An evaluation of the types and the results of surgical treatment for congenital scoliosis

Objective: We evaluated the types and the results of surgical treatment performed for congenital scoliosis.

Methods: Forty-one patients (26 females, 15 males; mean age 12.8 years) with congenital scoliosis were included. The patients were classified according to the Winter's system. Transpedicular hemiepiphysiodesis, "egg shell" procedure, and anterior hemiarthrodesis and posterior convex fusion were performed in infantile (n=1) and juvenile (n=8) patients. In the adolescent (n=32) group, posterior in situ fusion was performed for rigid curves (n=15), posterior fusion after correction with posterior instrumentation for moderate curves (n=8), and posterior fusion and correction with posterior instrumentation after an anterior osteotomy for segmentation failures (n=6). Five patients with unincarcerated fully segmented hemivertebrae had anterior or posterior instrumentation following anterior-posterior hemivertebrectomy. The mean follow-up was 51.8 months (range 26 to 132 months).

Results: Fourteen patients (34.2%) had formation failures, 19 patients (46.2%) had segmentation failures, and eight patients (19.6%) had mixed types of deformities. Klippel-Feil syndrome was detected in two patients, and heart valve abnormality was found in two patients. Although the infantile patient who underwent transpedicular hemiepiphysiodesis showed no improvement after surgery, a spontaneous correction rate of 60% was found during her final controls. Patients who underwent anterior hemiarthrodesis obtained a final correction rate of 54.3% following a 42% of correction at surgery. The correction rates for posterior instrumentation were 26.2% with translation and 49.3% after an anterior osteotomy. Patients who had anterior or posterior instrumentation after anterior-posterior hemivertebrectomy had final correction rates of 73.3% and 59.2%, respectively. Final evaluations showed that nine patients (21.9%) had no change in their curves, while 10 patients (24.4%) had spontaneous correction. Four patients developed superficial (n=2) and deep (n=2) infections following posterior instrumentation. Of these, three patients were successfully treated with debridement and antibiotic therapy, whereas one patient required implant removal in the eighth month. No neurologic deficits or systemic complications occurred during or after surgery.

Conclusions: Surgical treatment may yield successful results in progressive congenital scoliosis when an appropriate surgical technique is selected based on the patient's age and the type of deformity.