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J Pediatr Orthop. 2016 Dec;36(8):841-846.

Rib-based Distraction Surgery Maintains Total Spine Growth.

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*IWK Health Centre, Halifax, NS †Shriner's Hospital, Philadelphia, PA ‡Primary Children's Hospital, Salt Lake City, UT §Columbia Presbyterian Hospital New York, NY.



For children undergoing treatment of early onset scoliosis (EOS) using spine-based distraction, recently published research would suggest that total spine length (T1-S1) achieved after the initial lengthening procedure decreases with each subsequent lengthening. Our purpose was to evaluate the effect of rib-based distraction on spine growth in children with EOS.


This was a retrospective multi-center review of 35 patients treated with rib-based distraction (minimum 5 y follow-up). Radiographs were analyzed at initial implantation and just before each subsequent lengthening. The primary outcome was T1-S1 height, which was also analyzed as: Change in T1-S1 height per lengthening procedure, percent of expected age-based T1-S1 growth per lengthening time interval, percent increase in T1-S1 height as compared with postimplantation total spine height, and percent of expected T1-S1 growth based upon patient age at time of lengthening procedure.


Thirty-five patients with a mean age of 2.6 years at initial surgery were studied. Diagnoses included congenital (n=18), syndromic (n=7), idiopathic (n=5), and neuromuscular (n=5). Major Cobb angle was 63.5 degrees and kyphosis was 40.5 degree. Four postoperative time periods were compared: L1 (preoperative first lengthening surgery), L2-L5 (preoperative second lengthening to preoperative fifth lengthening), L6-L10 (preoperative sixth lengthening to preoperative 10th lengthening), L11-L15 (preoperative 11th lengthening to preoperative 15th lengthening). Cobb angle stayed relatively constant for each lengthening period while maximum kyphosis increased. Total spine height was 19.9 cm pre-implantation, 22.1 cm postimplantation, and 28.0 cm by the 15th lengthening (P<0.05). Percent expected T1-S1 growth per lengthening was 62% for L2-L5, 95% for L6-L10, and 52% for L11-L15. As compared with postimplantation spine height, over the course of 15 lengthening procedures, a further 27% increase in spine height was observed. When lengthening procedures were performed when children were under age 5 years, 82% of expected growth was observed; between ages 6 and 10 years, 76% of expected growth was observed; and beyond age 10 years, 14% of expected growth was observed.


Patients treated with rib-based distraction surgery had an increase in total spine height from 20 cm preimplantation to 28 cm by the 15th lengthening. They maintained greater than 75% of expected age-matched spine growth until age 10 years and lengthening procedures did not appear to follow a law of diminishing returns. Rib-based distraction is an effective means of maintaining spine growth which is likely beneficial for pulmonary development as compared with the natural history of EOS.


Level IV-Therapeutic study, case series.

[Indexed for MEDLINE]

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