title: Outcomes after spinal fusion for congenital scoliosis: instrumented versus uninstrumented spinal fusion.
abstract: METHODS
  retrospective case-control study.
  
  
  OBJECTIVE
  to compare radiographic and clinical outcomes in children with congenital scoliosis who had either instrumented or uninstrumented spinal fusion. SUMMARY OF BACKGROUND DATA.: Three previous studies have examined patients with spinal fusion for congenital scoliosis. Two have small case numbers with only short-term follow-up and the third is a large series without clinical outcomes.
  
  
  METHODS
  after approval from the authors' institutional review board, children who underwent instrumented or uninstrumented spinal fusion for congenital scoliosis were identified. All curves were measured before surgery, after surgery, and annually until final follow-up and the initial postoperative curve correction and the final curve correction were calculated. All patients were sent a Scoliosis Research Society-22 (SRS-22) outcomes instrument to complete at final follow-up.
  
  
  RESULTS
  a total of 51 subjects were identified. Thirty children were included in the instrumented group and 21 were in the uninstrumented group. For each child, the preoperative curves of the highest magnitude averaged 50° in the instrumented group and 46° in the uninstrumented group. Initial postoperative curve correction averaged 21° in the instrumented group and 4° in the uninstrumented group. At final follow-up, the curves had a mean progression of 10° from initial postoperative Cobb angles in the instrumented group and 8° in the uninstrumented group, or an average of 2° of progression per year from the initial postoperative curve correction in both groups compared with the postoperative curves. The total mean SRS-22 score for the instrumented group was 3.8 ± 0.8 and for the uninstrumented group was 4.1 ± 0.8. There was no difference between the two groups in the categories of function, pain, self-image, mental health, and satisfaction.
  
  
  CONCLUSIONS
  we were unable to distinguish between the two groups, using radiographic and clinical (patient-reported) outcome measures except that there was a difference in immediate postoperative curve correction between the two groups. Subjects in both groups showed postoperative curve progression at 2- to 14-year follow-up, but patients reported high-functioning clinical outcomes.
  
  
  METHODS
  Therapeutic level III.
authors.affiliation: Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI 48105, USA. fafarley@med.umich.edu
authors.forename: Frances A
authors.initials: FA
authors.lastname: Farley
authors.forename: Kelly L Vander
authors.initials: KL
authors.lastname: Have
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hensinger
authors.forename: Jonathan
authors.initials: J
authors.lastname: Streit
authors.forename: Lingling
authors.initials: L
authors.lastname: Zhang
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Caird
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000151:congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D011795:Surveys and Questionnaires; D055815:Young Adult