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Spine Deform. 2019 Sep;7(5):822-828. doi: 10.1016/j.jspd.2019.02.001.

Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis-5-Year Follow-up.

Author information

1
Zagazig University, Shaibet an Nakareyah, Markaz El-Zakazik, Ash Sharqia Governorate 44519, Egypt.
2
IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada.
3
Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA.
4
Growing Spine Study Group, 555 East Wells St, Suite 1100, Milwaukee, WI 53202, USA.
5
Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA 19140, USA.
6
Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
7
Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA.
8
IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada. Electronic address: ron.el-hawary@iwk.nshealth.ca.

Abstract

STUDY DESIGN:

Retrospective, comparative.

OBJECTIVES:

To determine if distraction-based surgeries will increase spine length in patients with nonidiopathic EOS and whether etiology affects final spine length.

SUMMARY OF BACKGROUND DATA:

As early-onset scoliosis (EOS) has many etiologies, it is unclear whether etiology affects the spine length achieved with distraction-based surgeries. Since distraction may produce kyphosis, sagittal spine length (SSL; curved arc length of the spine in the sagittal plane) should be utilized.

METHODS:

Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, 5 lengthenings) were identified from two EOS registries. Radiographic analysis preoperation, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with primary outcome of T1-S1 SSL.

RESULTS:

We identified 126 patients (67 congenital, 38 syndromic, 21 neuromuscular) with a mean preoperative age of 4.6 years, scoliosis 75°, kyphosis 48°, and a mean of 12 lengthenings. After initial correction (p < .05), scoliosis remained constant (58° at L11-L15) and kyphosis increased (38° at L1 to 60° at L11-L15) (p < .05). SSL increased for the entire group from 27.1 cm preoperation to 35.3 cm at L11-L15 (p < .05) and during the distraction phase (29.2 cm at L1 to 35.3 cm at L11-L15) (p < .05). Preoperative SSL was higher in neuromuscular compared with congenital patients and maintained that difference until the 10th lengthening. Preoperative SSL did not differ between syndromic and congenital patients (28.0 cm vs. 25.6 cm); however, syndromic patients had greater SSL after implantation (L1: 30.5 cm vs. 26.8 cm) (p < .05) and maintained that difference until the 15th lengthening (37.1 cm vs. 34.3 cm) (p < .05).

CONCLUSION:

At minimum 5-year follow-up, distraction-based surgeries increased spine length for all patients with nonidiopathic EOS; however, neuromusculars had higher preoperative spine length compared with congenital patients and maintained that difference until the 10th lengthening. Although congenital and syndromic patients had similar preoperative spine length, syndromic patients had greater SSL after implantation (L1) and maintained that difference until the 15th lengthening.

LEVEL OF EVIDENCE:

Level III.

KEYWORDS:

Early-onset scoliosis; Growing rods; Growth friendly; SSL; Sagittal spine length; Spine growth; VEPTR

PMID:
31495484
DOI:
10.1016/j.jspd.2019.02.001

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