TY - JOUR
T1 - Distraction-based treatment maintains predicted thoracic dimensions in early-onset scoliosis
AU - Glotzbecker, Michael P.
AU - Gold, Meryl
AU - Miller, Patrica
AU - Akbarnia, Behrooz A.
AU - Johnston, Charles
AU - Sanchez Perez Grueso, Francisco
AU - Shah, Suken A.
AU - Emans, John
N1 - Funding Information:
Author disclosures: MPG (member of research groups GSSG, CSSG); MG (none); PM (none); BAA (consultancy for KSpine, K2M, Ellipse Technologies, Inc, Nuvasive; stock/stock options from KSpine, Ellipse Technologies, Inc, Nuvasive; grants to institutions from Nuvasive, Pioneer, Integra Foundation, OREF, DePuy Spine; royalties from DePuy Spine); CJ (grants from Medtronic ; payment for lectures including service on speakers bureaus from Medtronic; royalties from Medtronic, W.B. Saunders/Elsevier); FSPG (grants from DePuy Sintes , K2M); SAS (grants from Setting Scoliosis Straight Foundation ; grants, personal fees, and nonfinancial support from DePuy Synthes Spine, Inc ; patent with royalties with DePuy Synthes Spine, Inc); JE (consultancy for Medtronics and Synthes Spine; royalties from Synthes Spine).
PY - 2014/5
Y1 - 2014/5
N2 - Study Design Retrospective cohort study. Objective Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. Summary of Background Data Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. Methods Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (pelvic inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on pelvic inlet width, and expressed as a percentile of predicted measure. Results Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of.78 to a postoperative percentile of.88 (p <.001); at long-term follow-up, it was.85. Absolute thoracic height increased at all 3 time points: 141.6, 159.79, and 203.45 mm, respectively Mean chest width was similar preoperatively (170 mm) and immediately postoperatively (166.5 mm) but increased at latest follow-up (206.9 mm). Chest width percentile was similar at all 3 times (.93,.90, and.91). Conclusions Distraction-based treatment increases absolute thoracic height over time. There is significant improvement in the thoracic height percentile normalized after initial surgery, which was maintained over time. Measuring expected gains as a percentile normalized for pelvic width may be a more relevant outcome measure compared with measuring only absolute values.
AB - Study Design Retrospective cohort study. Objective Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. Summary of Background Data Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. Methods Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (pelvic inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on pelvic inlet width, and expressed as a percentile of predicted measure. Results Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of.78 to a postoperative percentile of.88 (p <.001); at long-term follow-up, it was.85. Absolute thoracic height increased at all 3 time points: 141.6, 159.79, and 203.45 mm, respectively Mean chest width was similar preoperatively (170 mm) and immediately postoperatively (166.5 mm) but increased at latest follow-up (206.9 mm). Chest width percentile was similar at all 3 times (.93,.90, and.91). Conclusions Distraction-based treatment increases absolute thoracic height over time. There is significant improvement in the thoracic height percentile normalized after initial surgery, which was maintained over time. Measuring expected gains as a percentile normalized for pelvic width may be a more relevant outcome measure compared with measuring only absolute values.
KW - Distraction-based therapy
KW - Early onset scoliosis
KW - Pulmonary outcomes
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U2 - 10.1016/j.jspd.2014.03.001
DO - 10.1016/j.jspd.2014.03.001
M3 - Article
C2 - 27927419
AN - SCOPUS:84900021868
SN - 2212-134X
VL - 2
SP - 203
EP - 207
JO - Spine deformity
JF - Spine deformity
IS - 3
ER -