title: Final Fusion After Growing-Rod Treatment for Early Onset Scoliosis: Is It Really Final?
abstract: BACKGROUND
  Final fusion is thought to be the end point for patients with early onset scoliosis following treatment with the use of growing rods. But is it? The purpose of this study was to determine the incidence and cause of any reoperation after final fusion.
  
  
  METHODS
  A multicenter database of patients with early onset scoliosis was retrospectively analyzed to identify patients treated with growing rods with a minimum of 2 years of follow-up after final fusion. All reoperations were recorded. Reoperation was defined as a return to the operating room for any complication related to the final fusion surgery or etiology of the spinal deformity.
  
  
  RESULTS
  One hundred (84%) of 119 patients met the inclusion criteria: for 38 of the patients, the etiology of scoliosis was neuromuscular; for 31, syndromic; for 22, idiopathic; and for 9, congenital. The mean age at final fusion was 12.2 years (range, 8.5 to 18.7 years). The mean follow-up after final fusion was 4.3 years (range, 2 to 11.2 years). Twenty (20%) of the patients had 30 complications requiring reoperation (57 procedures). There was a mean of 1.5 complications per patient after final fusion. Eight patients with neuromuscular scoliosis, 8 with syndromic, 4 with idiopathic, and no patient with congenital scoliosis required reoperation. Nine (9%) of the patients experienced infection (33 reoperation procedures); 6 (6%) had instrumentation failure (8 procedures); 5 (5%) had painful or prominent instrumentation (6 procedures); 3 (3%) each had coronal deformity (3 procedures), pseudarthrosis (3 procedures), or sagittal deformity (3 procedures); and 1 (1%) had progressive crankshaft chest wall deformity requiring a thoracoplasty (1 procedure).
  
  
  CONCLUSIONS
  A higher-than-anticipated percentage of patients treated with growing rods required unplanned reoperation following final fusion. Long-term follow-up after final fusion is necessary to determine true final results. Patients and parents need to be counseled regarding the possibility of further surgery after final fusion.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Connie
authors.initials: C
authors.lastname: Poe-Kochert
authors.affiliation: Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Claire
authors.initials: C
authors.lastname: Shannon
authors.affiliation: Growing Spine Foundation, San Diego, California.
authors.forename: Jeff B
authors.initials: JB
authors.lastname: Pawelek
authors.affiliation: Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio ght@po.cwru.edu.
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
authors.affiliation: Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Christina K
authors.initials: CK
authors.lastname: Hardesty
authors.affiliation: Royal Orthopaedic Hospital, Birmingham, United Kingdom.
authors.forename: David S
authors.initials: DS
authors.lastname: Marks
authors.affiliation: Growing Spine Foundation, San Diego, California.
authors.forename: Behrooz A
authors.initials: BA
authors.lastname: Akbarnia
authors.affiliation: Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Richard E
authors.initials: RE
authors.lastname: McCarthy
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts.
authors.forename: John B
authors.initials: JB
authors.lastname: Emans
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome