Distraction-Based Surgeries Increase Thoracic Sagittal Spine Length After 10 Lengthening Surgeries for Patients With Idiopathic Early-Onset Scoliosis

Children's Spine Study Group

Research output: Contribution to journalArticle

Abstract

Study Design: Retrospective, comparative, multicenter. Objectives: To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Summary of Background Data: Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increases in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine. Methods: Patients with idiopathic EOS treated with distraction-based systems (minimum five-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2–L5, L6–L10) were evaluated with primary outcome of T1–T12 SSL. Results: We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p<.05), kyphosis 39° (50° RB vs. 34° SB; p<.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p<.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p<.05); L2–L5, 50° RB vs. 27° SB (p<.05); L6–L10, 56° RB vs. 26° SB (p<.05). SSL increased for both groups from preoperative to the 10th lengthening (p<.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the 10th lengthening (p<.05). After 10 lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p<.05). Conclusion: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS. Level of Evidence: Level III.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Scoliosis
Thoracic Surgery
Spine
Ribs
Thorax
Kyphosis
Growth

Keywords

  • Early-onset scoliosis
  • Sagittal spine length (SSL)
  • Spine growth
  • Three-dimensional true spine length (3D-TSL)

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{0fd76837726f40f7bd183371d64b6791,
title = "Distraction-Based Surgeries Increase Thoracic Sagittal Spine Length After 10 Lengthening Surgeries for Patients With Idiopathic Early-Onset Scoliosis",
abstract = "Study Design: Retrospective, comparative, multicenter. Objectives: To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Summary of Background Data: Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increases in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine. Methods: Patients with idiopathic EOS treated with distraction-based systems (minimum five-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2–L5, L6–L10) were evaluated with primary outcome of T1–T12 SSL. Results: We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p<.05), kyphosis 39° (50° RB vs. 34° SB; p<.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p<.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p<.05); L2–L5, 50° RB vs. 27° SB (p<.05); L6–L10, 56° RB vs. 26° SB (p<.05). SSL increased for both groups from preoperative to the 10th lengthening (p<.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the 10th lengthening (p<.05). After 10 lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27{\%}) than for SB patients (19{\%}) (p<.05). Conclusion: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS. Level of Evidence: Level III.",
keywords = "Early-onset scoliosis, Sagittal spine length (SSL), Spine growth, Three-dimensional true spine length (3D-TSL)",
author = "{Children's Spine Study Group} and Ron El-Hawary and Chukwunyerenwa, {Chukwudi K.} and Gauthier, {Luke E.} and Spurway, {Alan J.} and {St. Hilaire}, Tricia and McClung, {Anna M.} and Yehia El-Bromboly and Johnston, {Charles E}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2019.07.011",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Distraction-Based Surgeries Increase Thoracic Sagittal Spine Length After 10 Lengthening Surgeries for Patients With Idiopathic Early-Onset Scoliosis

AU - Children's Spine Study Group

AU - El-Hawary, Ron

AU - Chukwunyerenwa, Chukwudi K.

AU - Gauthier, Luke E.

AU - Spurway, Alan J.

AU - St. Hilaire, Tricia

AU - McClung, Anna M.

AU - El-Bromboly, Yehia

AU - Johnston, Charles E

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Study Design: Retrospective, comparative, multicenter. Objectives: To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Summary of Background Data: Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increases in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine. Methods: Patients with idiopathic EOS treated with distraction-based systems (minimum five-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2–L5, L6–L10) were evaluated with primary outcome of T1–T12 SSL. Results: We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p<.05), kyphosis 39° (50° RB vs. 34° SB; p<.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p<.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p<.05); L2–L5, 50° RB vs. 27° SB (p<.05); L6–L10, 56° RB vs. 26° SB (p<.05). SSL increased for both groups from preoperative to the 10th lengthening (p<.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the 10th lengthening (p<.05). After 10 lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p<.05). Conclusion: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS. Level of Evidence: Level III.

AB - Study Design: Retrospective, comparative, multicenter. Objectives: To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Summary of Background Data: Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increases in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine. Methods: Patients with idiopathic EOS treated with distraction-based systems (minimum five-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2–L5, L6–L10) were evaluated with primary outcome of T1–T12 SSL. Results: We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p<.05), kyphosis 39° (50° RB vs. 34° SB; p<.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p<.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p<.05); L2–L5, 50° RB vs. 27° SB (p<.05); L6–L10, 56° RB vs. 26° SB (p<.05). SSL increased for both groups from preoperative to the 10th lengthening (p<.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the 10th lengthening (p<.05). After 10 lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p<.05). Conclusion: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS. Level of Evidence: Level III.

KW - Early-onset scoliosis

KW - Sagittal spine length (SSL)

KW - Spine growth

KW - Three-dimensional true spine length (3D-TSL)

UR - http://www.scopus.com/inward/record.url?scp=85072052360&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072052360&partnerID=8YFLogxK

U2 - 10.1016/j.jspd.2019.07.011

DO - 10.1016/j.jspd.2019.07.011

M3 - Article

AN - SCOPUS:85072052360

JO - Spine Deformity

JF - Spine Deformity

SN - 2212-134X

ER -