Abstract
Purpose
To report and analyze development trends in the surgical treatment of congenital scoliosis (CS) in a large CS cohort over a 10-year period.
Methods
We retrospectively searched and extracted medical records of CS inpatients receiving posterior instrumented fusion surgery at our institute from January 2010 to December 2019. We analyzed information on demographics and surgical information, including the surgical approach, number of fused segments, use of osteotomy and titanium cage implantation, length of stay, intraoperative blood loss, and rates of complications and readmission.
Results
1207 CS inpatients were included. In the past decade, the proportion of patients younger than 5 years increased from 15.5 to 26.9%. The average number of fused segments decreased from 9.24 to 7.48, and the proportion of patients treated with short-segment fusion increased from 13.4 to 30.3%. The proportion of patients treated with osteotomy and titanium cage implantation increased from 55.65% and 12.03% to 76.5% and 40.22%. The average length of stay and blood loss decreased from 16.5 days and 816.1 ml to 13.5 days and 501.7 ml. The complication and readmission rates also decreased during these ten years.
Conclusion
During this ten-year period, the surgical treatment of CS at our institute showed trends toward a younger age at fusion, lower number of fused segments, higher rate of osteotomy and titanium cage implantation, reduced blood loss, shorter length of stay and lower rate complications and readmission. These results suggest performing osteotomy combined with titanium cage implantation at an earlier age can achieve fewer fused segments and complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Not applicable.
Code availability
Not applicable.
References
Giampietro PF, Blank RD, Raggio CL, Merchant S, Jacobsen FS, Faciszewski T, Shukla SK, Greenlee AR, Reynolds C, Schowalter DB (2003) Congenital and idiopathic scoliosis: clinical and genetic aspects. Clin Med Res 1(2):125–136. https://doi.org/10.3121/cmr.1.2.125
Mackel CE, Jada A, Samdani AF, Stephen JH, Bennett JT, Baaj AA, Hwang SW (2018) A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst 34(11):2155–2171. https://doi.org/10.1007/s00381-018-3915-6
Hedequist D, Emans J (2004) Congenital scoliosis. J Am Acad Orthop Surg 12(4):266–275. https://doi.org/10.5435/00124635-200407000-00007
Li S, Ou Y, Liu B, Zhu Y, Quan Z, Jiang D (2015) Comparison of osteotomy versus non-osteotomy approach for congenital scoliosis: a retrospective study of three surgical techniques. ANZ J Surg 85(4):249–254. https://doi.org/10.1111/ans.12886
Yaszay B, O’Brien M, Shufflebarger HL, Betz RR, Lonner B, Shah SA, Boachie-Adjei O, Crawford A, Letko L, Harms J, Gupta MC, Sponseller PD, Abel MF, Flynn J, Macagno A, Newton PO (2011) Efficacy of hemivertebra resection for congenital scoliosis: a multicenter retrospective comparison of three surgical techniques. Spine 36(24):2052–2060. https://doi.org/10.1097/BRS.0b013e318233f4bb
Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34(20):2213–2221. https://doi.org/10.1097/BRS.0b013e3181b53cba
Chang DG, Kim JH, Ha KY, Lee JS, Jang JS, Suk SI (2015) Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: greater than 7-year follow-up. Spine 40(8):E484-491. https://doi.org/10.1097/BRS.0000000000000809
Lee CS, Hwang CJ, Kim DJ, Kwon J, Kim YT, Lee MY, Yoon SJ, Lee DH (2014) Feasibility of correction with instrumentation only in congenital scoliosis. Neurosurgery 74(1):35–41. https://doi.org/10.1227/NEU.0000000000000194
Wang S, Zhang J, Qiu G, Li S, Zhang Y, Yang Y, Weng X (2017) Posterior-only hemivertebra resection with anterior structural reconstruction with titanium mesh cage and short segmental fusion for the treatment of congenital scoliokyphosis: the indications and preliminary results. Spine 42(22):1687–1692. https://doi.org/10.1097/BRS.0000000000002197
Aydogan M, Ozturk C, Tezer M, Mirzanli C, Karatoprak O, Hamzaoglu A (2008) Posterior vertebrectomy in kyphosis, scoliosis and kyphoscoliosis due to hemivertebra. J Pediatr Orthop B 17(1):33–37. https://doi.org/10.1097/01.bpb.0000218031.75557.f0
Zhang BB, Zhang T, Tao HR, Wu TL, Duan CG, Yang WZ, Li T, Li F, Liu M, Ma WR, Su W (2017) Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities. Eur Spine J 26(7):1871–1877. https://doi.org/10.1007/s00586-017-5061-3
Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27(21):E460-466. https://doi.org/10.1097/00007632-200211010-00019
Hedequist DJ, Hall JE, Emans JB (2004) The safety and efficacy of spinal instrumentation in children with congenital spine deformities. Spine 29(18):2081–2086. https://doi.org/10.1097/01.brs.0000138305.12790.de
Hedequist D, Yeon H, Emans J (2007) The use of allograft as a bone graft substitute in patients with congenital spine deformities. J Pediatr Orthop 27(6):686–689. https://doi.org/10.1097/BPO.0b013e318093f50d
Zhang Y, Peng Q, Wang S, Yang Y, Lin G, Zhang J (2019) A pilot study of influence of pedicle screw instrumentation on immature vertebra: a minimal 5-year follow-up in children younger than 5 years. J Neurosurg Pediatr. https://doi.org/10.3171/2018.12.PEDS18622
Ruf M, Harms J (2003) Posterior hemivertebra resection with transpedicular instrumentation: early correction in children aged 1 to 6 years. Spine 28(18):2132–2138. https://doi.org/10.1097/01.BRS.0000084627.57308.4A
Dimeglio A (2001) Growth in pediatric orthopaedics. J Pediatr Orthop 21(4):549–555
Terek RM, Wehner J, Lubicky JP (1991) Crankshaft phenomenon in congenital scoliosis: a preliminary report. J Pediatr Orthop 11(4):527–532. https://doi.org/10.1097/01241398-199107000-00021
Kesling KL, Lonstein JE, Denis F, Perra JH, Schwender JD, Transfeldt EE, Winter RB (2003) The crankshaft phenomenon after posterior spinal arthrodesis for congenital scoliosis: a review of 54 patients. Spine 28(3):267–271. https://doi.org/10.1097/01.BRS.0000042252.25531.A4
Funding
The study was supported by grants from the National Natural Science Foundation of China (81672123, 81972037, 81902178, 81822030 and 82072391), Natural Science Foundation of Beijing Municipality (7222133), Chinese Academy of Medical Sciences Initiative for Innovative Medicine (CIFMS, 2021-I2M-1-051).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Not applicable.
Ethics approval
This study has been approved from the Institutional Review Board.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lin, G., Du, Y., Wang, S. et al. Ten-year trends in surgical management of 1207 congenital scoliosis. Eur Spine J 32, 2533–2540 (2023). https://doi.org/10.1007/s00586-023-07685-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-023-07685-6