Johns Hopkins researchers have determined that a major operation to fuse the spines of children with a rare form of severe, early-onset scoliosis is unnecessary in some cases.
Some Scoliosis Surgery Not Necessary!
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“We have long thought this big final fusion surgery, after years of spine straightening treatment, was always necessary, and now we have found that that’s not true, ” says Paul Sponseller, M.D., a pediatric orthopedic surgeon at the Johns Hopkins University School of Medicine, in the July 6, 2016 news release.
According to the news release, “…the surgery in question is the so-called final surgical fusion, the last step in a lengthy treatment process for the small minority of scoliosis patients who develop curvatures in their spines shortly after birth. Most scoliosis develops in the teen years and is often treated more conservatively with braces and exercise.”
Dr. Sponseller and his colleagues “combed through an international database and picked out the records of 167 children who received growing rod treatments between 1995 and 2010. Some 137 of those patients underwent the final fusion, but Sponseller focused on the outcomes of the 30 who, in consultation with their doctors, opted out of that procedure. Half of those 30 patients were female; their mean age at first surgery was 7.1 years. They underwent an average of 5.4 lengthening procedures, and there was a mean of 3.7 years of follow-up after their last surgery.”
“The team found that in the three to seven years following their last growing rod surgery, the spines of 26 stayed straight. The remaining four patients were considered special cases because their rods got infected and had to be removed.”
Dr. Sponseller told OTW, “What led to this work was my observation of patients doing well and auto-fusing over time. It was surprising to find that by carefully doing growing rod surgery over the years, you could get as good a correction as you could with a final fusion at the end. Surgeons should not feel compelled to automatically take patients back for fusion if they are doing well at maturity.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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