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Prevalence of junctional kyphosis in early-onset scoliosis: can it be corrected at final fusion?

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Abstract

Purpose

To investigate the risk and predictive factors of junctional issues after conversion from Traditional growing rod (TGR) to definitive spinal fusion in Early-onset scoliosis (EOS).

Methods

Retrospective review of a multicenter EOS database. TGR patients who received final fusion with at least two-year follow-up were included. Proximal (PJA) and Distal junctional angles (DJA) on pre-final fusion, post-final fusion (within one year of surgery), and at latest follow-up were measured on lateral upright spinal radiographs. Differences in values among designated time points and predictive factors of junctional issues were evaluated statistically.

Results

Forty-six of 251 patients (28 females, 18 males and mean age at final fusion: 12 ± 2 [9–17] years) met the inclusion criteria. Mean follow-up between first postoperative measurement and latest follow-up was 49 ± 22 (24–112) months. No statistical differences in PJA and DJA values were available at pre-fusion, first post-fusion, or latest follow-up (p = 0.827, p = 0.076). Fifty percent of patients had extension of TGR instrumentation at fusion, either proximal or distal. No factor including sex and etiology, lumbar lordosis, thoracic kyphosis, major curve magnitude, PJA, and DJA at pre-fusion was found to be a predictive issue for extension of index TGR instrumentation, except the history of at least one implant-related complication during the period from index surgery to the definitive fusion.

Conclusion

PJA and DJA remained stable when transitioning from TGR to final posterior spinal fusion. But 50% of patients had extension of construction at fusion, either proximal or distal.

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Funding

No funds were received in support of this study.

Author information

Authors and Affiliations

  1. Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Mutlu Cobanoglu, Petya Yorgova, Geraldine Neiss & Suken A. Shah

  2. Department of Orthopedics and Traumatology, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey

    Mutlu Cobanoglu

  3. Growing Pediatric Spine Study Group, Valley Forge, PA, USA

    Jeff B. Pawelek

  4. Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

    George H. Thompson

  5. Children’s Orthopaedics Center, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    David L. Skaggs

  6. Division of Pediatric Orthopaedics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Viral V. Jain

  7. Department of Orthopaedic Surgery, University of California-San Diego, San Diego, CA, USA

    Behrooz A. Akbarnia

Authors
  1. Mutlu Cobanoglu
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  2. Petya Yorgova
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  3. Geraldine Neiss
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  4. Jeff B. Pawelek
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  5. George H. Thompson
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  6. David L. Skaggs
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  7. Viral V. Jain
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  8. Behrooz A. Akbarnia
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  9. Suken A. Shah
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Consortia

Pediatric Spine Study Group

Contributions

MC made substantial contributions to the conception or design of the work, acquisition of data, analysis of data, interpretation of data; drafting the work, revising critically for important intellectual content; final approval of version to be published.

PY made substantial contributions to the acquisition of data; drafting the work; final approval of version to be published.

GN made substantial contributions to the acquisition of data; final approval of version to be published.

JBP made substantial contributions to the acquisition of data; drafting the work; final approval of version to be published.

GHT made substantial contributions to the drafting the work; final approval of version to be published.

DLS made substantial contributions to the drafting the work; final approval of version to be published.

VVJ made substantial contributions to the drafting the work; final approval of version to be published.

BAA made substantial contributions to the final approval of version to be published.

SAS made substantial contributions to the conception or design of the work, interpretation of data; drafting the work, revising critically for important intellectual content; final approval of version to be published.

The Growing Spine Study Group made substantial contributions to the acquisition of data; drafting the work; final approval of version to be published.

Corresponding author

Correspondence to Suken A. Shah.

Ethics declarations

Conflicts of interest

The authors declare that they no conflict of interest.

Dr. Akbarnia reports grants and personal fees from Nuvasive, personal fees from K2M, personal fees from DePuy Synthes, personal fees from NociMed, personal fees from Viseon, grants from SeaSpine, outside the submitted work.

Suken Shah has received consulting fees from NuVasive, Inc. and DePuy Synthes Spine, outside the scope of this work.

Dr. Thompson reports personal fees and other from OrthoPediatrics, personal fees from Wolter Kluwer, other from Shriner's Hospital for Children, other from Nuvasive, other from Scoliosis Research Society, outside the submitted work.

The Growing Spine Study Group reports grants from the Growing Spine Foundation, Pediatric Orthopedic Society of North America, Food and Drug Administration, and Nuvasive, outside of the submitted work.

The remaining authors (Mutlu Cobanoglu, Petya Yorgova, Geraldine Neiss, Jeff B. Pawelek, David L. Skaggs, and Viral V. Jain) declare that there is no conflict of interest regarding the publication of this paper.

Ethical approval

This study was performed using the Growing Spine Database Registry. Our institution is an active participant in the registry with an approved prospective study, approved by our institutional review board, and all sites in the registry have similar approval.

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Cobanoglu, M., Yorgova, P., Neiss, G. et al. Prevalence of junctional kyphosis in early-onset scoliosis: can it be corrected at final fusion?. Eur Spine J 30, 3563–3569 (2021). https://doi.org/10.1007/s00586-021-06968-0

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  • DOI: https://doi.org/10.1007/s00586-021-06968-0

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