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Spine Deform. 2020 Feb;8(1):129-133. doi: 10.1007/s43390-020-00048-x. Epub 2020 Jan 24.

Prospectively collected surgeon indications for discontinuation of a lengthening program for early-onset scoliosis.

Author information

1
Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 708, MSC 622, Charleston, SC, 29425, USA. murphyr@musc.edu.
2
Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 708, MSC 622, Charleston, SC, 29425, USA.
3
Childrens Spine Foundation, P.O. Box 397, Valley Forge, PA, 19481, USA.
4
Primary Children's Medical Center, 100 Mario Capecchi Dr, Salt Lake City, UT, 84113, USA.
5
Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
6
Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA.
7
Children's Hospital Colorado, 3615 Martin Luther King Blvd, Denver, CO, 80205, USA.
8
Campbell Clinic, 8000 Centerview Parkway, Suite 500, Memphis, TN, 38018, USA.

Abstract

INTRODUCTION:

At some point after children with early-onset scoliosis (EOS) undergo implantation of a distraction construct to control deformity and promote growth, a decision is made to discontinue lengthening. The purpose of this study was to evaluate surgeon indications for discontinuation of a lengthening program and to evaluate patient outcomes.

METHODS:

As a part of a multicenter database, surgeons prospectively completed a questionnaire at the completion of growth-friendly treatment. Surgeon indications for discontinuation included patient age, pain/functional status, implant status, and spinal deformity parameters. Patient demographics, scoliosis type, deformity parameters, and length of time in a growing program were queried. Patients were treated with a final fusion or observation, and rate of secondary surgeries was analyzed.

RESULTS:

Questionnaires were completed on 121 patients (61% female). EOS etiology was 31% neuromuscular, 43% congenital, 16% idiopathic, and 10% syndromic. Average age at initiation of growing program was 6.8 ± 3.1 years, and average age at discontinuation was 12.7 ± 2.5 years. The most commonly cited indications for discontinuation of a lengthening program included bone age/skeletal maturity (n = 46), patient age (n = 33), and diminishing returns with expansions (n = 33). A larger coronal Cobb angle was found in patients who underwent definitive fusion (65°) when compared with continued observation (55°, p = 0.001). Twenty-nine (24%) patients were initially treated with observation after completion of a growing construct. In this subgroup, at a minimum of 2 years' (average 3.8 years') follow-up, 26/29 (90%) patients remained stable with observation alone; whereas, three (10%) underwent delayed final fusion surgery.

CONCLUSIONS:

The most common surgeon-cited indications for discontinuation of a lengthening program in EOS patients are skeletal maturity and patient age. The majority of patients (76%) underwent definitive spinal fusion after discontinuation of a lengthening program; whereas, those treated with observation alone had a survivorship of 90% at a minimum follow-up of two years.

KEYWORDS:

Early-onset scoliosis; Final fusion; Lengthening

PMID:
31981149
DOI:
10.1007/s43390-020-00048-x

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