Researchers at Johns Hopkins medicine found final surgical fusion for children with severe, early-onset scoliosis can be eliminated in many cases, in a review of medical records. Study results are published in The Journal of Bone & Joint Surgery.
“We have long thought this big final fusion surgery, after years of spine straightening treatment, was always necessary, and now we have found that that is not true,” Paul D. Sponseller, MD, pediatric orthopedic surgeon at the Johns Hopkins University School of Medicine and an author of the study, said in a university press release.
According to the release, final surgical fusion is often the last step in treatment for a minority of scoliosis patients with severe, early-onset scoliosis. Children typically undergo growing rod treatment until they reach skeletal maturity. Surgeons then perform the final procedure, in which they insert rods and screws to maintain the spine’s alignment using a bone from the patient’s hip or tissue bank to “fuse” and stabilize the structure, with a goal of preventing the development of further deformity. Sponseller said he and other surgeons noticed children’s bones tend to begin stiffening on their own during rod insertion operations, which suggested the final fusion may be unnecessary.
Using an international database, Sponseller and colleagues analyzed the records of 167 children who received growing rod treatments between 1995 and 2010. Among those children, 137 patients underwent final fusion, while 30 opted out of the procedure after consultation with their doctors.
Half of the 30 patients who did not undergo final surgical fusion were female and their mean age at first surgery was 7.1 years. They underwent an average of 5.4 lengthening procedures, and follow-up occurred at a mean of 3.7 years after their most recent surgery.
In the 3-year-to-7-year period following the last growing rod surgery, the spines of 26 patients stayed straight. The remaining four patients were considered special cases because their growing rods had to be removed due to infection.
While additional research is needed to confirm the results, Sponseller said the findings suggest hundreds of early-onset scoliosis patients currently reaching their mature height may be able to forgo what he called a “grueling” operation.
“These patients have gone through a long and arduous process,” he said. “The payoff is that they often do not often need a big surgery at the end.”