Summary
The objective of this study was to evaluate the long term outcome of combined anterior and posterior convex spinal epiphysiodesis in the treatment of congenital scoliosis. The study covered 53 patients (27 male, 26 female) with a minimum follow up period from surgery of 3 years (mean 8.8 years, range 3–22.5 years). Of these, 34 were skeletally mature when reviewed. Clinical assessment and sequential measurement of Cobb angles were used to chart the course of the deformity following surgery. The types of vertebral anomalies encountered were: 4 unsegmented bars, 7 unsegmented bars with hemivertebrae, 30 hemivertebrae (of which 2 were double hemivertebrae) and 12 complex (unclassifiable) patterns. The severe types were concentrated in the thoracic spine. Results are presented with reference to the type and site of anomaly and to the age of the patient at the time of surgery. Where deformity was due to an unsegmented bar (with or without hemivertebra) the rate of change of Cobb angle was slowed, but not reversed, following surgery, For the complex anomalies there was a reduction in the rate of progression of deformity following surgery, however, the final Cobb angle still increased from a mean of 61° to 70°. In contrast, the rate of progression reversed or slowed in 97% of the hemivertebra patients following surgery, producing a change in mean Cobb angle from 41° pre-operatively to 35° post-operatively. For each type of anomaly the correction achieved was greater where the surgery was performed at a younger age. Final outcome was influenced by the site of anomaly, with a better correction being achieved in the lumbar than the thoracic spine. In conclusion, we feel that convex epiphysiodesis has an important role in the surgical management of congenital scoliosis and, for hemivertebrae in particular, it can produce significant correction of deformity.
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References
Andrew T, Piggott H (1985) Growth arrest for progressive scoliosis; combined anterior and posterior fusion of the convexity. J Bone Joint Surg [br] 67: 193–197
Codivilla A (1901) Sulla scoliosi congenita. Arch Ortop 18: 65
Compere EL (1932) Excision of hemivertebra for correction of congenital scoliosis. J Bone Joint Surg 14: 555
Hass SL (1939) Experimental production of scoliosis. J Bone Joint Surg 11: 963–968
Kieffer J, Dubousset J (1993) Combined anterior and posterior convex epiphysiodesis for progressive congenital scoliosis in children aged <- 5 years. Eur Spine J 3: 120–125
MacLennan A (1922) Scoliosis. BMJ 2: 864–866
McMaster MJ, Otashku K (1982) The natural history of congenital scoliosis. J Bone Joint Surg [Am] 64: 1128–1147
Mery (1706) Histoire de l'Academie des Sciences, Paris
Nachlas LW, Borden JN (1954) The cure of experimental scoliosis by directed growth control. J Bone Joint Surg [Am] 33: 24–34
Nasca RJ, Stelling FH, Steel HH (1975) Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars. J Bone Joint Surg [Am] 57: 456–466
Paré A (1634) Collected works. Translated by T. Johnson, London
Roaf R (1963) The treatment of progressive scoliosis by unilateral growth arrest. J Bone Joint Surg [Br] 45: 637–651
Royle ND (1928) The operative removal of an accessory vertebra. Med J Aust 1: 467
Smith AD, Von Lackum WH, Wylie R (1954) An operation for stapling vertebral bodies in congenital scoliosis. J Bone Joint Surg [Am] 36: 342–347
Thompson AG, Piggott H (1986) Combined anterior and posterior convex side growth arrest in treatment of scoliosis. Presented at the annual meeting of the Scoliosis Research Society, Bermuda, 22 September
Tsou PM, Yau ACMC, Hodgson AR (1980) Embryogenesis and prenatal development of congenital vertebral anomalies and their classification. Clin Orthop 152: 231
Winter RB, Lonstein JE, Denis F, Sta-Ana de la Rosa H (1988) Convex growth arrest for progressive congenital scoliosis due to hemivertebrae. J Pediatr Orthop 8: 633–638
Winter RB, Moe JH, Eilers VE (1968) Congenital scoliosis: a study of 234 patients treated and untreated. J Bone Joint Surg [Am] 50: 1–47
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Marks, D.S., Sayampanathan, S.R.E., Thompson, A.G. et al. Long-term results of convex epiphysiodesis for congenital scoliosis. Eur Spine J 4, 296–301 (1995). https://doi.org/10.1007/BF00301039
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DOI: https://doi.org/10.1007/BF00301039