Subcutaneous rodding for progressive spinal curvatures: early results

This study retrospectively reviewed the clinical records and radiographs of 11 patients with progressive early-onset scoliosis who failed to respond to nonoperative management and who underwent consecutive distraction of subcutaneous rods. Eleven children were treated by consecutive distraction of subcutaneous rods, and in two patients with rodding and anterior apical fusion. At surgery, the average patient age was 5.66 years, with a mean Cobb angle of 74 degrees and an average Pedriole angle of 39 degrees. The etiology of the scoliosis included four syndromic and one each congenital, post-rib resection, post-spinal tumor resection, neurofibromatosis, myelomeningocele, infantile idiopathic, and juvenile idiopathic. Subcutaneous rodding halted curve progression in all patients. At an average of 5.1 years after surgery, one patient showed no deterioration of the curve and nine patients showed an improvement of > or =40% in the magnitude of the original curvature. Eight of these patients had already had definitive surgery performed with segmental spinal instrumentation and fusion. Spinal growth occurred in all 11 patients and ranged from 0.5 to 4.5 cm (mean 2.0). Early results from these patients show that subcutaneous rodding with consecutive distraction allows correction of progressive early-onset scoliosis that failed to respond to nonsurgical management, preserving the individual growth potential of the spinal column and delaying definitive surgical treatment. Rotational deformity did not deteriorate radiographically, but clinical deformity increased subjectively. The amount of growth achieved and the number of procedures required to obtain these results raises the question of whether patients would be better served by a single anterior, posterior fusion and instrumentation at a young age.