The Efficiency of Epiphysiodesis for Growth Modulation in Patients with Congenital Scoliosis: A Systematic Review

Congenital scoliosis (CS) is a challenging entity in spinal surgery. Convex growth arrest (CGA) is a therapeutic method aiming at inhibiting growth on the curve convexity while remaining growth of concavity corrects the scoliotic curve over time. In the view of controversies in current clinical studies for efficiency of CGA in CS patients, we performed a systematic review of the literature to clarify the debate. 

A comprehensive literature search was performed to identify studies assessing CGA outcome in CS patients, in following databases and search engines: Ovid MEDLINE, PubMed, Scopus, Cochrane Central Register of Controlled Trials (CCTR), EMBASE, Google Scholar, and Web of Science. Two authors screened the search results and selected the studies by the supervision of senior authors.

In 19 studies, including 363 patients, age at surgery was 58.76 months ranging from 4 to 216 months. Anterior and posterior hemiepiphysiodesis was the most common approach. Eight studies added instrumentation to CGA. Follow-up mean was 64.57 months. Nine studies reported true epiphysiodesis effect (postoperative and final follow-up CCA difference): from among 162 patients, 69 improved, 59 stabilized, and 34 progressed. Other studies reported preoperative and final follow-up CCA difference: among 88 patients, 49 improved, 32 stabilized, and 7 progressed. Preoperative curve magnitude, sagittal plane deformities, age <5 years, and type of spinal anomalies did not affect CGA outcome. Instrumentation was preferred in complicated spinal anomalies and older ages.

CGA alone or with instrumentation is a feasible CS treatment, however the criteria for choosing suitable candidates need reconsideration.