Comparative Analysis of Shoulder Balance through Growth Guidance Techniques in the Surgical Treatment of Early-onset Scoliosis

Abstract

Objective: The purpose of this study was to compare the efficacy of growth guidance techniques (single and dual growing rods, Vertical Expandable Prosthetic Titanium Rod-VEPTR) on shoulder balance, in the surgical treatment of early-onset scoliosis. Methods: Thirty six patients with early-onset scoliosis (EOS) due to various etiologies who were operated on in two different institutions were included in the study and they were divided in 3 groups. Group 1 consisted of 11 patients (mean age 7.5 years) who were treated with a single growing rod, Group 2 had 13 patients (mean age 8.1 years) who were treated with dual growing rods, and Group 3 consisted of 12 patients (mean age 4.1 years) who were treated with VEPTR technique. The coracoid height difference (CHD), clavicular tilt angle difference (CTAD) and clavicula-rib cage intersection difference (CRID) were measured on standing anteroposterior X-ray images in the preoperative, early postoperative and the last follow-up periods. Data obtained from these measurements were subject to statistical analysis. Results: The average postoperative follow up period was 3.04 (range: 2.3 to 4.8) years for Group 1, 2.23 (range: 1 to 3.1) years for Group 2 and 2.18 (range: 1 to 3.2) years for Group 3. Clinical improvement in shoulder balance was obtained for Group 1 and Group 2 post-operatively, but there was no significance in the comparison among the three groups. Conclusion: The effect of growth guidance techniques on shoulder balance remains unpredictable in the surgical treatment of early-onset scoliosis.