Achievement of Guided Growth in Children With Low-Tone Neuromuscular Early-Onset Scoliosis Using a Segmental Sublaminar Instrumentation Technique.

Abstract

Segmental sublaminar spinal instrumentation without fusion results in guided growth and correction of deformity in early-onset scoliosis (EOS). The purpose of this study is to report the outcomes of a series of children with low-tone EOS that were treated surgically with a modification of a Luque trolley technique. This study is a retrospective chart and radiographic review of a single-center series of 13 consecutive children who met inclusion criteria with documented progression of scoliosis greater than 25°. All children received surgical treatment with guided growth without fusion using a modified Luque trolley technique. The children's preoperative, postoperative, and most recent radiographs were assessed for Cobb angle, T1-T12 and T1-S1 height, and sagittal alignment including proximal junctional kyphosis. Surgimap spine software was used for calibration and measurement purposes. Complications and need for repeat and/or secondary surgical procedures were recorded. The mean age at surgery was 7.4 years (4.6-10.5). On average, 15 segments (13-16) were instrumented. None of the children went on to a spontaneous fusion, and the average growth rate per year from T1-T12 and T1-S1 was 0.9 cm/y and 1.5 cm/y, respectively. The mean total growth from T1-T12 and T1-S1 was 22.3 cm (16.6-30.2) and 37.5 cm (30.1-46.4). A total of three additional surgeries were needed in two children to address complications. There were no mortalities. Sublaminar guided growth is a safe and effective treatment in the Low Tone Neuromuscular subset of EOS. Follow-up studies failed to show signs of auto fusion, and implant failure was not observed in our cohort. All children displayed growth postoperatively without the need for multiple distraction-based surgeries. Guided growth minimizes the risks associated with multiple surgical procedures while maintaining correction and allowing for near-normal rates of spinal growth.