Lessons learned from short fusion with vertebrectomy for congenital early-onset scoliosis : a minimal follow-up of ten years until skeletal maturity.

Abstract

Short fusion with vertebrectomy is a common form of surgical treatment for patients with congenital early-onset scoliosis (CEOS) and failure of vertebral formation. While the deformity may be effectively corrected postoperatively, the correction may be lost in the long term. To date, only a few studies have included long-term follow-up until skeletal maturity. The aim of this study was to evaluate the ultimate clinical outcomes of short fusion with vertebrectomy for these patients by defining a successful outcome and analyzing the risk factors for an unsuccessful outcome. Data about patients with CEOS who underwent short fusion with vertebrectomy at our hospital between January 2006 and December 2014 were collected retrospectively. A total of 41 patients who reached skeletal maturity, with a mean follow-up of 11.1 years (10 to 15; SD 1.3) were enrolled. A successful outcome was defined as those with a residual curve of < 30° at follow-up after skeletal maturity, maintained coronal and sagittal balance, and without the need for revision surgery. Patients were divided into a successful group and an unsuccessful group. Demographic characteristics, parameters of correction of the deformity, complications, and 22-item Scoliosis Research Society (SRS-22) scores were recorded and compared. Risk factors for an unsuccessful outcome were analyzed by binary logistic regression. The main curve decreased significantly from 38.3° (SD 14.9°) to 8.9° (SD 6.7°) after surgery (p < 0.001), with a loss of correction to 17.3° (SD 16.3°) at the final follow-up (p < 0.001). The success rate was 73% (30 of 41). Binary logistic regression analysis revealed that the coronal balance distance (CBD) was an independent risk factor for an unsuccessful outcome. There were 16 complications in the successful group and 22 complications in the unsuccessful group. The total SRS-22 and self-image domain scores were significantly higher in the successful group (p < 0.001, p = 0.001). Patients with CEOS who are treated with short fusion with vertebrectomy require close follow-up until skeletal maturity. A total of 30 patients (73%) had a successful outcome, possibly linked to significantly better SRS-22 self-image domain scores. Severe preoperative deformity, especially a large CBD, increased the risk of an unsuccessful outcome.