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Short fusion with vertebrectomy during growth in congenital spinal deformity: is early surgical intervention
Hiroko Matsumoto1, Noriaki Kawakami2, Toshiyuki Saito3
1Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, 3959 Broadway, Suite 800 North, New York, NY, 10032, USA.
Study Design:
This was a multi-center retrospective cohort study included consecutive pediatric patients who were admitted to 8 institutions for the treatment of congenital spinal deformity from 1991 to 2012.
Objective:
The purpose of this study was to compare curve corrections and balances, reoperations, and complications at 2-year follow-up between those treated early vs. late. Although early intervention has been recommended, no empirical study has examined the optimal timing of short fusion among patients with congenital spinal deformity.
Methods:
Patients with congenital spinal deformity with formation failure undergoing vertebrectomy with short fusion (≤ 6 fusion segments) were categorized as early (surgery at ≤ 6 years) and late (7-18 years) fusion. Outcomes included coronal and sagittal curve corrections at immediate and 2-year evaluations; loss of curve correction from immediate to 2-year follow-up; coronal and sagittal balance at 2 years; and inter-operative, major and minor short-term postoperative, and long-term postoperative complications and reoperations.
Results:
Early fusion (N = 79) compared to late fusion (N = 96) was associated with greater percent curve correction at immediate (71% vs. 60%, p = 0.0046) and 2-year (63% vs. 52%, p = 0.0153) evaluations adjusting for surgeon experience and preoperative coronal balance. These associations were significant for males and those with 3-level fusions but not 4 to 6-level fusions. Early fusion compared with late fusion had more intraoperative (6% vs. 1%) and postoperative long-term complications (27% vs. 18%), as well as unplanned reoperations (13% vs. 9%). Early vs. late fusion had fewer short-term complications, both major (6% vs. 15%) and minor (6% vs. 15%).
Conclusions:
Patients who underwent early treatment achieved larger major curve correction by 10% compared to patients with late treatment when assessed at 2-year postoperative evaluation. However, early fusion should be considered with careful attention to possible increased risk of reoperations.
Level Of Evidence:
Level III.
