Spine. Volume 36(2), 15 January 2011, p E112–E122

Outcomes After Spinal Fusion for Congenital Scoliosis: Instrumented Versus Uninstrumented Spinal Fusion

Farley, Frances A. MD*; Have, Kelly L. Vander MD*; Hensinger, Robert N. MD*; Streit, Jonathan MD†; Zhang, Lingling MS‡; Caird, Michelle S. MD*
Author Information
*Department of Orthopedic Surgery, University of Michigan, Ann Arbor.
†School of Medicine, University of Michigan, Ann Arbor.
‡Center for Statistical Consultation and Research, University of Michigan, Ann Arbor.
© 2011 Lippincott Williams & Wilkins, Inc.

Study Design. Retrospective case-control study.

Objective. To compare radiographic and clinical outcomes in children with congenital scoliosis who had either instrumented or uninstrumented spinal fusion.

Summary of Background Data. Three previous studies have examined patients with spinal fusion for congenital scoliosis. Two have small case numbers with only short-term follow-up and the third is a large series without clinical outcomes.

Methods. After approval from the authors' institutional review board, children who underwent instrumented or uninstrumented spinal fusion for congenital scoliosis were identified. All curves were measured before surgery, after surgery, and annually until final follow-up and the initial postoperative curve correction and the final curve correction were calculated. All patients were sent a Scoliosis Research Society-22 (SRS-22) outcomes instrument to complete at final follow-up.

Results. A total of 51 subjects were identified. Thirty children were included in the instrumented group and 21 were in the uninstrumented group. For each child, the preoperative curves of the highest magnitude averaged 50° in the instrumented group and 46° in the uninstrumented group. Initial postoperative curve correction averaged 21° in the instrumented group and 4° in the uninstrumented group. At final follow-up, the curves had a mean progression of 10° from initial postoperative Cobb angles in the instrumented group and 8° in the uninstrumented group, or an average of 2° of progression per year from the initial postoperative curve correction in both groups compared with the postoperative curves. The total mean SRS-22 score for the instrumented group was 3.8 ± 0.8 and for the uninstrumented group was 4.1 ± 0.8. There was no difference between the two groups in the categories of function, pain, self-image, mental health, and satisfaction.

Conclusion. We were unable to distinguish between the two groups, using radiographic and clinical (patient-reported) outcome measures except that there was a difference in immediate postoperative curve correction between the two groups. Subjects in both groups showed postoperative curve progression at 2- to 14-year follow-up, but patients reported high-functioning clinical outcomes.

Level of evidence: Therapeutic level III