Surgical treatment for neurofibromatosis type 1-related dystrophic scoliosis in children aged 8 to 11: traditional growing rod or posterior spinal fusion?

BACKGROUND: To compare the clinical outcomes of posterior spinal fusion (PSF) and traditional growing rod (TGR) surgery for neurofibromatosis type 1-associated dystrophic scoliosis (NF1-DS) in children aged 8–11 years. The aim is also to identify the factors that influence surgical selection and spinal growth. METHODS: Patients with NF1-DS and major thoracic curves involving at least five vertebral levels were enrolled and divided into PSF and TGR groups. Demographic, radiographic and surgical data were analyzed for both a 1:1 propensity score-matched cohort (n = 26) and the full cohort (n = 39). Logistic regression was used to identify factors influencing surgical selection, and Spearman correlation was used to analyze spinal growth predictors. RESULTS: PSF achieved greater initial curve correction than TGR (61.0% vs. 47.0%, p = 0.025; 58.0% vs. 52.0%, p = 0.015), though there was no difference at the final follow-up. TGR showed greater thoracic (5.2–5.6 cm vs. 3.4–3.5 cm) and spinal height gains (9.0–10.3 cm vs. 4.6–4.9 cm). TGR required more surgeries (5.0 vs. 1.0, p = 0.001), but complication rates were similar. Initial apical vertebra translation (AVT) independently guided surgical selection: PSF for AVT < 46.6 mm and TGR for AVT > 46.6 mm. In the TGR group, greater spinal growth positively correlated with initial curve magnitude, coronal balance, and AVT, while in the PSF group, it positively correlated with the initial main curve correction rate. CONCLUSIONS: This study provides clinical evidence to guide surgical decision-making for 8-11-year-old patients with NF1-DS.