• Tyler A Tetreault, Tiffany N Phan, WrenTishya A LTALJackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA., Michael J Heffernan, John B Emans, Lawrence I Karlin, Amer F Samdani, Ilkka J Helenius, Michael G Vitale, Lindsay M Andras, and Pediatric Spine Study Group.
• Jackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
• Spine. 2024 Aug 29.

Study DesignRetrospective, Multicenter.ObjectiveDetermine if posterior column osteotomies (PCO) at time of conversion from growth friendly instrumentation (GFI) to definitive fusion in early onset scoliosis (EOS) graduates impacts outcomes.Summary Of Background DataIncreasing spinal rigidity following treatment of EOS with GFI can limit curve correction at time of conversion to definitive spinal fusion. PCO are often employed at the time of fusion to improve flexibility. This technique's efficacy has not been studied.MethodsEOS patients with GFI undergoing conversion to fusion were grouped by those that did or did not have PCO. Patients with inadequate radiographs, <2 years follow-up, or three-column osteotomies at time of fusion were excluded.Results832 patients met inclusion criteria. 175 (21%) patients had PCO. Age at index surgery was younger (6.6 vs. 7.4 y, P =0.0009) and the mean duration of GFI was greater (6.2 vs. 5.5 y, P =0.009) in the PCO group. Prior to fusion, curve magnitude was similar between the groups (PCO=61.9 degrees, no PCO=59.3 degrees, P=0.18). On average 4.4 osteotomies (range: 1 - 12) were performed for the PCO group and EBL (PCO=820 cc vs no PCO=752 cc, P<0.01) and surgical time (PCO=403 min vs no PCO=349 min, P<0.01) were greater. Postoperatively, mean curve correction (PCO=16.6, no PCO=14.4 degrees, P=0.18) was similar. Accounting for preoperative curve magnitude, there was a relationship between number of PCOs and curve correction (P=0.04). There was no relationship between degrees of correction per osteotomy and duration of GFI (P=0.12). Postoperative complications at 2 years were similar (PCO=25% vs no PCO=27%, P=0.63).ConclusionEOS graduates achieve minimal correction at time of conversion regardless of whether PCOs are performed. PCOs increase EBL and operative time but have a similar complication rate. More PCOs resulted in more correction, though less than that anticipated in a previously uninstrumented spine.Level Of EvidenceIII.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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