Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis—5-Year Follow-up

Children's Spine Study Group, Growing Spine Study Group

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Spine
Scoliosis
Kyphosis
Registries
Retrospective Studies

Keywords

  • Early-onset scoliosis
  • Growing rods
  • Growth friendly
  • Sagittal spine length
  • Spine growth
  • SSL
  • VEPTR

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis—5-Year Follow-up. / Children's Spine Study Group; Growing Spine Study Group.

In: Spine Deformity, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis—5-Year Follow-up",
abstract = "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.",
keywords = "Early-onset scoliosis, Growing rods, Growth friendly, Sagittal spine length, Spine growth, SSL, VEPTR",
author = "{Children's Spine Study Group} and {Growing Spine Study Group} and Yehia ElBromboly and Jennifer Hurry and Kedar Padhye and Johnston, {Charles E} and Anna McClung and Amer Samdani and Michael Glotzbecker and Abdallah Attia and {St. Hilaire}, Tricia and Ron El-Hawary",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2019.02.001",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
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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 E

AU - McClung, Anna

AU - Samdani, Amer

AU - Glotzbecker, Michael

AU - Attia, Abdallah

AU - St. Hilaire, Tricia

AU - El-Hawary, Ron

PY - 2019/1/1

Y1 - 2019/1/1

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 - Sagittal spine length

KW - Spine growth

KW - SSL

KW - VEPTR

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DO - 10.1016/j.jspd.2019.02.001

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JO - Spine Deformity

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