Scoliosis surgery outcomes in the setting of osteogenesis imperfecta: a scoping systematic review and meta-analysis

Osteogenesis imperfecta (OI) is a rare genetic condition that leads to poor bone quality and scoliosis development. To date, the surgical management of scoliosis in the setting of OI is poorly defined, be it with traditional posterior spinal fusion (PSF) or newer growth-friendly instrumentation (GFI) approaches. Correspondingly, the aim of this study was to quantitatively pool the available metadata in the literature regarding the surgical outcomes of OI patients undergoing surgical correction.

Multiple electronic databases from inception to August 2025 were searched following PRISMA guidelines. Respective cohort-level outcomes were then abstracted and pooled by means of meta-analysis utilizing random-effects modeling, and trends were evaluated by meta-regression analysis.

A total of 14 studies were identified for inclusion, describing 321 OI patients surgically treated by PSF (n = 301, 94%) and GFI (n = 20, 6%). Across the cohort, median male percentage and mean age at surgery were 46% and 14.1 years, respectively; 20% were OI type 1, 51% were OI type 3, and 9% were OI type 4 as reported by Sillence Classification. Adjuncts described included traction in 8/14 (57%) studies, preoperative bisphosphonates in 6/14 (43%) studies, and intraoperative cement in 3/14 (21%) studies. Meta-analysis demonstrated overall incidence of postoperative complications following surgical correction of scoliosis to be 21% (95% CI 12-31%), with a statistical difference between PSF and GFI groups (P-heterogeneity < 0.01). Trim-and-fill analyses imputed 3 additional studies to re-estimate the complication incidence to be lower at 14% (95% CI 3-24%) for the PSF-only group. Pooled incidence of revision surgery was 6% (95% CI 2-12%), with a statistical difference between PSF and GFI groups (P-heterogeneity < 0.01) as well. Certainty of outcomes was deemed very low, with quality of evidence ranging from high to moderate.

Overall, there are non-negligible complication and revision rates in the surgical treatment of scoliosis in the setting of OI. These rates are lower in the setting of PSF alone, and the use of surgical adjuncts and GFI approaches requires further study to understand their role in the treatment paradigm of OI scoliosis. Larger, collaborative efforts will improve the granularity of our findings in the future.