Early-onset scoliosis is a potentially deadly curve in the spine that can damage a child’s heart and lung function as it progresses. Adolescents with scoliosis are traditionally treated with a single spinal fusion, where rods and screws are inserted to fuse the spine in a straighter position.

Parents want to make informed choices and a new study finds that preadolescent children with severe neuromuscular scoliosis who are treated with growth-friendly surgery prior to spinal fusion have more complications and unplanned subsequent surgeries than those who only have the spinal fusion.

Young children whose spines are still growing may be treated with what’s called “growth-friendly” surgery, in which expandable rods are placed in the spine to grow along with the child. These rods are typically removed for a spinal fusion after the spine achieves sufficient growth.

But for those around 8-11 years old, the question of which route to take becomes more complicated for physicians, says G. Ying Li, M.D., service chief of pediatric orthopaedics at University of Michigan Health C.S. Mott Children’s Hospital.

In an international study, Li and a team of researchers analyzed surgical outcomes of 59 preadolescents with early-onset neuromuscular scoliosis treated with a spinal fusion surgery, 43 of whom had undergone prior growth-friendly surgeries. They found that the single spinal fusion patients had greater curve correction and spines that were 50% straighter compared to the patients who had received growth-friendly treatment first.

“For someone who may not understand the implications, 11 years old may still be considered small and young, so they may think it’s a no-brainer to insert the expandable rods,” Li said. “However, the rods are associated with a lot of complications. Some types of rods need to be expanded surgically every six months, which brings repeated exposures to anesthesia and more infections from going through the same scar. Even the newer magnetic rods that can be expanded non-surgically have been found to have complications associated with the rods themselves. There are far fewer complications with a single spinal fusion.”

Over several years of follow up, the single spinal fusion group had an average of 1.6 surgeries and 25% experienced complications, while the growth-friendly group averaged 8.7 surgeries and 84% experienced complications. Overall, the patients who had undergone growth-friendly surgery had eight times more complications and nine times more unplanned trips to the operating room.