Young patients with early-onset scoliosis, a dangerous curvature of the spine, have two options for surgery, but a new study finds one of the procedures results in fewer complications.
For 8- to 11-year-olds, growth-friendly surgery that allows the spine to continue growing might sound preferable, but researchers say it leads to far more operations and complications than spinal fusion.
The difference was not small: Those young patients who had growth-friendly surgery had eight times more complications and nine times more unplanned trips to the operating room than those who got only spinal fusion, the researchers found.
"Patients who had growth-friendly surgery did have an increase in the length of their spine over time, whereas the spine stops growing after a spinal fusion, so this is a very important factor for families to consider -- whether growth is more important than the complications," said study co-author Dr. G. Ying Li.
"However, if you hear this difference in complications and the number of surgeries, I think most parents would lean towards the single fusion, which was also found to have a lower financial impact and burden on the families in our study," said Li, service chief of pediatric orthopedics at University of Michigan Health's C.S. Mott Children's Hospital.
Early-onset scoliosis is scoliosis diagnosed before age 10. It is potentially deadly and can cause heart and lung damage as it progresses, Li and colleagues noted in a hospital news release.
For the study, they reviewed medical records of 59 preadolescents with early-onset neuromuscular scoliosis treated with a spinal fusion surgery. Forty-three of the kids had undergone prior growth-friendly surgeries.
They found the patients who had a single spinal fusion surgery had greater curve correction and spines that were 50% straighter compared to the patients who had received growth-friendly treatment first.
The international study followed the patients for several years. The group who had single spinal fusion had an average of 1.6 surgeries, and 25% experienced complications. The group who also had the growth-friendly surgery averaged 8.7 surgeries, and 84% experienced complications.
While teens with scoliosis are traditionally treated with a single spinal fusion, young children whose spines are still growing may be treated with growth-friendly surgery.
In the growth-friendly surgery, expandable rods are placed in the spine to grow along with the child. Usually they're removed for a spinal fusion after the spine achieves sufficient growth.
In spinal fusion, rods and screws are inserted to fuse the spine in a straighter position.
The question of what to do with kids around 8 to 11 is less clear-cut than it is for older and younger children, Li explained.
"For someone who may not understand the implications, 11 years old may still be considered small and young, so they may think it's a no-brainer to insert the expandable rods," Li said. "However, the rods are associated with a lot of complications. Some types of rods need to be expanded surgically every six months, which brings repeated exposures to anesthesia and more infections from going through the same scar. Even the newer magnetic rods that can be expanded non-surgically have been found to have complications associated with the rods themselves. There are far fewer complications with a single spinal fusion."
The findings were published Dec. 29 in the journal Spine Deformity. The team called for further studies, including an assessment of changes in health-related quality of life with the two options.
"The gain in spine length in the patients who underwent growth-friendly surgery prior to spinal fusion was at the expense of significantly increased rates of complications and unplanned surgeries," Li said. "There is more to investigate, but a ‘one-and-done' surgery with a single spinal fusion may be the best option for many of these kids."
The U.S. National Institute of Arthritis and Musculoskeletal and skin disease has more on scoliosis.
SOURCE: Michigan Medicine -- University of Michigan, news release, Dec. 29, 2021