Surgical outcomes by age at the time of surgery in the treatment of congenital scoliosis in children under age 10 years

Abstract

Background context: There is little information regarding the surgical outcomes with regard to the timing of surgery in children under age 10 years for congenital scoliosis with a long-term follow-up.

Purpose: The purpose of this study was to compare the surgical outcomes for congenital scoliosis in children 6 years or older but less than 10 years of age.

Study design: This is a retrospective study.

Patient sample: Eighteen congenital scoliosis patients under age 10 years at the time of surgery were treated by posterior hemivertebra resection and bilateral pedicle screw fixation.

Outcome measures: Outcome measures are radiological outcomes (plain radiographs and computed tomography) and complications.

Methods: Eighteen congenital scoliosis patients (n=18) under age 10 years at the time of surgery were treated by posterior hemivertebra resection and bilateral pedicle screw fixation. These cases were retrospectively studied and had a minimum of 7-year follow-up. We assigned patients into two groups: Group 1 (n=9) patients who had surgery before 6 years of age and Group 2 (n=9) those who had surgery after 6 years of age.

Results: The groups were not found to be statistically different in operative time, blood loss, and follow-up period. In the Group 1, the mean Cobb angle of the main curve was 32.4° before surgery, 6.4° after surgery, and 9.1° at last follow-up. In the Group 2, the mean Cobb angle of the main curve was 36.5° before surgery, 10.4° after surgery, and 14.5° at last follow-up. There was significantly better deformity correction of main curve immediate postoperatively and at last follow-up in Group 1. No significant difference was observed in growth rate of the vertebral body and spinal canal parameters comparing the two groups at the vertebra with or without screws. There was no crankshaft phenomena, no clinical or radiographic features suggestive of spinal stenosis during follow-up, and no major vascular or neurological complications related to the pedicle screws in either group.

Conclusions: In congenital scoliosis patients, posterior hemivertebra resection after pedicle screw fixation before the age of 6 years had significantly better deformity correction and did not cause a negative effect on the growth of vertebral body or spinal canal compared with the group treated after 6 years of age. Therefore, early surgical correction of a congenital hemivertebra in children under 6 years of age, before structural changes occur, effectively achieves a more satisfactory correction without causing iatrogenic spinal stenosis or neurologic complications compared with children older than 6 years but under 10 years of age.

Keywords: Congenital scoliosis; Growing spine; Hemivertebra resection; Immature spine; Pedicle screw fixation; Posterior vertebral column resection; Vertebral body growth.