Neuromuscular and syndromic deformities of the spine in children and adolescents: some aspects of the effectiveness of growth-friendly structures and polysegmental fixation

Objective. To compare the efficacy and safety of using growth-friendly technologies and polysegmental final spinal fusion in the treatment of syndromic and neuromuscular deformities in children.

Material and Methods. The clinical, anamnestic, and radiographic data of 82 operated patients under 18 years of age with neuromuscular (n = 59) and syndromic (n = 23) scoliosis were analyzed. Deformity correction was performed in two variants: 1) final spinal fusion (n = 48) by means of long polysegmental CD fixation – Long Fusion (LF) – through an open approach using two- (n = 42), three- (n = 5), or four-rod (n = 1) system; 2) traditional growing rods (TGR; n = 34) in variant of one (n = 11) or two rods (n = 22), including their bilateral (n = 9) or unilateral (n = 13) installation on the concave side of the deformity. The spinal deformity magnitude (in degrees according to the Cobb scale) before and after surgery, surgery duration and blood loss were assessed.

Results. Both methods demonstrated effectiveness in correcting spinal deformity for each etiologic group. The key difference is the safety profile: a threefold reduction in intraoperative blood loss in the TGR group compared to the LF group (p < 0.001).

Conclusion. The TGR technique, developed for actively growing patients, can be effective for both younger (over 9–10 years old) and older (over 15 years old) adolescents with severe somatic symptoms which does not preclude delayed polysegmental stabilization or potentially remains an option for final surgery.

1. Клинические рекомендации «Нервно-мышечный сколиоз». Одобрены Научно-практическим советом Минздрава России, 2025. [Электронный ресурс]. URL: https://pravo.ppt.ru/klinicheskie-rekomendatsii/320797. [Neuromuscular scoliosis: Clinical practice guidelines. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation, 2025. Available at: https://pravo.ppt.ru/klinicheskie-rekomendatsii/320797].

2. Rumalla K, Yarbrough CK, Pugely AJ, Koester L, Dorward IG. Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications, and in-hospital outcomes. J Neurosurg Spine. 2016;25:500–508. DOI: https://doi.org/10.3171/2016.2.SPINE151377

3. Cognetti D, Keeny HM, Samdani AF, Pahys JM, Hanson DS, Blanke K, Hwang SW. Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database. Neurosurg Focus. 2017;43:E10. DOI: https://doi.org/10.3171/2017.7.FOCUS17384

4. Loughenbury PR, Tsirikos AI. Current concepts in the treatment of neuromuscular scoliosis: clinical assessment, treatment options, and surgical outcomes. Bone Jt Open. 2022;3:85–92. DOI: https://doi.org/10.1302/2633-1462.31.BJO-2021-0178.R1

5. Rajappa K, Rudraprasad MS, Pai PK. Growth rods and guided growth techniques in the treatment of early-onset scoliosis. In: Zacharia B., Raja S.D.C., KV N. (eds). Paediatric Scoliosis. Springer, Singapore, 2023. DOI: https://doi.org/10.1007/978-981-99-3017-3_25

6. Yang JS, McElroy MJ, Akbarnia BA, Salari P, Oliveira D, Thompson GH, Emans JB, Yazici M, Skaggs DL, Shah SA, Kostial PN, Sponseller PD. Growing rods for spinal deformity: characterizing consensus and variation in current use. J Pediatr Orthop. 2010;30:264–270. DOI: https://doi.org/10.1097/BPO.0b013e3181d40f94

7. Yoshida B, Valenzuela-Moss J, Tetreault T, Wren T, Silverman-Lloyd N, Phan T, Andras L, Heffernan M. What happens when you wait? Larger curves require more resources for less correction in neuromuscular scoliosis. Dev Med Child Neurol. 2024;66(Suppl: AACPDM 2024 Scientific Posters):97. DOI: https://doi.org/10.1111/dmcn.16088

8. Chung AS, Renfree S, Lockwood DB, Karlen J, Belthur M. Syndromic scoliosis: national trends in surgical management and inpatient hospital outcomes. Spine (Phila Pa 1976). 2019;44:1564–1570. DOI: https://doi.org/10.1097/BRS.0000000000003134

9. Hughes MS, Swarup I, Makarewich CA, Williams BA, Talwar D, Cahill PJ, Flynn JM, Anari JB. Expert consensus for early onset scoliosis surgery. J Pediatr Orthop. 2020 Aug;40:e621–e628. DOI: https://doi.org/10.1097/BPO.0000000000001473

10. Макарова А.В., Альшаова М.А.А., Маслак О.С., Мушкин А.Ю. Изменение объема и пневматизации легких у детей в раннем периоде после хирургической коррекции тяжелого нейромышечного сколиоза, осложненного дыхательной недостаточностью: когортное исследование. Вопросы современной педиатрии. 2024;23(3):174–180. [Makarova AV, Alshaowa MAA, Maslak OS, Mushkin AYu. Lung volume and pneumatization changes in children in early posy-surgical period after correction of sever neuromuscular scoliosis complicated with respiratory failure: cohort study. Current Pediatrics. 2024;23(3):174–180]. DOI: https://doi.org/10.15690/vsp.v23i3.2766 EDN: https://elibrary.ru/DJIGJM

11. Keil LG, Nash AB, Stürmer T, Golightly YM, Lin FC, Stone JD, Sanders JO, Louer CR. When is a growth-friendly strategy warranted? a matched comparison of growing rods versus primary posterior spinal fusion in juveniles with early-onset scoliosis. J Pediatr Orthop. 2021;41:e859–e864. DOI: https://doi.org/10.1097/BPO.0000000000001926

12. Elmeshneb MA, Hassanin MA, Elnady B, Sleem A, Le GT, Patel MS, Quraishi NA. Surgical complications in neuromuscular scoliosis surgery: systema-tic review and meta-analysis of the last ten years. Eur Spine J. 2024;33:2666–2676. DOI: https://doi.org/10.1007/s00586-024-08338-y

13. Rajkumar S, Iyer RR, Stone L, Kelly MP, Plonsker J, Brandel M, Gonda DD, Mazur MD, Ikeda DS, Lucas DJ, Choi PM, Ravindra VM. Frequency and predictors of complication clustering within 30 days of spinal fusion surgery: a study of children with neuromuscular scoliosis. Spine Deform. 2024;12:727–738. DOI: https://doi.org/10.1007/s43390-023-00813-8

14. Kontakis MG, Pazarlis K, Karlsson T, Jonsson H, Schizas N. Growing rods in meningomyelocele lead to increased risk for complications in comparison with fusion; a retrospective study of 30 patients treated for at the University Hospital of Uppsala. Eur Spine J. 2024;33:739–745. DOI: https://doi.org/10.1007/s00586-023-07996-8

15. Cahill PJ, Marvil S, Cuddihy L, Schutt C, Idema J, Clements DH, Antonacci MD, Asghar J, Samdani AF, Betz RR. Autofusion in the immature spine treated with growing rods. Spine (Phila Pa 1976). 2010;35:E1199–203. DOI: https://doi.org/10.1097/BRS.0b013e3181e21b50

16. Menapace B, Jain V, Sturm P. Autofusion in early-onset scoliosis growing constructs: occurrence, risk factors, and impacts. Spine Deform. 2024;12:1155–1163. DOI: https://doi.org/10.1007/s43390-024-00853-8

17. Hatem A, Elmorshidy EM, Elkot A, Hassan KM, El-Sharkawi M. Autofusion in growing rod surgery for early onset scoliosis; what do we know so far? SICOT J. 2024;10:15. DOI: https://doi.org/10.1051/sicotj/2024011

18. Gupta K, Barik S, Sarkar MH, Chaudhary S, Sinha SK, Raj V, Kandwal P. Use of growth rod systems for management of early onset scoliosis in cerebral palsy: a systematic review. Turk Neurosurg. 2023;33:177–184. DOI: https://doi.org/10.5137/1019-5149.JTN.41939-22.2

19. Li Y, Swallow J, Gagnier J, Cahill PJ, Sponseller PD, Garg S, Thompson GH, Ramo BA. Growth friendly surgery results in more growth but a higher complication rate and unplanned returns to the operating room compared to single fusion in neuromuscular early onset scoliosis: a multicenter retrospective cohort study. Spine Deform. 2021;9:851–858. DOI: https://doi.org/10.1007/s43390-020-00270-7

20. Gao R, Bai Y, Zhang X, Cao J, Guo D, Yao Z, Liu H. Outcomes and safety of traditional growing rod technique in the treatment of early-onset dystrophic scoliosis secondary to type 1 neurofibromatosis with intraspinal rib head dislocation in children. J Pediatr Orthop. 2023;43:e223–e229. DOI: https://doi.org/10.1097/BPO.0000000000002319