ABSTRACT

Early-onset scoliosis includes many etiologies and many types of curves usually requiring surgical treatment in young children. Surgical treatments tailored for deformity control and the preservation of growth in young children include fusionless techniques, the most popular of which is the dual growing rod technique. In this prospective study, 22 early-onset scoliosis patients treated with the traditional dual growing rod technique whose foundation anchors were mostly pedicle screws have been followed for a minimum of twenty-four months. Routine lengthenings were performed every six months on an outpatient basis. The radiological progress of the patients was tracked with routine radiographs at each preoperative and postoperative visit. Growth of the vertebral column was evaluated by the measurement of instrumented and uninstrumented vertebral levels. A total of 22 patients whose average age at the index operation was 63.7 months were included in the study; 22 index and 90 routine lengthening procedures were performed. Radiographic progress of the patients was as follows: scoliosis decreased from an average of 50° (range 25°-98°) to 27° (range 8°-52°) post final follow up visit. Kyphosis did not change significantly. Apical vertebral rotation decreased from 20.5° (range 0°-45°) to 14.2° (range 0°-25°) as measured by the Perdriolle method. Segments t hat were included in the instrumentation increased in height from 16.8 (range 12.5-22) mm to 18.8 (range 12.5-22) mm while segments that were not included increased from 17.6 (range 14.3-23) mm to 19.5 (range 1722) mm. No final fusions were performed at the time of the study. We have found that distal and proximal pedicle screw fixation, dual rod application and routine lengthenings every six months provide an adequate, safe and effective method for the three-dimensional control of deformity while allowing for continued vertebral growth.