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Growth-friendly surgery results in more growth but a higher complication rate and unplanned returns to the operating room compared to single fusion in neuromuscular early-onset scoliosis: a multicenter retrospective cohort study

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Abstract

Purpose

Compare radiographic outcomes, complications, and QoL in neuromuscular early-onset scoliosis (EOS) patients treated with single posterior spinal fusion (PSF) versus growth-friendly surgery and definitive fusion (GFDF).

Methods

In a retrospective cohort study, children with neuromuscular EOS, age 8–11 years at index surgery with PSF or GF devices, with minimum 2-year follow-up after final fusion were identified from a multicenter database.

Results

16 PSF and 43 GFDF patients were analyzed. Demographics were similar except PSF patients were older at index surgery and had shorter follow-up. PSF patients had greater percentage major curve correction (62% vs 38%, p = 0.001) and smaller major curve at final follow-up (23° vs 40°, p = 0.005). The GFDF group underwent over five times more surgeries (8.7 vs 1.6, p = 0.0001). Four PSF patients (25%) experienced ten complications, resulting in five unplanned returns to the operating room (UPROR) in three patients (19%). 36 GFDF patients (84%) experienced 83 complications, resulting in 45 UPRORs in 24 patients (56%). Poisson regression adjusted for age showed that the GFDF group had more complications (p = 0.001) and UPRORs (p = 0.01). Although the GFDF patients had smaller preoperative T1–T12 and T1–S1 lengths, these were similar to the PSF patients at final follow-up, indicating that the GFDF patients had greater spinal growth. PSF patients had better postoperative EOSQ-24 Financial Impact and Family Burden scores.

Conclusion

While there was a difference in age at index surgery, PSF may be more effective than GFDF at controlling neuromuscular EOS. GFDF patients achieved more spinal growth but eight times more complications and nine times more UPRORs.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The software application and code used for the statistical analysis are available from the corresponding author on reasonable request.

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Funding

The study was funded by departmental resources.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, C.S. Mott Children’s Hospital, Michigan Medicine, 1540 E. Hospital Dr., SPC 4241, Ann Arbor, MI, 48109-4241, USA

    Ying Li & Jennylee Swallow

  2. Department of Orthopaedic Surgery and Department of Epidemiology, School of Public Health, Michigan Medicine, Ann Arbor, MI, USA

    Joel Gagnier

  3. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Patrick J. Cahill

  4. Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA

    Paul D. Sponseller

  5. Department of Orthopaedic Surgery, Children’s Hospital Colorado, Aurora, CO, USA

    Sumeet Garg

  6. Department of Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    George H. Thompson

  7. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and University of Texas Southwestern, Dallas, TX, USA

    Brandon A. Ramo

Authors
  1. Ying Li
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  7. George H. Thompson
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Consortia

Pediatric Spine Study Group

Contributions

YL: made substantial contributions to the conception or design of the work, and performed analysis and interpretation of data; drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JS: performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JG: performed data analysis; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PJC: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PDS: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SG: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GHT: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BAR: made substantial contributions to the conception or design of the work and performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Pediatric Spine Study Group: performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ying Li.

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Conflict of interest

Dr. Li has received a research grant and non-financial support from the Scoliosis Research Society. Dr. Cahill has received a research grant from the Pediatric Spine Study Group and has received personal fees from NuVasive. Dr. Sponseller has received a grant from Depuy Synthes/Johnson and Johnson, and has received personal fees from Depuy Synthes/Johnson and Johnson, Globus, and OrthoPediatrics. Dr. Garg has received grants from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America, and has received personal fees from Medtronic, NuVasive, and ACI Clinical. Dr. Thompson has received personal fees from Shriners Hospitals for Children and Wolters Kluwer, personal fees and non-financial support from Broadwater, personal fees and royalties from OrthoPediatrics, and non-financial support from NuVasive and the Scoliosis Research Society. The Pediatric Spine Study Group has received research grants from the Pediatric Orthopaedic Society of North America, Food and Drug Administration, Depuy Synthes/Johnson and Johnson, NuVasive, Children’s Spine Foundation, and Growing Spine Foundation. The remaining authors declare that they have no conflicts of interest.

Ethics approval

IRB approval, University of Michigan, HUM 00082789, 1/7/14.

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Informed consent to participate in this study was obtained from the parent or legal guardian of all participants.

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Not applicable.

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Li, Y., Swallow, J., Gagnier, J. et al. Growth-friendly surgery results in more growth but a higher complication rate and unplanned returns to the operating room compared to single fusion in neuromuscular early-onset scoliosis: a multicenter retrospective cohort study. Spine Deform 9, 851–858 (2021). https://doi.org/10.1007/s43390-020-00270-7

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  • DOI: https://doi.org/10.1007/s43390-020-00270-7

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