Outcomes of Revision Surgeries for Failed Procedures in Adults with Spinal Deformities: A Systematic Review

Introduction: Revision surgeries for adult spinal deformity (ASD) are sometimes needed due to complications or unsatisfactory results following primary procedures. ASD in adults presents unique challenges related to age-related degeneration, previous surgical interventions, and higher complication risks. Evaluating the outcomes of revision surgeries is crucial for improving management and care strategies in these complex cases. This systematic review aims to assess the outcomes of revision surgeries for adults with failed ASD procedures, focusing on correction rates, complication rates, and patient satisfaction.

Methods: Based on the PRISMA guidelines, a systematic search was conducted across Embase, Scopus, Web of Science, and PubMed up until September 15th, 2024, using the relevant key terms.

Results: Five studies encompassing 295 patients (77.6% females) with ASD were included. The mean age at the time of revision surgery was 58.46 years. Reasons for revision surgeries varied and included advanced sagittal imbalance, proximal junctional kyphosis (PJK), pseudoarthrosis, coronal imbalance, implant failure, rod fractures, proximal junctional failure (PJF), distal junctional failure (DJF), and loss of correction in 29, 13, 29, 8, 7, 28, 21, 12, and 38 patients, respectively. Functional outcomes significantly improved post-revision: Oswestry Disability Index (ODI) decreased from 58.97 to 35.98, SF-36 Mental Component Scores (MCS) increased from 43.04 to 48.56, and SF-36 Physical Component Scores (PCS) improved from 33.88 to 38.57. VAS back pain decreased from 7.53 to 3.49, and VAS leg pain reduced from 6.22 to 3.56. Radiographic outcomes showed improvements in thoracic kyphosis (40.03° to 42.91°), SVA (64.38 mm to 22.83 mm), and pelvic tilt (26.52° to 19.17°). The overall complication rate was 26.10%, with 17 intraoperative complications and 60 postoperative complications, including 16 cardiopulmonary issues and 11 wound infections. Quality assessment using JBI checklists indicated variable risk of bias across studies.

Conclusion : Revision surgeries for ASD result in substantial improvements in both functional and radiographic outcomes despite the associated high complication rate. These findings emphasize the complexity of revision procedures and highlight the need for careful patient selection and comprehensive risk management in ASD surgery.