To compare the results of spinal fusion in patients with open triradiate cartilages (OTRC) and closed triradiate cartilages (CTRC).
Patients with OTRC at the time of spinal fusion may be at increased risk of developing postoperative changes related to growth.
From a database of patients with adolescent idiopathic scoliosis, we identified 44 patients with OTRC (mean age, 11.6 years) and 450 patients with CTRC (mean age, 15.6 years) and a minimum follow-up of 2 years. Patients in both groups were treated with anterior-only, posterior-only, or combined anterior and posterior spinal fusion; none had all-pedicle screw posterior instrumentation.
In the OTRC group, anterior or posterior instrumentation, but not the combined approach, resulted in a significant mean late increase in the main curve (4.4° and 7.3° vs. 0°, respectively; P = 0.002), an approach-related difference not seen in the CTRC group. Significantly more OTRC patients had proximal levels added on after surgery than did CTRC patients (18% vs. 8%, respectively; P = 0.02), and there was a trend toward this phenomenon distally (29% vs. 19%, respectively; P = 0.10). Proximal and distal junctional kyphosis was not significantly different between the 2 groups. Reoperation rate was 11% and 7% for OTRC and CTRC patients, respectively. For the selectively fused Lenke 1C curves in OTRC and CTRC patients, there was a trend in the uninstrumented lumbar curve toward a smaller lumbar curve before surgery (36° and 41°, respectively; P = 0.07) and a larger curve after surgery (27° and 24°, respectively; P = 0.07).
Patients with scoliosis and OTRC have a greater risk of adding-on proximally and of loss of correction with anterior-only instrumentation; they may also have less predictable lumbar correction from selective thoracic fusion. However, after combined surgery, they have results similar to those of more skeletally mature patients.
We retrospectively compared the results of spinal fusion in pediatric patients with adolescent idiopathic scoliosis and OTRC (44) or CTRC (450). OTRC patients have a greater risk of having levels added on proximally and of loss of correction with anterior-only instrumentation. They may also have less predictable lumbar correction from selective thoracic fusion.
From the *Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD; †Shriner’s Hospital, Philadelphia, PA; ‡University of California, San Diego, CA; §Washington University, St. Louis, MO; ¶Woodridge Orthopaedics, Wheat Ridge, CO; ∥Division of Pediatric Orthopaedics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; **Texas Scottish Rite Hospital, Dallas, TX; and ††Scoliosis Associates, New York, NY.
Acknowledgment date: October 9, 2007. Revision date: November 29, 2007. Acceptance date: December 3, 2007.
The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.
Corporate/Industry funds were received in support of this work. Although one or more of the authors(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript, benefits will be directed solely to a research fund, foundation, educational institution, or other nonprofit organization which the author(s) has/have been associated.
This project was supported by DePuy Spine, Inc.
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