Three cases of revision surgery for exacerbated deformity due to long-term neglect after failed corrective fixation of adolescent idiopathic scoliosis.

Purpose: Implant-related complications can occur after the surgery for adolescent idiopathic scoliosis (AIS) and remain untreated for long periods until they become painful enough for intervention. This can result in a rigid deformity with vertebral fusion and disc degeneration within the scoliotic curve. This report aimed to emphasize the importance of early revision surgery illustrated in three unique cases.

Case description: The cases presented were as follows: a 48-year-old female who had experienced implant failure following posterior corrective fixation left untreated for 25 years; a 32-year-old female who had experienced implant failure following anterior corrective fixation left untreated for 16 years; and a 23-year-old male who had experienced pseudarthrosis following posterior corrective fixation and had been left untreated for 5 years following implant removal. All patients exhibited vertebral fusion and disc degeneration within the exacerbated major thoracolumbar/lumbar scoliotic curve as well as kyphotic deformity because of prolonged neglect after implant failure. In all cases, surgery required an anteroposterior combined procedure with anterior intervertebral release, posterior fusion mass osteotomy, and asymmetric pedicle subtraction osteotomy.

Conclusion: When implant failure occurs after AIS surgery, early surgical intervention can enable less extensive revision with reduced risk before stiffness and fusion of the bone mass develop. Regular long-term follow-up is therefore essential for early detection of implant failure. Moreover, when recommending revision surgery, it is critical to intervene at an appropriate time, ensuring that patients fully understand both the risks and benefits, including the psychological burden of residual deformity.