Pediatric Spine Foundation

Title: Growth-friendly surgery results in more growth but a higher complication rate and unplanned returns to the operating room compared to single fusion in neuromuscular early-onset scoliosis: a multicenter retrospective cohort study

Authors: Ying Li, Jennylee Swallow, Joel Gagnier, Patrick J. Cahill, Paul D. Sponseller, Sumeet Garg, George H. Thompson, Brandon A. Ramo, Pediatric Spine Study Group

Journal: Spine Deformity

Date: December 08, 2020

Excerpt: While there was a difference in age at index surgery, PSF (single posterior spinal fusion) may be more effective than GFDF (Growth friendly surgery followed by definitive fusion) at controlling neuromuscular EOS. GFDF patients achieved more spinal growth but eight times more complications and nine times more UPRORs (unplanned returns to the operating room).

Keywords: Early onset scoliosis, Neuromuscular, Spinal fusion, Growth-friendly surgery, Complications

Summary:

Purpose

The purpose of this study was to compare the outcomes of growth-friendly surgery and single fusion surgery in patients with neuromuscular early-onset scoliosis. Specifically, the study aimed to see how each surgery affected growth, complications, and the need for additional surgeries.

Results

  • The PSF (single fusion surgery) group had a greater percentage of major curve correction (62% vs 38%) and smaller major curve magnitude at final follow-up (23 vs 40 degrees).
  • The GFDF (growth friendly) group underwent a mean of 8.7 surgeries compared to 1.6 surgeries in the PSF (single fusion) group.
  • 56% of patients treated with growth-friendly treatments had complications resulting in unplanned surgical intervention, while only 19% of single posterior spinal fusion patients needed unplanned surgery.

Discussion Points

  • Single Posterior Spinal Fusion (PSF) may be more effective than Growth-Friendly surgery followed by definitive fusion at controlling neuromuscular EOS, as the PSF group had increased curve correction and less unplanned returns to the operating room than the growth friendly group.
  • While growth-Friendly patients gained a greater percentage of spine growth, they also had significantly increased complication and unplanned return to the operating room (UPROR) rates, and decreased postoperative financial impact and family burden quality of life scores on the EOSQ-24.