Does Hi-PoAD technique work for congenital scoliosis: a single centre case series.

PURPOSE: To evaluate the efficacy of the Hi-PoAD technique in treating select cases of Congenital scoliosis.

METHODS: A retrospective study was conducted, including 38 patients with congenital scoliosis who were operated on by posterior single-stage surgery using the Hi-PoAD technique, and were actively followed for a minimum follow-up time of two years. This special technique involved a combination of high-density pedicle screws, Ponte osteotomies, asymmetric rod contouring, and direct vertebral rotation. All cases were performed between 2016 and 2022 at a single tertiary care hospital by a senior spine surgeon. Surgical data were collected, and improvements in radiologic and clinical parameters were assessed post-surgery, at 1 and 2 years, and the final follow-up, focusing on deformity correction, coronal balance, and clinical outcomes.

RESULTS: The average follow-up duration was 4.8 years (2-8 years). The average coronal Cobb angle improved significantly, decreasing from 76 ± 20 to 37 ± 17 (p < 0.001). Apical vertebral rotation (AVR) reduced from 2.31 ± 0.57 to 1.23 ± 0.43 (p < 0.001), and C7PL/CSVL distances reduced from 3.42 ± 2.84 cm to 1.16 ± 0.9 cm (p < 0.001). Two early post-operative wound infections were observed, one deep and one superficial, both of which resolved with debridement and implant retention; one neuromonitoring drop was seen while doing the correction. No mechanical complications, including proximal/distal junctional kyphosis, progression of deformity, or non-union, were seen in the study population during the follow-up period.

CONCLUSIONS: The Hi-PoAD technique, originally developed for adolescent idiopathic scoliosis (AIS), appears to be a feasible surgical option for selected patients with congenital scoliosis. In this series, it achieved meaningful deformity correction with a low rate of neurological and overall complications. The use of multiple pedicle screw anchors distributes corrective forces across several vertebral levels and may contribute to effective deformity correction. Further prospective studies are warranted to define better its indications, safety profile, and long-term outcomes.