Vertebral Wedge Osteotomies for the Fusionless Treatment of Paralytic Scoliosis: Two-Year Follow-up**

Summary: An assessment of the clinical efficacy and functional impact of a fusionless treatment for paralytic scoliosis was performed. Radiographic and functional data suggest this procedure is a potential treatment option for paralytic scoliosis.

Study Design: Two-year follow-up analysis of a fusionless surgical technique to treat scoliosis secondary to spinal cord injury or myelodysplasia in children and adolescents.

Objectives: To evaluate clinical efficacy and functional impact of a fusionless treatment for paralytic scoliosis at two-years follow-up.

Methods: Fourteen patients with scoliosis secondary to spinal cord injury or myelodysplasia underwent a fusionless vertebral wedge** osteotomy procedure. Thirteen of these patients were available for minimum two-year follow-up (average 43 months). Current radiographs were measured and compared to preoperative films. The functional impact of the procedure was evaluated using three outcome measures. The Pediatric Outcomes Data Collection Instrument (PODCI), the Functional Independence Measure (FIM) scale, and a self-reported activity scale were all obtained preoperatively and at the most recent follow-up.

Results: Eight (62%) patients had improvement in the coronal Cobb angle with an average correction of 45%. Two (15%) patients' curves measured the same (+/- 5°) at last follow-up. Three (23%) patients' curves had worsened. Two of these three patients required fusion with an average delay to fusion of 30 months. One patient required a fusion below the curve for pelvic obliquity. There were no neurologic complications. FIM scores and PODCI scores for upper extremity function, pain and happiness did not show statistical difference in preoperative and current values. Statistically significant improvement was seen in self-reported activity performance and satisfaction as compared to preoperative values on last follow-up.

Conclusion: Vertebral wedge osteotomy is a potential fusionless treatment option for paralytic scoliosis. At two-year follow-up there was no loss of function. In addition, there was some improvement in pre-surgical self-reported activities in this series of patients. Ten (77%) patients in the series either had improvement or maintained their Cobb angle measurements. Although two patients required fusion, these patients had 2.5 years of subsequent further growth prior to fusion.

FDA Diclosure Cleared: No ** Vertebral wedge-rod construct (Medtronic)