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Spine Deform. 2019 Jan;7(1):152-157. doi: 10.1016/j.jspd.2018.05.011.

Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs.

Author information

1
Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Electronic address: Larson.Noelle@mayo.edu.
2
Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
3
Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA.
4
Growing Spine Foundation, 555 East Wells Street, Suite 1100, Milwaukee, WI 53202, USA.
5
Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA.
6
Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
7
Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.

Abstract

STUDY DESIGN:

Retrospective review of prospectively collected data.

OBJECTIVE:

To compare the use of spine-based versus rib-based implants for the treatment of early-onset scoliosis (EOS) in the setting of rib fusions.

SUMMARY OF BACKGROUND DATA:

Treatment for severe early-onset spinal deformity with rib fusions includes growing spine devices with proximal rib or spine anchors. The results of treatment, however, have not been compared between spine-based versus rib-based proximal anchors.

METHODS:

169 patients with rib fusions treated with rib-based or spine-based constructs and minimum two-year follow-up were included. Sixteen patients were treated with proximal spine-based anchors and 153 with proximal rib-based devices (VEPTRs). Overall, 104 of the patients with rib-based fixation underwent thoracoplasty at the index surgery. We evaluated change in T1-T12 and T1-S1 height, coronal Cobb angle, kyphosis, and number of lengthening/revision surgeries.

RESULTS:

Kyphosis increased a mean of 7° in the rib-based group and decreased a mean of 20 degrees in the spine-based group (p = .002). Major Cobb angle decreased in both groups (p < .0001); however, the spine-based group had greater Cobb angle improvement (24 vs. 11 degrees, p = .04). From implant and lengthening of distraction devices, there was a mean 3.3-cm (22%) increase in T1-T12 height and a mean of 8.0 lengthenings in the rib-based group compared with a 5.7-cm increase and 6.3 lengthening surgeries in the spine-based group. Patients with rib-based constructs had a mean of 11 total procedures, whereas spine-based patients had a mean of 8.

CONCLUSIONS:

Patients underwent a mean of eight lengthening surgeries before final fusion or cessation of lengthening with a modest 2.3-cm increase in T1-T12 height. Compared with proximal rib anchors, proximal spine anchors controlled kyphosis and improved Cobb angle correction for early-onset scoliosis with rib fusions.

KEYWORDS:

Chest wall; Deformity; Early-onset scoliosis; Growing spine; Rib; Spine; Thoracic; VEPTR

PMID:
30587309
PMCID:
PMC6311710
[Available on 2020-01-01]
DOI:
10.1016/j.jspd.2018.05.011
[Indexed for MEDLINE]

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