Severe Infantile Scoliosis Treated with Repetitive Distractions Followed by Definitive Arthrodesis

The purpose was to evaluate patients with severe infantile scoliosis treated in their childhood with repetitive distractions and followed at a later age by definitive spinal fusion.

Fifty-six patients with severe scoliosis were treated with repetitive distractions and 38 of them had reached the age for performing definitive correction and fusion.

Twenty males and 18 females presented different etiologies: 12 congenital, 8 neuromuscular, 3 neurofibromatosis, 2 idiopathic and 13 miscellaneous.

The average age when starting the program of consecutive distractions was 7+6 and at the time of performing the posterior fusion was 13+4. All these patients were treated with Harrington rods for the repetitive distraction program. There were a mean of 3,7 distractions for patient with a mean break of 1+1 between them. During definitive correction in 13 of them anterior fusion was performed as well. In all of them posterior instrumented fusion with different implants along the time were performed. The follow-up of the definitive correction was 2+6. In scoliosis the mean angular value (MAV) preop was 78º, previous to the final arthrodesis was 75º and after final correction was 54º. In thoracic kyphosis the MAV was 51º, 43º and 45º respectively while considering lumbar lordosis the MAV was 32º, 23º and 30º also respectively.

Complications in the period of distractions were: 21 infections, 13 broken rods, 19 dislodgement of the hooks and 8 cases of supra-arthrodesis kyphosis. Complications regarding the final correction and fusion were: 4 infections, 2 kyphosis above and 1 below the fused area, 1 seudoarthrosis and 1 incomplete paraplegia that resolved when the implants were removed. We observed only one case of crankshaft phenomenon.

The treatment of severe infantile scoliosis has several problems. Early spine fusion promotes a short trunk and a poor correction. Repetitive distractions with minimal fusion around the hooks has a great morbidity, but we achieved a reasonable delay in the progression of the curves. Most of the curves have improved initially, afterwards maintained their angular values and the final correction showed stiffness of the curves. This program is a reasonable treatment for dealing with very severe infantile