Final fusion outcomes in early-onset scoliosis treated with growing rods: a systematic review and meta-analysis protocol

Severe early-onset scoliosis (EOS) is typically managed with growing rod (GR) implantation followed by final fusion (FF) once skeletal maturity is obtained. However, FF is associated with a high rate of complications and may be unnecessary in some patients. Other methods of ‘graduation’, such as cessation of lengthening with GRs left in situ, are being explored. The outcomes of FF are poorly understood. We aim to rectify this knowledge gap by synthesizing data on the outcomes of FF in EOS treated with GRs. A systematic review and meta-analysis will be conducted in accordance with PRISMA 2020 guidelines. PubMed and Embase will be queried from inception until 2025. We will include original articles reporting radiographic or clinical (lung function, quality of life, complications) outcomes of FF in children with GR-treated EOS. Meta-analysis will be performed in RStudio using a random effects model. Continuous outcomes will be reported as pooled mean, mean difference and standardized mean difference, and dichotomous outcomes as proportions and risk ratios. Sensitivity and subgroup analyses will be conducted. Ethical approval is not required. Our findings will have implications for clinical decision-making when choosing between methods of graduation from GRs. The results of subgroup analyses may help to refine the indications for FF by identifying favourable prognostic factors. By analysing clinically meaningful yet overlooked outcomes such as lung function and quality of life scales, our findings may have utility in patient counselling.