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Surgical and Health-related Quality-of-Life Outcomes of Growing Rod “Graduates” With Severe versus Moderate Early-onset Scoliosis

Helenius, Ilkka J., MD, PhD; Sponseller, Paul D., MD, MBA; McClung, Anna, BSN, RN; Pawelek, Jeff B., BS; Yazici, Muharrem, MD§; Emans, John B., MD; Thompson, George H., MD||; Johnston, Charles E., MD∗∗; Shah, Suken A., MD††; Akbarnia, Behrooz A., MD‡‡

doi: 10.1097/BRS.0000000000002922

Study Design. A retrospective review of a prospective, multicenter database.

Objective. The aim of this study was to compare surgical and quality-of-life outcomes at the end of growing rod treatment in patients with severe versus moderate early-onset scoliosis (EOS).

Summary of Background Data. Knowledge of the outcomes of severe EOS after growth-friendly treatment is limited because this condition is uncommon.

Methods. We identified 40 children with severe EOS (major curve ≥90°) treated with growing rods before age 10 with minimum 2-year follow-up after last lengthening or final fusion. From the same registry, we matched 40 patients with moderate EOS (major curve < 90°). Twenty-seven patients in the severe group and 12 in the moderate group underwent final fusion (P < 0.001).

Results. Mean preoperative curves were 102° (range, 90°–139°) in the severe group and 63° (range, 33°–88°) in the moderate group (P < 0.001). At final follow-up, mean curves were 56° (range, 10°–91°) and 36° (range, 12°–89°), respectively (P < 0.001). Fourteen (35%) children in the severe group and 32 (80%) in the moderate group had scoliosis of < 45° at final follow-up [risk ratio (RR), 0.44; 95% confidence interval (95% CI), 0.20–0.57]. At final follow-up, 30 (75%) children in the severe group and 35 (88%) in the moderate group had achieved T1-T12 length of ≥18 cm (RR, 0.86; 95% CI, 0.70–1.09). Thirty-five children in the severe group and 26 in the moderate group had at least one complication (RR, 1.35; 95% CI, 1.05–1.73). Mean 24-Item Early-Onset Scoliosis Questionnaire scores were similar between groups at final follow-up.

Conclusion. Delaying surgery until the major curve has progressed beyond 90° is associated with larger residual deformity and more complications than treating at a lesser curve magnitude. Quality-of-life outcomes were similar between those with severe and moderate EOS.

Level of Evidence: 3

Growing rod treatment achieved T1-T12 length of ≥18 cm in most children with severe EOS. One-third of patients with severe EOS had scoliosis of <45° at the end of growth-friendly treatment. The highest score of the 11 domains in the EOSQ-24 questionnaire was for pulmonary function in both groups.

Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD

Growing Spine Foundation, Milwaukee, WI

§Department of Orthopaedics, Hacettepe University, Faculty of Medicine, Sihhiye, Ankara, Turkey

Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA

||Division of Pediatric Orthopaedic Surgery, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, OH

∗∗Department of Orthopedics, Texas Scottish Rite Hospital, Dallas, TX

††Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE

‡‡Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA.

Address correspondence and reprint requests to Ilkka J. Helenius, MD, PhD, Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland; E-mail:

Received 19 June, 2018

Revised 16 August, 2018

Accepted 17 October, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties, stocks, travel/accommodations/meeting expenses.

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