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Spine Deform. 2014 May;2(3):203-207. doi: 10.1016/j.jspd.2014.03.001. Epub 2014 May 8.

Distraction-Based Treatment Maintains Predicted Thoracic Dimensions in Early-Onset Scoliosis.

Author information

1
Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. Electronic address: Michael.Glotzbecker@childrens.harvard.edu.
2
Department of Orthopaedic Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
3
San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr #300, La Jolla, San Diego, CA 92037, USA.
4
Orthopedics, Texas Scottish Rite Hospital for Children, 2222 Welborn St. Dallas, TX 75219, USA.
5
Hospital Universitario La Paz, Pedro Rico 31. 8 G, Madrid 28029, Spain.
6
Department of Orthopaedics, Nemours/Alfred I DuPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19899, USA.

Abstract

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.

KEYWORDS:

Distraction-based therapy; Early onset scoliosis; Pulmonary outcomes

PMID:
27927419
DOI:
10.1016/j.jspd.2014.03.001

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