Case-Matched Comparison of Spinal Fusion Versus Growing Rods for Progressive Idiopathic Scoliosis in Skeletally Immature Patients

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Abstract

Study Design.

Multicenter study of retrospectively and prospectively collected data.

Objectives.

To compare outcomes of spinal fusion (SF) versus growing rod (GR) surgery using a case-matched series.

Summary of Background Data.

Scoliosis surgeons face two distinct treatment options for progressive idiopathic scoliosis in skeletally immature patients: definitive SF or growth-friendly surgery such as GR. No previous studies have directly compared outcomes between these two techniques.

Methods.

A multicenter database identified 11 GR patients who met the following criteria: (1) idiopathic etiology; (2) 9 years to 11 years old at initial surgery; (3) major thoracic curve; (4) had “final” SF. A second multicenter database was used to identify SF patient matches. A one-to-one patient match was performed based on age, major curve size, and curve apex.

Results.

Preoperative age was 10.1 years for GR and 10.8 years for SF (P = 0.003). GR had a mean 2.8 lengthenings before final fusion. Follow-up time after spinal fusion (3.8 vs. 4.5 years; P = 0.51) and age at latest follow-up (16.4 vs. 15.3 years; P = 0.28) were similar between GR and SF groups. Initial curve correction was significantly greater for SF compared with GR after initial GR surgery (71% vs. 38%; P < 0.001). SF patients had better overall curve correction at latest follow-up (63% vs. 44%; P = 0.08). Overall increase in T1-S1 was 23% for GR and 19% for SF (P = 0.42). Overall increase in T1-T12 was 19% for GR and 17% for SF (P = 0.76). Complications requiring unplanned surgery occurred in one GR patient and two SF patients. Number of surgeries was significantly higher in GR (54) compared with SF (13).

Conclusion.

SF patients had greater curve correction and marginally less spinal and thoracic height gain compared with GR patients. GR patients underwent significantly more surgical procedures. These findings suggest GR treatment does not benefit older patients with juvenile idiopathic scoliosis.

Conclusion.

Level of Evidence: 4

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