Qualitative Analysis of the Literature on Distraction-Based Techniques for Early-Onset Scoliosis

Early-onset scoliosis (EOS) presents significant clinical challenges due to its impact on growth and pulmonary development. Because the available evidence is heterogeneous and high-quality comparative trials are scarce, we incorporated an exploratory qualitative content analysis to complement the systematic review. Fifty documents, including comparative studies, systematic reviews, a health technology assessment report, and economic evaluations, were analyzed by using NVivo qualitative analysis software (QSR International, Melbourne, Australia) and categorized into six thematic groups. These included studies evaluating the three main distraction-based techniques, traditional growing rods, magnetically controlled growing rods, and Vertical Expandable Prosthetic Titanium Rib (VEPTR). Word-cloud visualizations showed that most studies consistently emphasized patients, surgical techniques, deformity correction, and growth-related aspects, represented by concepts associated with curve correction and spinal height gain, such as Cobb angle and T1-S1 height. Follow-up and procedural aspects also appeared frequently, whereas economic evaluations focused on costs and resource use. In contrast, clinically important areas such as pulmonary function, health-related quality of life, and long-term outcomes were infrequently addressed across categories, revealing major evidence gaps. This qualitative approach highlights the dimensions most commonly explored in the literature, identifies underrepresented outcomes relevant to clinical decision-making, and underscores the need for future research that integrates functional and patient-centered measures to support comprehensive care planning in EOS.