Outcomes of growing rod surgery for severe compared with moderate early-onset scoliosis: a matched comparative study

Area of Science:

• Orthopedic Surgery
• Pediatric Spine Deformities
• Scoliosis Research

Background:

• Early-onset scoliosis (EOS) presents significant challenges in pediatric orthopedic care.
• Growing rod techniques are employed to manage spinal deformities while allowing for trunk growth.
• Comparing outcomes in severe versus moderate EOS is crucial for treatment optimization.

Purpose of the Study:

• To compare the surgical outcomes of growing rods in patients with severe early-onset scoliosis (EOS) versus moderate EOS.
• To evaluate curve correction, spinal height increase, and complication rates between the two EOS severity groups.

Main Methods:

• A multicenter database review identified 107 children with severe EOS (major curve ≥ 90°) and 107 matched controls with moderate EOS.
• Patients were treated with growing rods before age ten, with a minimum two-year follow-up and at least three lengthening procedures.
• Outcomes analyzed included curve correction, T1-S1 height increase, and complication incidence.

Main Results:

• Preoperative curves averaged 101° in severe EOS and 67° in moderate EOS, corrected to 57° and 40° respectively. T1-S1 height increased by 54 mm in severe EOS and 27 mm in moderate EOS initially.
• While both groups experienced height increase during distraction, the mean number of complications was higher in the severe EOS group (2.6 vs 1.9).
• Postoperative neurological deficits occurred in 4.7% of the severe group and 2.8% of the moderate group, with no statistically significant difference.

Conclusions:

• Growing rods are an effective surgical option for severe early-onset scoliosis.
• Treatment of severe EOS with growing rods is associated with a significantly higher risk of complications compared to moderate EOS.
• Careful patient selection and management are essential due to the increased complication profile in severe EOS.