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Purpose <p>In severe, congenital early-onset scoliosis (EOS), surgery seeks maximal 3D correction, halted progression, and preserved spinal growth with minimal interventions. Distraction-based constructs (DBCs) aim for major correction and growth, but often require repeated surgeries. Shilla growth guidance surgery (SGGS) offers apical correction with fewer lengthenings. Limited data compare these techniques in the setting of a three-column osteotomy (3CO). This study compares radiographic and clinical outcomes of 3COs instrumented with DBC and SGGS for severe congenital EOS.</p> Methods <p>A multicenter database identified patients with congenital EOS who underwent a 3CO with SGGS or DBC. Prospectively collected clinical and radiographic data were analyzed retrospectively. All patients had a minimum of 2-years of follow-up. Data were measured at preoperative, postoperative, 2-year follow-up, and pre-definitive fusion timepoints. The cohort included 32 patients: 12 SGGS and 20 DBC.</p> Results <p>Mean age at index surgery was similar between groups (SGGS: 5.3 years; DBC: 4.3 years), as was mean follow-up (SGGS: 4.1 years; DBC: 5.7 years). SGGS patients underwent fewer total surgeries (mean 2) compared to DBC (mean 4; <i>p</i> = 0.035). Rates of unplanned reoperations (UPRORs) trended toward significance (SGGS: 2; DBC: 4.6; <i>p</i> = 0.087). DBC patients underwent a mean of 6.9 lengthenings. Preoperative coronal deformity was similar between groups, but final correction was greater with SGGS (43° vs. 59°, <i>p</i> = 0.025). Postoperative T1-S1 spinal growth was greater for SGGS (11.2 mm/year vs 2.1 mm/year, <i>p</i> = 0.04). Complication rates were similar (SGGS: 7 patients, 58%; DBC: 14 patients, 70%), with comparable causes.</p> Conclusions <p>This is the first study to compare SGGS and DBC with 3COs for congenital EOS. SGGS achieved greater deformity correction, higher observed T1-S1 growth/year, and required fewer interventions. Complication and UPRORs were similar, though UPROR rates trended lower with SGGS. These findings should be considered when selecting SGGS vs. DBC to protect the 3CO in congenital EOS, supporting shared decision-making with families.</p>

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Shilla growth guidance vs. distraction-based constructs for severe, early-onset congenital scoliosis treated with 3-column osteotomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Arnaldo Martinez Rivera,
  • Jeffrey T. Galla,
  • Paul Sponseller,
  • Richard McCarthy,
  • Charles Johnston,
  • Scott J. Luhmann

摘要

Purpose

In severe, congenital early-onset scoliosis (EOS), surgery seeks maximal 3D correction, halted progression, and preserved spinal growth with minimal interventions. Distraction-based constructs (DBCs) aim for major correction and growth, but often require repeated surgeries. Shilla growth guidance surgery (SGGS) offers apical correction with fewer lengthenings. Limited data compare these techniques in the setting of a three-column osteotomy (3CO). This study compares radiographic and clinical outcomes of 3COs instrumented with DBC and SGGS for severe congenital EOS.

Methods

A multicenter database identified patients with congenital EOS who underwent a 3CO with SGGS or DBC. Prospectively collected clinical and radiographic data were analyzed retrospectively. All patients had a minimum of 2-years of follow-up. Data were measured at preoperative, postoperative, 2-year follow-up, and pre-definitive fusion timepoints. The cohort included 32 patients: 12 SGGS and 20 DBC.

Results

Mean age at index surgery was similar between groups (SGGS: 5.3 years; DBC: 4.3 years), as was mean follow-up (SGGS: 4.1 years; DBC: 5.7 years). SGGS patients underwent fewer total surgeries (mean 2) compared to DBC (mean 4; p = 0.035). Rates of unplanned reoperations (UPRORs) trended toward significance (SGGS: 2; DBC: 4.6; p = 0.087). DBC patients underwent a mean of 6.9 lengthenings. Preoperative coronal deformity was similar between groups, but final correction was greater with SGGS (43° vs. 59°, p = 0.025). Postoperative T1-S1 spinal growth was greater for SGGS (11.2 mm/year vs 2.1 mm/year, p = 0.04). Complication rates were similar (SGGS: 7 patients, 58%; DBC: 14 patients, 70%), with comparable causes.

Conclusions

This is the first study to compare SGGS and DBC with 3COs for congenital EOS. SGGS achieved greater deformity correction, higher observed T1-S1 growth/year, and required fewer interventions. Complication and UPRORs were similar, though UPROR rates trended lower with SGGS. These findings should be considered when selecting SGGS vs. DBC to protect the 3CO in congenital EOS, supporting shared decision-making with families.