Surgical Management of Early Onset Scoliosis Cases

Abstract

Background: Early-onset scoliosis (EOS) is defined as a scoliotic deformity (coronal imbalance >10˚) present between the ages of 4 and 10 due to heterogeneous etiologies. Traditional dual-growing rods (TDGR) are effective distraction-based methods used to correct and control the progressive. Nevertheless, these children may have complications with the initial surgery and following lengthening procedures. Objective: This study aims to evaluate the safety, efficacy, and complications of the TDGR technique in patients with EOS. Methods: This prospective clinical case series study was conducted on 18 patients with EOS more than 60˚. All patients underwent an initial fusionless surgery using TDGR for correction of scoliosis followed by two serial distraction procedures for lengthening the growing rod at 6-month intervals. The Cobb's angle of the major curve, thoracic kyphosis angle, T1- S1 length, and coronal and sagittal balance were measured preoperatively, immediately postoperatively, and before and after every lengthening procedure. Due to anesthesia requirements, respiratory function tests were done preoperatively for 12 patients and performed postoperatively only for 12 patients. Results: The mean preoperative Cobb’s angle decreased from 79.22° to 43.66° postoperatively (P-value= 0.005). The mean T1-S1 length increased from 24.13 cm pre-operatively to 27.38 cm after initial surgery and 28.2 cm after the 2nd lengthening procedure (P-value <0.05). The mean pre-operative thoracic kyphosis angle decreased significantly in comparison to immediate post-operative measurements and after the 2^nd lengthening procedure (P-value <0.05). Pulmonary functions improved in 12 patients with an increase in FEV1 by a mean of 13%. The complication rate was 22.22 %. The specific complications reported were wound infection, rod malplacement, rod migration, and rod breakage, each occurring in a single case (5.55% each). Conclusion: The TDGR technique is a safe and effective treatment for deformity control and continuous spinal growth in selected patients with EOS.