Comparison of surgical outcomes between early definitive fusion and traditional growing rod for juvenile scoliosis

Abstract

Introduction: In juveniles with progressive curves, there is a controversy regarding the indication of early definitive fusion (EF) vs. traditional growing rod (TGR). The purpose of this study is to compare radiographic outcomes and complications of EF vs. TGR surgery for immature patients at a single institution.

Material: There were 16 patients treated by EF who met the following criteria: (1) diagnosis before 10 years old; (2) grade 0 of Risser sign; (3) had definitive spinal fusion at the age of 9-11 years; (4) excluding congenital scoliosis, neurofibromatosis. To compare the outcomes, 11 patients treated by TGR who underwent the initial surgery at the age of 9-11 years were included in this study. Average age at the initial surgery were 10.5±0.6, 10.5±0.8 years respectively (p=0.87). The magnitude of the major curve was 98±16, 92±23 degree respectively (p=0.42).

Results: Four patients in the group EF underwent staged surgeries. The average number of fused segments were 14±2, 15±1, respectively (p=0.18). Initial curve correction in the group EF was significantly greater than that in the group TGR after the initial surgery (60% vs. 40%; p<0.01). There was not significant difference in the overall correction rate of major curve (58% vs. 44%; p=0.12). The group EF maintained the thoracic kyphosis at latest follow-up better than the group TGR (34±15 vs. 56±29 degree; p=0.01). T1-12 height at latest follow-up were similar between the group EF and TGR (215±24 vs. 223±27 mm; p=0.42). Number of surgeries in the group EF was significantly lower than those in the group TGR (1.4±0.5 vs. 8.6±3.2; p<0.01).

Conclusion: While similar spinal growth was obtained in both groups, the number of operations could be reduced by EF. Early definitive spinal fusion might be a surgery of choice for 9- to 11-year-old children with EOS.