THE LONG-TERM RESULTS OF VARIOUS TREATMENT OPTIONS IN CONGENITAL SCOLIOSIS

Abstract

Purpose of the study: The comparation of long-term clinical as well as radiological results is the main aim of our study.

Material and Methods: We evaluated security and efficiency of conservative as well various surgical treatment methods in our group of 650 patients treated in our department since 1976. An average follow up is16 years. An average age in time of detection was 6,5 y. in group of conservative treatment and 2,3 y. in group of surgically managed patients. An average age in time of surgery was 9,8 y.

Results:

1. group A: conservative treatment – 321 pts. (49%) – the magnitude of the curves was at time of detection on average 35,7 degrees according to Cobb angle and 39,8 at time of last control with FU 13,7 year.

2. group B: hemiepiphyseodesis – 102 pts. (16%) – the time of surgery was 6,6 years, follow up was 14,2 years. The magnitude of the curves was at time of detection on average 44,1 degrees, 44,2 preoperatively, 34,4 postoperatively and 38,4 at time of last control. Final result of correction was 9,8 degrees (22%).

3. group C: posterior instrumentated fusion – 145 pts. (22%) – the time of surgery was 8,6 years, follow up was 18,9 years. The magnitude of the curves was at time of detection on average 59,2 degrees, 65,5 preoperatively, 39,9 postoperatively. Final result of correction was 25,6° (38%).

4. group D1: strut graft with posterior instrumentated fusion – 27 pts. – the time of surgery was 11,8 years, follow up was 19,5 years. The magnitude of the curves was at time of detection on average 54,4 degrees, 65,6 preoperatively, 38,6 postoperatively. Final result of correction was 26° (40%).

5. group D2: anterior osteotomy with posterior instrumentated fusion – 33 pts. – the time of surgery was 9,9 years, follow up was 18,3 years. The magnitude of the curves was at time of detection on average 58,1 degrees, 65 preoperatively, 37 postoperatively. Final result of correction was 28° (43%).

6. group D3: combined hemivertebrectomy with posterior instrumentated fusion – 22 pts. – the time of surgery was 10,2 years, follow up was 12,1 years. The magnitude of the curves was at time of detection on average 46,4 degrees, 51,3 preoperatively, 20,3 postoperatively. Final result of correction was 31,3° (61%).

Conclusions: Early detection, good timing and choosing of adequate surgical treatment type are the main factors of quality treatment results. All methods of surgical treatment led to the improvment in magnitude of the scoliotic curve. The best method seems combined combined hemivertebrectomy with posterior instrumentated fusion.