TY - JOUR
T1 - Distraction-based surgeries increase thoracic sagittal spine length after ten 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 - Hilaire, Tricia St
AU - McClung, Anna M.
AU - El-Bromboly, Yehia
AU - Johnston, Charles E.
N1 - Funding Information:
REH (personal fees from DePuy Synthes Spine, Medtronic Spine, and Apifix Ltd; grants from DePuy Synthes Spine and Medtronic Spine; other from Children's Spine Foundation, Pediatric Orthopedic Society of North America, and Scoliosis Research Society; personal fees from Wishbone Medical Inc., outside the submitted work), CKC (none), LEG (none), AJS (none), TSH (none), AMM (none), YEB (none), CEJ (reports other from Medtronics and Elsevier, outside the submitted work), Children's Spine Study Group (grants from DePuy Synthes Spine, grants from NuVasive, outside the submitted work).
Publisher Copyright:
© 2020, Scoliosis Research Society.
PY - 2020/4/1
Y1 - 2020/4/1
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: 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 increase 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 5-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 < 0.05), kyphosis 39° (50° RB vs. 34° SB; p < 0.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p < 0.05). 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 < 0.05); L2–L5, 50° RB vs. 27° SB (p < 0.05); L6–L10, 56° RB vs. 26° SB (p < 0.05). SSL increased for both groups from preoperative to the tenth lengthening (p < 0.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the tenth lengthening (p < 0.05). After ten lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p < 0.05). 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: 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 increase 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 5-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 < 0.05), kyphosis 39° (50° RB vs. 34° SB; p < 0.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p < 0.05). 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 < 0.05); L2–L5, 50° RB vs. 27° SB (p < 0.05); L6–L10, 56° RB vs. 26° SB (p < 0.05). SSL increased for both groups from preoperative to the tenth lengthening (p < 0.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the tenth lengthening (p < 0.05). After ten lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p < 0.05). 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)
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U2 - 10.1007/s43390-019-00025-z
DO - 10.1007/s43390-019-00025-z
M3 - Article
C2 - 32026442
AN - SCOPUS:85079805247
SN - 2212-134X
VL - 8
SP - 303
EP - 309
JO - Spine deformity
JF - Spine deformity
IS - 2
ER -