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Journal of Korean Neurosurgical Society > Volume 31(2); 2002 > Article
Journal of Korean Neurosurgical Society 2002;31(2): 107-112.
Clinical Analysis of Re-Operation after Thoracic and Lumbar Spinal Fusion Surgery.
Joo Han Kim, Sung Jun Lim, Tai Hyung Cho, Jung Yul Park, Hoon Kap Lee, Jung Keun Suh
Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea.
The purpose of this study is to review retrospectively 28 patients with re-operation due to complications related to instrumentation from thoracic and lumbar spinal fusion surgery.
A total of 285 patients underwent spinal fusion surgery with instrumentation between 1996 and 2000. Of these, 11 men and 17 women(mean age 46 years, range 21 to 69 years) presented with complications related to instrumentation. Previous surgery was preformed for vertebral column instability secondary to fracture(4), spondylolisthesis(12), failed back surgery syndrome(7), osteomyelitis(1), herniated nuclus pulposus(4). All patients underwent repeated spinal surgery including removal of instrument, new instrument fixation, or I & D. The mean follow-up period after second operation was 19 months.
The complications related instrumentation system include six interbody fusion system retropulsion, eight screw loosenings, five screw fractures, three screw malpositions, three osteomyelitis, and one donor site infection. After repeated surgery, eight became asymptomatic and did not require further treatment, but eleven showed persistent low back pain without neurological deficits and the remaining nine continued to have nerve root deficits.
In conclusion, spinal fusion surgery with instrumentation offers an immediate postoperative stability of the thoracic and lumbar spine and enhances early fusion. However, it may be associated with few, but significant, complications which may permanantly. The proper selection of patients and meticulous surgical technique for surgery are probably the most important factors associated good outcomes and prevention of complications.
Key Words: Spinal fusion; Spondylolisthesis; Failed back surgery; Spinal instability
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