Safety of Posterior Instrumentation in Congenital Scoliosis: A Long–Term Follow-Up

Purpose: The use of instrumentation in congenital scoliosis has been the subject of controversy. This study designed to compare the safety and outcomes of posterior spinal fusion (PSF) with and without instrumentation in congenital scoliosis.

Methods: Medical records and radiographs of all consecutive patients with congenital scoliosis without hyperkyphosis (under 45 degrees), treated by PSF in one institution between 1977 and 1996 were retrospectively reviewed. There were 41 patients (31 female, 10 male). Anomalies included hemivertebrae in 15, Unilateral bar 14, mixed 9, wedged 2 and block vertebra in 1 patient. Nineteen had instrumentation and 22 had no instrumentation. The mean follow-up was 8 +3 yrs (3+6 yrs to17+6 yrs).

Results:

Twelve patients had curve progression of less than 10° (6 instrumented), and 4 had loss of more than 20 degrees (all not instrumented). There were 4 re-operations (1 instrumented). There were no persistent pain, neurological deficit or death.

Conclusions: The use of instrumentation in congenital scoliosis has always been controversial. Our experience indicates that the use of posterior instrumentation in congenital scoliosis is safe. It provides better initial correction, better maintenance of correction and a decrease in the rate of re-operation.