In Adolescent Idiopathic Scoliosis, Do All Instrument-Related Complications Require Revision Surgery?
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".