Surgical treatment of congenital upper thoracic scoliosis: at minimum 2-year follow-up.

BACKGROUND: To investigate the clinical outcomes and related complications of surgery for congenital upper thoracic scoliosis . METHODS: A retrospective analysis was conducted on 27 cases who was operated for congenital upper thoracic scoliosis from January 2010 to June 2025. There were 10 males and 17 females, with an average age of (11.0 ± 4.3) years (5 to 18 years). The main radiographic parameters included: Cobb angle of the main curvature, apical vertebral translation (AVT), trunk shift (TS), radiographic shoulder height (RSH), T1 tilt, Thoracic kyphosis (TK) and lumbar lordosis (LL), which were recorded and compared before surgery, after surgery, and final follow-up. Data analysis was performed with paired T-test and Wilcoxon signed-rank test, and the occurrence of complications in patients was recorded. RESULTS: The procedures were successfully completed in all 27 patients, unilateral fixation was performed in 13 cases, while bilateral fixation was performed in 14 cases; The fused segments were (5 ± 1.7), and the follow-up time was 49.6 months (range: 24 to 145 months). The Cobb angle of the main curvature was improved from (42.6 ± 12.5)° before surgery to (14.3 ± 8.9)° after surgery, and was (11.0 ± 9.5)° at the final follow-up (P < 0.01), with a correction rate of 74.2%. The AVT, RSH, T1 tilt and clavicle angle improved significantly at the final follow-up (P < 0.05); while TS, Thoracic kyphosis and lumbar lordosis were maintained without significant differences between pre-operation and post-operation (P > 0.05). A total of 3 patients underwent revision surgery, all of them had good recovery after revision surgery. CONCLUSION: Posterior surgical intervention for congenital upper thoracic scoliosis achieves favorable clinical and radiographic outcomes. The absence of major neurological complications supports its viability as a primary treatment modality for this complex deformity. Be aware of high risk of complications, especially for distal adding-on.