Results of surgical treatment of early-onset scoliosis using growth-friendly implants: analysis of a 10-year monocentric cohort

Abstract

Objective. To evaluate early and medium-term results of surgical treatment of early-onset scoliosis using the principle of growth-friendly systems.Material and Methods. A retrospective analysis of the medical records of 54 patients treated using surgical distractible metal implants was carried out. Patients were divided into 4 etiological groups: congenital (n = 17), systemic (n = 12), idiopathic (n = 16) and neurogenic scoliosis (9). The boy/girl ratio was 11/43. The average age at which patients started treatment was 9.6 years, and at the end of treatment – 13.2 years.Results. Radiometric parameters were assessed during and after completion of treatment. The Cobb angle of the main curve of deformity before treatment averaged 56.1°, after the primary operation – 31.8°, and after completion of treatment – 23.2°. Correction of the main deformity curve for the entire period of multi-stage surgical treatment was 57.8 %. The highest initial magnitude of deformity was noted in the group of neuromuscular scoliosis (67.6°), and the lowest in the group of congenital pathology (50.4°). In the groups of systemic and idiopathic scoliosis, the preoperative values were very close: 53.4° for systemic scoliosis and 57.6° for idiopathic scoliosis. According to the results of staged treatment in the neuromuscular scoliosis group, the residual curvature of the main curve was the lowest, and the percentage of its correction was the highest – 18.9° and 73.6 %, respectively, versus 24.5° and 49.7 % in the congenital scoliosis group. The effectiveness of treatment with an assessment of the percentage of correction after final instrumentation in groups of idiopathic and systemic scoliosis was close: 23,0° and 62.3 %, and 28.5° and 51.5 %, respectively. Identical average values of the main curve angle after final instrumentation were noted in all four etiological groups (on average, 23.2°). Changes in thoracic kyphosis and lumbar lordosis were insignificant. During the treatment, 22 unplanned surgical interventions were performed in 15 patients.Conclusion. This study revealed a number of key points that in the future may help in the formation of clearer algorithms of selecting the most optimal technique: neurogenic scoliosis is most successfully corrected by growing systems, and congenital scoliosis shows less pronounced correction of deformity and a greater relative number of complications per patient with a single use of growing systems, which requires caution during staged surgical treatment.