Study design: A retrospective comparative study.
Objective: This study compares the effect of age at the time of surgery on clinical and health-related quality-of-life (HRQoL) outcomes at 10-year follow-up in pediatric patients with congenital scoliosis (CS). Several studies have evaluated the outcomes of surgical treatments of CS during the growth period; however, age at surgery and its long-term effects have been assessed in only a few case reports.
Methods: We enrolled patients with CS who underwent spinal fusion at the age of 18 years or younger in our study. We evaluated 97 patients (38 males, 59 females; average age 16.5 years) who met our inclusion criteria, including the availability of outcome data for a minimum of 10-year post-surgery. We divided patients into two groups in terms of the age at surgery: early fusion (EF) and late fusion (LF) groups. Clinical outcomes included re-operations, major curve corrections immediately and at 10-year follow-up, Scoliosis Research Society (SRS)-22 questionnaire, and percentage forced vital capacity (%FVC).
Results: The EF group (33 patients) and the LF group (64 patients) did not differ significantly in terms of demographics. In all domains, the EF group had better HRQoL than the LF group. More patients (52%) in the EF group required re-operation than in the LF group (23%). In addition, patients with short fusion (< 7 segments, p = 0.0011) and greater T1-T12 height (≥ 22 cm, p = 0.0088) had better %FVC than their counterparts.
Conclusions: Age at surgery might have some non-negligible impacts on patients' HRQoL and clinical outcomes. Our study highlighted the important factors in surgical considerations of choosing the appropriate timing for spinal fusion, performing shorter fusions, and achieving an acceptable curve correction without allowing further curve progression that required re-operations.
Level of evidence: Level III.