Outcomes of Definitive Spine Fusion Using All-pedicle-Screw Constructs in Skeletally Immature Patients Aged 8 to 10 Years With Severe Idiopathic Early-Onset Scoliosis

Abstract

Background: The choice between growth-sparing techniques or definitive spine fusion for severe idiopathic early-onset scoliosis (IEOS) in skeletally immature patients aged 8 to 10 years represents a challenging dilemma. Although growth-sparing techniques show high complication rates in severe IEOS, the outcomes of definitive fusion in borderline skeletally immature patients with severe IEOS have not been investigated. We aimed to investigate the outcomes of early definitive fusion using all-pedicle-screw constructs in skeletally immature patients aged 8 to 10 years with severe IEOS. Methods: The inclusion criteria were as follows: IEOS, age 8 years or above, major coronal curve ≥90 degrees, thoracic height >18 cm, no history of previous spine surgery, no intraspinal anomalies and at least 3 years of postoperative follow-up. Patients underwent instrumented spinal fusion with all-pedicle-screw constructs and multiple Ponte osteotomies. All patients completed the Scoliosis Research Society 22 revision (Arabic version) questionnaire and Body Image Disturbance Questionnaire-Scoliosis version (BIDQ-S) preoperatively and at the last follow-up. Results: Fifty-five patients (24 males, 31 females; mean age: 8.96 y; range: 8 to 10 y) with severe IEOS met the inclusion criteria (mean follow-up period: 4.1±0.6 y; range: 3 to 5 y). The mean major coronal Cobb angle improved significantly (P<0.001) from 107±12.5 degrees to 26.8±6.8 degrees. Mean thoracic kyphosis improved significantly (P<0.001) from 57.2±15.8 degrees to 31.2±4.4 degrees. The loss of correction at the latest follow-up was nonsignificant. The total Scoliosis Research Society 22 revision (SRS-22r) score improved significantly from 2.5±1 to 4.3±0.7. The mean BIDQ-S score improved significantly from 4.1±0.3 to 1.6±0.3. The immediate postoperative gains in the mean thoracic height (T1-T12) and spinal height (T1-S1) were 14.9% and 19.6%, respectively, and the overall height increase at the latest follow-up was 17.8% and 23.8%, respectively. One patient underwent revision for implant failure (rod breakage). Conclusion: Early definitive fusion for skeletally immature patients with severe IEOS yielded excellent correction with major improvements in patient quality of life. Severe IEOS poses a significant risk, but definitive fusion can potentially mitigate that risk in patients aged 8 to 10 years.

Children’s orthopaedics

“…from Cairo (Egypt) studied the all-pediclescrew construct for correction and fusion in the eight-to ten-year age group, which is a more traditional approach. 7 The major coronal curve had to be a minimum of 90° for inclusion with a thoracic height greater than 18 cm and no his- (SD 0.3). In terms of gains in mean thoracic height (measured from T1 to T12 and mean spinal height from T1 to S1), these improved by 14.9% and 19.6% respectively at the immediate postoperative measurements and by 17.8% and 23.8% at final measured follow-up.…”

“…This paper from Cairo (Egypt) studied the all-pedicle-screw construct for correction and fusion in the eight- to ten-year age group, which is a more traditional approach. 7 The major coronal curve had to be a minimum of 90° for inclusion with a thoracic height greater than 18 cm and no history of previous spinal surgery, plus at least three years of postoperative follow-up. Patients underwent instrumented spinal fusion with an all-pedicle-screw construct and completed the Scoliosis Research Society (SRS-22) questionnaire and the body image disturbance questionnaire-scoliosis (BIDQ-S) both preoperatively and at final follow-up.…”