stopped incompletely because
of massive bleeding, and then the correction was successfully concluded 14 days later.

According to the medical files, 21 out of 40 patients (52.5%) received one or more operative
revisions, for a total of 23 surgical revisions:


Within the first 30 days post surgery, 3 out of 40 patients (7.5%) received early operative
revision for the dislocation of hooks or rods.

At an average of 45.7 months (range 11 to 142 months), 19 out of 40 patients (47.5%;
including 2 patients with early revision) received late operative revisions.

At this occasion, we documented the revision rate of the highest significance (9 out of 16
procedures; 56%), not in the first year of introduction but rather for 1992, the third and last
year of application. Despite thorough data analysis, we could not find any explanations for
this.

The reasons were late infection (10 out of 40 patients; 25%) with the development of fistulae
(7 cases) or putrid secretion (3 cases), which was resolved with the complete removal of
instrumentation after all. We documented 5 out of 7 fistulae at the distal end of the
instrumentation. The average time until revision was 35.5 months (range 14 to 56 months)
after CD instrumentation. There were no bacteriological findings of any pathogens after a
maximum time of cultivation of 48 hours.

Furthermore, complete implant removal was necessary in 8 out of 40 patients (20%) for late
operate site pain (LOSP). No infections or non-unions were detected intraoperatively, but
there was a partial implant loosening in the caudal section of the implant in 6 cases, including
corrosion in 2 out of 6 cases and broken cranial transverse connectors in 2 other cases. The
average time until removal of instrumentation was 62.7 months (range 18 to 146 months)
postoperatively.

Moreover, one more patient received partial device removal for prominent instrumentation 11
months postoperatively.

Therefore, only 22 out of 40 CD instrumentations (55%) were still in situ.

The statistical analysis showed only tendency but no significant influence for the distal end of
the instrumentation: 8 out of 16 patients (50%) with instrumentation including lumbar level 4
or 5 received implant removal for infection or LOSP. On the other side, 10 out of 24 patients
(41.7%) with distal end of instrumentation until lumbar level 1, 2 or 3 received implant
removal. This difference was not statistically significant (p > 0.05). Moreover, the statistical
analysis showed no significant influences for the removal of instrumentation compared to
patients with instrumentation still in situ (18 versus 22 patients) for e.g. sex, type of curve
(right thoracic, double or other curves), or other demographic parameters.
Rather scary that in 45% of patients the implants had to be removed. And that most revision surgeries had to be done after 1 to almost 5 years because of late infections.

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