In a retrospective study of medical records, researchers at Johns Hopkins Medicine have concluded that growing-rod treatment for children with severe, early-onset scoliosis can be eliminated in many cases.
“We have long thought this big final fusion surgery, after years of spine straightening treatment, was always necessary, and now we have found that that is not true,” says Paul Sponseller, a paediatric orthopaedic surgeon at the Johns Hopkins University School of Medicine (Baltimore, USA) and an author of a report on the study published in The Journal of Bone & Joint Surgery.
Sponseller says the finding underscores a growing interest among patients and physicians to question the need for certain tests and surgical procedures long considered routine.
According to a press release, Sponseller says that he and other surgeons had noticed during rod insertion operations that the children’s spinal bones began fuse on their own, suggesting that the final fusion might not be needed.
To find out, Sponseller and his colleagues combed through an international database and picked out the records of 167 children who received growing rod treatments between 1995 and 2010. Some 137 of those patients underwent the final fusion, but Sponseller focused on the outcomes of the 30 who, in consultation with their doctors, opted out of that procedure. Half of those 30 patients were female; their mean age at first surgery was 7.1 years. They underwent an average of 5.4 lengthening procedures, and there was a mean of 3.7 years of follow-up after their last surgery.
The team found that in the three to seven years following their last growing rod surgery, the spines of 26 stayed straight. The remaining four patients were considered special cases because their rods had become infected and had to be removed.
Sponseller cautions that the study was small and based on records from a variety of institutions, and that those children who forgo the final fusion will require “continued observation” over the long haul. Moreover, he says, further research is needed to determine if similar results will be found for children receiving newer rod implants that can be lengthened magnetically without multiple operations.
Nonetheless, he says, the Johns Hopkins findings suggest that the hundreds of early-onset scoliosis patients currently reaching their mature height in the US can likely forgo a “grueling” final procedure.
“These patients have gone through a long and arduous process,” Sponseller says. “The payoff is that they often do not often need a big surgery at the end.”
Sponseller’s work is part of a larger effort at Johns Hopkins and elsewhere to challenge conventional wisdom in medicine and minimise unnecessary medical procedures.
