Growth-Friendly Versus Posterior Spinal Fusion Surgery for Congenital Kyphosis: A Multicenter Analysis of Complications, Reoperations, and Patient Outcomes.

Abstract

Surgical interventions for congenital kyphosis (CK) in the growing child include posterior spinal fusions (PSF) with instrumentation and growth-friendly (GF) procedures. While GF approaches aim to preserve spinal growth, they may increase complications and unplanned reoperations (UPRORs). This study compares complications, UPRORs, and radiographic and patient-reported outcomes between PSF and GF approaches for CK. An international, multicenter database for early-onset spinal deformity was queried to identify patients with CK who underwent primary operative management of the spinal deformity. The inclusion criteria were patients 9-years of age and younger with a preintervention sagittal kyphosis greater than their major coronal deformity, with the major coronal deformity being <35 degrees, and were followed up for at least 2-years postoperatively. A total of 54 patients (27 PSF; 27 GF) met the inclusion criteria with similar ages and follow-up periods. Preoperative and postoperative sagittal deformity was similar between groups. Both corrected sagittal deformity (PSF: -12 degrees, P=0.0182; GF: -25 degrees, P=0.0003) similarly postoperatively and at final follow-up. Preoperative and postoperative coronal deformity was also similar between groups, but PSF saw better corrections postoperatively (PSF: -6 degrees, GF: 1 degrees, P=0.0343). Coronal deformity correction was similar at final follow-up. T1-S1 length increased similarly for both groups at postoperative and final follow-up. Thirteen patients (41%) of the PSF group experienced complications compared with 36 patients (63%) in the GF group (P=0.0048). Five patients (19%) in the PSF group experienced a UPROR compared with 14 patients (33%) in the GF group (P=0.0470). The PSF group saw greater improvements in the EOSQ-24 general health domain (PSF: +23, GF: -6, P=0.0336), with all other scores being similar. In this study, PSF patients had similar deformity correction and EOSQ-24 scores with fewer complications and UPRORs than GF patients. In addition, though GF aims to preserve spinal growth, T1-S1 growth overtime was similar between groups. Clinicians should weigh the risk and benefits of both approaches for each patient's unique CK deformity to optimize shared surgical decision-making. Level III.