TY - JOUR
T1 - Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis—5-Year Follow-up
AU - Children's Spine Study Group
AU - Growing Spine Study Group
AU - ElBromboly, Yehia
AU - Hurry, Jennifer
AU - Padhye, Kedar
AU - Johnston, Charles
AU - McClung, Anna
AU - Samdani, Amer
AU - Glotzbecker, Michael
AU - Attia, Abdallah
AU - St. Hilaire, Tricia
AU - El-Hawary, Ron
N1 - Funding Information:
Author disclosures: YE (none), JH (none), KP (none), CJ (other from Medtronics and Elsevier, outside the submitted work), AM (none), AS (personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, Misonix, Stryker, and Zimmer Biomet; other from Setting Scoliosis Straight Foundation, Scoliosis Research Society, and Children's Spine Study Group [CSSG], outside the submitted work), MG (other from Orthobullets, NuVasive, DePuy, Zimmer Biomet, Medtronic, the Global Spine Study Group [GSSG], CSSG, the Harms Study Group [HSG], outside the submitted work), AA (none), TSH (none), REH (personal fees from DePuy Synthes Spine, Medtronic Spine, and Apifix Ltd.; grants from DePuy Synthes Spine, United States and Medtronic Spine, United States; other from Children's Spine Foundation, United States, Pediatric Orthopedic Society of North America, and Scoliosis Research Society, United States; personal fees from Wishbone Medical, outside the submitted work), Children's Spine Study Group (none), Growing Spine Study Group (grants from DePuy Synthes Spine and NuVasive, outside the submitted work).
PY - 2019/9
Y1 - 2019/9
N2 - Study Design: Retrospective, comparative. Objectives: To determine if distraction-based surgeries will increase spine length in patients with nonidiopathic EOS and whether etiology affects final spine length. Summary of Background Data: As early-onset scoliosis (EOS) has many etiologies, it is unclear whether etiology affects the spine length achieved with distraction-based surgeries. Since distraction may produce kyphosis, sagittal spine length (SSL; curved arc length of the spine in the sagittal plane) should be utilized. Methods: Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, 5 lengthenings) were identified from two EOS registries. Radiographic analysis preoperation, postimplant (L1), and after each lengthening (L2–L5, L6–L10, L11–L15) was performed with primary outcome of T1–S1 SSL. Results: We identified 126 patients (67 congenital, 38 syndromic, 21 neuromuscular) with a mean preoperative age of 4.6 years, scoliosis 75°, kyphosis 48°, and a mean of 12 lengthenings. After initial correction (p <.05), scoliosis remained constant (58° at L11–L15) and kyphosis increased (38° at L1 to 60° at L11–L15) (p <.05). SSL increased for the entire group from 27.1 cm preoperation to 35.3 cm at L11–L15 (p <.05) and during the distraction phase (29.2 cm at L1 to 35.3 cm at L11–L15) (p <.05). Preoperative SSL was higher in neuromuscular compared with congenital patients and maintained that difference until the 10th lengthening. Preoperative SSL did not differ between syndromic and congenital patients (28.0 cm vs. 25.6 cm); however, syndromic patients had greater SSL after implantation (L1: 30.5 cm vs. 26.8 cm) (p <.05) and maintained that difference until the 15th lengthening (37.1 cm vs. 34.3 cm) (p <.05). Conclusion: At minimum 5-year follow-up, distraction-based surgeries increased spine length for all patients with nonidiopathic EOS; however, neuromusculars had higher preoperative spine length compared with congenital patients and maintained that difference until the 10th lengthening. Although congenital and syndromic patients had similar preoperative spine length, syndromic patients had greater SSL after implantation (L1) and maintained that difference until the 15th lengthening. Level of Evidence: Level III.
AB - Study Design: Retrospective, comparative. Objectives: To determine if distraction-based surgeries will increase spine length in patients with nonidiopathic EOS and whether etiology affects final spine length. Summary of Background Data: As early-onset scoliosis (EOS) has many etiologies, it is unclear whether etiology affects the spine length achieved with distraction-based surgeries. Since distraction may produce kyphosis, sagittal spine length (SSL; curved arc length of the spine in the sagittal plane) should be utilized. Methods: Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, 5 lengthenings) were identified from two EOS registries. Radiographic analysis preoperation, postimplant (L1), and after each lengthening (L2–L5, L6–L10, L11–L15) was performed with primary outcome of T1–S1 SSL. Results: We identified 126 patients (67 congenital, 38 syndromic, 21 neuromuscular) with a mean preoperative age of 4.6 years, scoliosis 75°, kyphosis 48°, and a mean of 12 lengthenings. After initial correction (p <.05), scoliosis remained constant (58° at L11–L15) and kyphosis increased (38° at L1 to 60° at L11–L15) (p <.05). SSL increased for the entire group from 27.1 cm preoperation to 35.3 cm at L11–L15 (p <.05) and during the distraction phase (29.2 cm at L1 to 35.3 cm at L11–L15) (p <.05). Preoperative SSL was higher in neuromuscular compared with congenital patients and maintained that difference until the 10th lengthening. Preoperative SSL did not differ between syndromic and congenital patients (28.0 cm vs. 25.6 cm); however, syndromic patients had greater SSL after implantation (L1: 30.5 cm vs. 26.8 cm) (p <.05) and maintained that difference until the 15th lengthening (37.1 cm vs. 34.3 cm) (p <.05). Conclusion: At minimum 5-year follow-up, distraction-based surgeries increased spine length for all patients with nonidiopathic EOS; however, neuromusculars had higher preoperative spine length compared with congenital patients and maintained that difference until the 10th lengthening. Although congenital and syndromic patients had similar preoperative spine length, syndromic patients had greater SSL after implantation (L1) and maintained that difference until the 15th lengthening. Level of Evidence: Level III.
KW - Early-onset scoliosis
KW - Growing rods
KW - Growth friendly
KW - SSL
KW - Sagittal spine length
KW - Spine growth
KW - VEPTR
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U2 - 10.1016/j.jspd.2019.02.001
DO - 10.1016/j.jspd.2019.02.001
M3 - Article
C2 - 31495484
AN - SCOPUS:85063103992
VL - 7
SP - 822
EP - 828
JO - Spine Deformity
JF - Spine Deformity
SN - 2212-134X
IS - 5
ER -