Mechanical complications following surgical treatment of syndromic scoliosis: impact of growth-friendly constructs and definitive fusion strategies

Background Syndromic scoliosis represents a heterogeneous group of spinal deformities associated with genetic, connective tissue, neurocutaneous, chromosomal, and developmental disorders. Surgical treatment is frequently complicated by abnormal bone quality, ligamentous laxity, multisystem involvement, and elevated complication rates. However, data regarding postoperative mechanical complications and revision burden in syndromic scoliosis remain limited. Methods This retrospective cohort study included consecutive patients with syndromic scoliosis who underwent surgical treatment at a single tertiary spine center between January 2021 and December 2025. Patients with neuromuscular scoliosis and those with a follow-up duration shorter than 24 months were excluded. Patients were categorized into five etiological groups: connective tissue disorders, neurocutaneous disorders, skeletal dysplasia syndromes, chromosomal/genetic syndromes, and congenital/developmental syndromes. Mechanical complications, revision surgery, and revision-free survival were evaluated. Comparative analyses were performed between growth-friendly constructs and definitive fusion procedures. Results A total of 48 surgically treated patients with syndromic scoliosis were included. Mean age at surgery was 11.9 ± 4.0 years, and mean follow-up duration was 37.6 ± 14.6 months. The mean coronal Cobb angle improved from 72.8° ± 28.4° preoperatively to 33.9° ± 20.1° at final follow-up, with a mean correction rate of 58.6% ± 17.3%. Mechanical complications occurred in 9 patients (18.8%), and revision surgery was required in 9 patients (18.8%). Compared with definitive fusion procedures, growth-friendly constructs demonstrated significantly higher rates of mechanical complications (50.0% vs. 5.9%, p = 0.001), revision surgery (50.0% vs. 5.9%, p = 0.001), and rod breakage (28.6% vs. 0%, p = 0.003). Kaplan–Meier analysis demonstrated significantly lower revision-free survival in the growth-friendly group (log-rank p < 0.001). Exploratory univariable logistic regression demonstrated a significant association between growth-friendly constructs and postoperative mechanical complications (OR 16.0, 95% CI 2.62–97.65; p = 0.003). Conclusions Surgical treatment of syndromic scoliosis is associated with a substantial burden of mechanical complications and revision surgery. Growth-friendly constructs were associated with significantly higher mechanical complication, rod breakage, and revision rates, as well as lower revision-free survival, compared with definitive fusion procedures. Careful patient selection, construct choice, and long-term surveillance remain essential in this complex patient population.