Is It Safe to Correct and Instrument Congenital Scoliosis?

Purpose: Determine the safety and efficacy of correction and instrumentation of congenital spinal deformity using segmental instrumentation.

Materials and Methods: Retrospective review of charts and radiographs of patients who underwent surgical correction for congenital spine deformity was performed. The reviewer was an independent, unbiased observer. The preoperative diagnosis, deformity type and corrective techniques, as well as intra-op and post-op complications were reviewed.

Results: A total of nineteen patients, fifteen female and four male, with an average age of 16 (range 3-34 years) and a minimum follow-up of 2 years form the basis of this report. Eight out of nineteen patients had previous surgery; five posterior only and three combined anterior and posterior procedures. Thirteen patients had congenital scoliosis, five patients had congenital kyphosis and one patient had congenital lordosis as their primary deformity. Posterior only correction and instrumentation was performed in five out of nineteen patients; combined anterior and posterior correction and instrumentation was performed in fourteen out of nineteen patients. The anterior release and fusion of the spinal column included a combination of anterior discectomies and osteotomies in all patients. In addition, vertebral column shortening via apical resection was performed in five patients. The posterior release included posterior osteotomies in all (19/19) patients, posterior arch resection was performed in five patients, two patients had decancellation procedures. A majority of the patients had a combination of hooks, pedicle screws and sub-laminar wires (11/19), while (3/19) had hooks and screws only, hooks and sub-laminar wires only (2/19), screws and cables (1/19), hooks only (1/19), and screws only (1/19). In most patients, multiple rods were used to achieve correction; 10/19 patients received a 3-rod construct and 3/19 patients received a 4-rod construct, while only 6/19 patients received a 2-rod construct. The average operative time for the anterior procedures was 2.5 hours, while the average time for posterior procedures was 4.5 hours. The average blood loss was 2500 ml. The major curve was corrected from a pre-op average of 69.2 to a post-op average of 34.2 (46% correction). The compensatory curve was corrected from a pre-op average of 40.8 to a post-op average of 16.7 (60% correction). The average loss of correction between the post-op and final follow-up period was 4.5 for the major curve and 2.6 for the compensatory curve. All patients had SSEP or a combination of SSEP and MEP's. No patient had any neurologic loss during or after surgery. Complications included 1 dural tear, 1 lung laceration, and 1 failure of hardware. There were no cases of pseudoarthrosis or infections. The literature is sparse regarding treatment of congenital spinal deformity with modern instrumentation methods. This study provides a comprehensive review of patients undergoing corrective maneuvers and instrumentation in this high risk population.

Conclusion: Correction and instrumentation of spinal deformity associated with congenital vertebral malformations to realign the spinal column using translation, compression, and vertebral column shortening for corrective maneuvers with instrumentation, can be done safely and effectively.