Achievement of Guided Growth in Children With Low-Tone Neuromuscular Early-Onset Scoliosis Using a Segmental Sublaminar Instrumentation Technique

Abstract

Objectives/Summary of Background DataSegmental sublaminar spinal instrumentation without fusion results in guided growth and correction of deformity in early-onset scoliosis (EOS). The purpose of this study is to report the outcomes of a series of children with low-tone EOS that were treated surgically with a modification of a Luque trolley technique. MethodsThis study is a retrospective chart and radiographic review of a single-center series of 13 consecutive children who met inclusion criteria with documented progression of scoliosis greater than 25°. All children received surgical treatment with guided growth without fusion using a modified Luque trolley technique. The children's preoperative, postoperative, and most recent radiographs were assessed for Cobb angle, T1–T12 and T1–S1 height, and sagittal alignment including proximal junctional kyphosis. Surgimap spine software was used for calibration and measurement purposes. Complications and need for repeat and/or secondary surgical procedures were recorded. ResultsThe mean age at surgery was 7.4 years (4.6–10.5). On average, 15 segments (13–16) were instrumented. None of the children went on to a spontaneous fusion, and the average growth rate per year from T1–T12 and T1–S1 was 0.9 cm/y and 1.5 cm/y, respectively. The mean total growth from T1–T12 and T1–S1 was 22.3 cm (16.6–30.2) and 37.5 cm (30.1–46.4). A total of three additional surgeries were needed in two children to address complications. There were no mortalities. ConclusionsSublaminar guided growth is a safe and effective treatment in the Low Tone Neuromuscular subset of EOS. Follow-up studies failed to show signs of auto fusion, and implant failure was not observed in our cohort. All children displayed growth postoperatively without the need for multiple distraction-based surgeries. Guided growth minimizes the risks associated with multiple surgical procedures while maintaining correction and allowing for near-normal rates of spinal growth.