Comparison of osteotomy versus non-osteotomy approach for congenital scoliosis: a retrospective study of three surgical techniques

BACKGROUND Currently, there are many reports about congenital scoliosis (CS) treatment, but there are still controversies existing with respect to selecting its surgical methods. METHODS Retrospective analyses were conducted on 31 CS patients. The surgical treatments included the following: posterior instrumentation (10 patients; group 1), pedicle subtraction osteotomy (11 patients; group 2) and vertebral column resection (10 patients; group 3). RESULTS All patients had remarkable improvements in morphology, image findings, visual analogue scale and American Spinal Injury Association classification. Groups 2 and 3 had greater preoperative sagittal Cobb's angle (25.0, 62.2 and 9.2°, respectively), greater intra-operative blood loss (604.5, 620.0 and 460.0 mL, respectively) and fewer fused segments (5.8, 6.3 and 9.2, respectively) than group 1. As compared with group 1, groups 2 and 3 had greater correction rate of coronal Cobb's angle (79.6 ± 12.8, 78.2 ± 10.1% versus 56.1 ± 11.1%), and coronal trunk inclination (77.6 ± 14.2, 85.2 ± 11.0% versus 45.0 ± 42.5%). The sagittal Cobb's angle correction rates of three groups were 67.7 ± 42.9, 79.3 ± 27.6, 84.3 ± 12.1%, respectively, which showed no significant difference (P = 0.461). With an average follow-up of 3.5, 3.2 and 4.0 years, the correction loss rate of coronal Cobb's angle in group 1 was higher than those of groups 2 and 3. CONCLUSION For CS patients, osteotomy procedure had less fused segments, along with a greater correction rate and lower correction loss, which were more advantageous for those with severe deformity in sagittal plane or nerve decompression requirements.