title: Posterior Spinal Fusion With Pedicle Screws in Patients With Idiopathic Scoliosis and Open Triradiate Cartilage: Does Deformity Progression Occur?
abstract: BACKGROUND
  Anterior-posterior spinal fusion (APSF) is the traditional treatment for patients with idiopathic scoliosis and open triradiate cartilage (OTRC). Our goals were to assess whether posterior-only spinal fusion (PSF) with pedicle screws can halt deformity progression as effectively as APSF in patients with OTRC, and whether selection of the distal fusion level influences curve progression.
  
  
  METHODS
  We studied a prospective multicenter database to identify all children with 2-year radiographic and clinical follow-up who were 11 years or younger with Risser grade 0 and OTRC who were treated with (1) PSF (OTRC-PSF group, N=20); or (2) APSF (OTRC-APSF group, N=9). A reference group was constructed of 20 children who were 18 years or younger with Risser grade 4 or 5 and closed triradiate cartilage (CTRC) and who were treated with PSF (CTRC-PSF group) and matched in preoperative curve magnitude and type to the OTRC-PSF group. The 3 groups were compared with respect to operative time, blood loss, length of hospital stay, and radiographic and functional outcomes (significance, P<0.05).
  
  
  RESULTS
  OTRC-APSF patients had significantly longer operative time (P<0.01), greater blood loss (P=0.02), and longer hospital stays (P<0.01) than OTRC-PSF patients. At 2 years, 7 (35%) OTRC-PSF patients had >10 degrees of curve progression compared with no patients in the OTRC-APSF group (P=0.042) and 1 patient in the CTRC-PSF group (P=0.018). The OTRC-PSF group had the highest number of patients fused to the stable vertebra. Of the 11 OTRC-PSF patients fused to 1 vertebra short of stable, 6 (55%) had >10 degrees of curve progression. Of the 9 OTRC-PSF patients fused to at least the stable vertebra or lower, only 1 (11%) had curve progression. There were no significant differences in Scoliosis Research Society outcome scores between OTRC-PSF patients who did and those who did not have >10 degrees of curve progression.
  
  
  CONCLUSIONS
  PSF with pedicle screws was associated with curve progression in a significantly greater proportion of patients with OTRC compared with APSF. Not fusing to stable was also associated with curve progression in patients treated with PSF but not APSF.
  
  
  METHODS
  Level III-therapeutic.
authors.affiliation: *Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD †Department of Orthopedics, Rady Children's Hospital, San Diego, CA ‡Mount Sinai Beth Israel, New York, NY §Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE ∥Department of Orthopaedic Surgery, University of Miami, Miami, FL ¶The Institute for Spine and Scoliosis, Lawrenceville, NJ.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.forename: Peter O
authors.initials: PO
authors.lastname: Newton
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.forename: Suken A
authors.initials: SA
authors.lastname: Shah
authors.forename: Harry
authors.initials: H
authors.lastname: Shufflebarger
authors.forename: Tracey P
authors.initials: TP
authors.lastname: Bastrom
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Marks
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002356:Cartilage / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D065289:Pedicle Screws; D011446:Prospective Studies; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome