Surgical and health-related quality-of-life outcomes of growing rod "graduates" with severe versus moderate early-onset scoliosis

Study Design.A retrospective review of a prospective, multicenter database.Objective.The aim of this study was to compare surgical and quality-of-life outcomes at the end of growing rod treatment in patients with severe versus moderate early-onset scoliosis (EOS).Summary of Background Data.Knowledge of the outcomes of severe EOS after growth-friendly treatment is limited because this condition is uncommon.Methods.We identified 40 children with severe EOS (major curve ≥90°) treated with growing rods before age 10 with minimum 2-year follow-up after last lengthening or final fusion. From the same registry, we matched 40 patients with moderate EOS (major curve<90°). Twenty-seven patients in the severe group and 12 in the moderate group underwent final fusion (P<0.001).Results.Mean preoperative curves were 102° (range, 90°-139°) in the severe group and 63° (range, 33°-88°) in the moderate group (P<0.001). At final follow-up, mean curves were 56° (range, 10°-91°) and 36° (range, 12°-89°), respectively (P<0.001). Fourteen (35%) children in the severe group and 32 (80%) in the moderate group had scoliosis of<45° at final follow-up [risk ratio (RR), 0.44; 95% confidence interval (95% CI), 0.20-0.57]. At final follow-up, 30 (75%) children in the severe group and 35 (88%) in the moderate group had achieved T1-T12 length of ≥18cm (RR, 0.86; 95% CI, 0.70-1.09). Thirty-five children in the severe group and 26 in the moderate group had at least one complication (RR, 1.35; 95% CI, 1.05-1.73). Mean 24-Item Early-Onset Scoliosis Questionnaire scores were similar between groups at final follow-up.Conclusion.Delaying surgery until the major curve has progressed beyond 90° is associated with larger residual deformity and more complications than treating at a lesser curve magnitude. Quality-of-life outcomes were similar between those with severe and moderate EOS.Level of Evidence: 3.