Is Final Fusion Necessary for Growing-Rod Graduates: A Systematic Review and Meta-Analysis

Abstract

Study Design Systematic review and meta-analysis. Objectives The need for definitive fusion for growing rod graduates is a controversial topic in the management of Early-onset scoliosis (EOS) patients. The authors performed a systematic review and meta-analysis on the available literature to evaluate the outcomes of growing rod graduates undergoing final fusion or observation with implants in-situ. Methods An extensive literature search was carried out aimed at identifying articles reporting outcomes in growing rod graduates. Apart from the study characteristics and demographic details, the extracted data included Cobb’s correction, trunk height parameters, and revision rate. The extracted data was analyzed and forest plots were generated to draw comparisons between the observation and fusion groups. Results Of the 11 included studies, 6 were case-control and 5 were case series. The authors did not find any significant difference between the 2 groups with respect to the pre-index and final Cobb’s correction, T1-T12 or T1-S1 height gain in either over-all, or sub-analysis with case-control studies. The meta-analysis showed a significantly higher revision rate in patients undergoing a definitive fusion procedure. Conclusion The current analysis revealed comparable outcomes in terms of correction rate and gain in the trunk height but a lesser need of revisions in observation sub-group. The lack of good quality evidence and the need for prospective and randomized trials was also propounded by this review.

Bipolar Fusionless Versus Standard Fusion Surgery in Neuromuscular Scoliosis

“…Our results support the conclusion of a recent systematic review of the literature, 35 which revealed a higher risk of complications in patients who underwent definitive fusion, further arguing for the solidity of mini-invasive constructs and against the need for posterior fusion. In their review, Ahuja and colleagues showed no differences regarding curve correction between fused and unfused patients, which is in line with our own results.…”

“…The BFC allowing further growth of the spine is therefore indicated in immature patients, as confirmed by our own study, allowing early removal of bracing, which has been demonstrated to have a negative impact on the quality of life and treatment satisfaction while not avoiding curve progression 36,37 . Furthermore, the solidity of the BFC makes final spinal fusion unnecessary, preventing further surgical interventions in skeletally mature patients, as demonstrated by long-term studies and recent meta-analyses 17,33,35 …”

“…36,37 Furthermore, the solidity of the BFC makes final spinal fusion unnecessary, preventing further surgical interventions in skeletally mature patients, as demonstrated by long-term studies and recent meta-analyses. 17,33,35 From our experience, some points are worth highlighting. In the first stages of our experience with BFC, we kept both SPF and BFC for NMC based on age (younger for BFC) and general conditions (better conditions for SPF).…”

Distal foundation augmentation enhances the “Bridge” role of single traditional growing rods in the treatment of severe early-onset scoliosis: a retrospective comparative cohort study

“…After sTGR implantation, there was no significant difference in the major curve or the MK correction rate between the groups. The maximum correction of spinal deformity has been reported to occur during the initial implantation of a TGR (16). After that, the spinal malalignment fluctuates with the lengthening, and the final fusion can only obtain a modest correction due to autofusion and spinal rigidity caused by distractions (17).…”

The Comparison of enhanced recovery after surgery versus traditional pathway in early-onset scoliosis surgery

“…Despite the safety and feasibility of growing fusion rods for EOS, the surgical treatment causes significant pain, trauma, and psychological stress in pediatric patients [7][8]. In addition, a series of complications after surgery, such as bleeding, infection, and nerve function impairment, can lead to prolonged recovery time [9][10]. The challenges of postoperative care for PSF surgery are reducing patient pain and complications from analgesic medications and facilitating recovery from physical trauma.…”