Clinical outcomes after surgical treatment of severe congenital spinal deformity in skeletally mature patients: A minimum two-year follow-up study.

Abstract

<h4>Background</h4>Severe congenital spinal deformity is a rare but challenging condition. This study aimed to investigate the clinical outcomes following posterior surgical correction of severe congenital spinal deformities.<h4>Methods</h4>Consecutive patients who underwent surgery for severe congenital spinal deformities between September 1, 2010 and August 31, 2022 were retrospectively included. Standardized data were collected, including baseline demographic characteristics, intraoperative variables, and postoperative outcomes. Scoliosis Research Society-22 revised (SRS-22r) scores and radiographic parameters were evaluated preoperatively and at least 2 years postoperatively. Additionally, SRS-22r scores were compared between patients with and without complications, and potential risk factors for surgical complications were analyzed.<h4>Results</h4>Fifty-seven patients (25 males and 32 females) were included. The mean patient age was 21.9 ± 10.6 years (range: 14-49 years), and the mean follow-up period was 10.2 ± 4.2 years (range: 2-12 years). The preoperative coronal and sagittal Cobb angle was 70.0° ± 34.7° and 96.5° ± 21.2°, respectively. After a follow-up period of at least 2 years, the average correction rates were 60.5% ± 20.4% for the coronal plane and 67.5 ± 16.5% for the sagittal plane. Forty-four complications occurred in 21 (36.8%) patients. Clinically, patients with complications reported significantly lower postoperative SRS-22r satisfaction scores (3.9 ± 0.8 vs. 4.3 ± 0.6, p = 0.034) than those without complications at least 2 years postoperatively. Risk factors for major complications included kyphotic deformity, greater sagittal curve magnitude, higher sagittal and total deformity angular ratios (DARs), and increased fusion levels. Stratified analyses showed that total DAR (T-DAR) > 27 was associated with a higher incidence of neurological complications (44.4 vs. 9.5%, p = 0.015).<h4>Conclusions</h4>Sustained spinal correction and favorable patient-reported outcomes for at least 2 years postoperatively were obtained in skeletally mature patients with severe congenital spinal deformities. However, the patients showed high rates of complications that were significantly associated with kyphotic deformity, larger sagittal curve magnitude, higher DAR values, and increased fusion levels.