Surgical study done in 1996

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Spine. 1996 Aug 15;21(16):1884-8.

Convex spinal epiphysiodesis in the management of progressive

infantile idiopathic scoliosis.

Marks DS, Iqbal MJ, AG, Piggott H.

Department of Spinal Surgery, Royal Orthopaedic Hospital,

Birmingham, England.

STUDY DESIGN: Retrospective review of patient records with current

clinical and radiographic assessment.

OBJECTIVE: To evaluate the long-term result of anterior and

posterior convex spinal growth arrest, with or without

instrumentation, in managing infantile idiopathic scoliosis.

SUMMARY OF BACKGROUND DATA: There were 12 male and 10 female

patients studied, with a mean follow-up period of 10 years, 9

months. The mean Cobb angle before surgery was 65 degrees. All had a

rib vertebral angle difference more than 20 degrees. The mean age at

surgery was 6 years. Nine patients had epiphysiodesis alone; nine

patients also underwent Harrington instrumentation simultaneously,

and four underwent Harrington instrumentation 2-4 years later.

METHOD: Clinical evaluation and sequential measurements of Cobb

angle were done.

RESULTS: The epiphysiodesis-only group had a mean preoperative Cobb

angle of 72 degrees, mean progression of curves of +12 degrees, and

mean rate of progression of +2.5 degrees per year: the group's

postoperative figures were 92 degrees, +15 degrees, and +3 degrees

per year, respectively. The epiphysiodesis and late Harrington rod

group had a mean preoperative Cobb angle of 56 degrees, mean

progression of +12 degrees, and a mean rate of progression of +5

degrees per year; the group's postoperative Cobb angle averaged 62

degrees, progression +6 degrees, and rate of progression +1 degree

per year. The epiphysiodesis with simultaneous Harrington rod group

had a preoperative mean Cobb angle of 60 degrees, mean progression

of +18 degrees, and mean rate of progression of +6 degrees per

years. After surgery, these improved to 58 degrees, correction of 2

degrees, and rate of correction of 0.5 degree per year.

CONCLUSION: Combined anterior and posterior convex spinal growth

arrest alone does not prevent progression of deformity in infantile

idiopathic scoliosis. The addition of posterior instrumentation can

slow or arrest deformity progression but not reverse it.