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

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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.

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Funding

No funding was used for data acquisition, analysis, or for manuscript writing or preparation.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 708, MSC 622, Charleston, SC, 29425, USA

    Robert F. Murphy & William R. Barfield

  2. Childrens Spine Foundation, P.O. Box 397, Valley Forge, PA, 19481, USA

    Tricia St Hilaire

  3. Primary Children’s Medical Center, 100 Mario Capecchi Dr, Salt Lake City, UT, 84113, USA

    John T. Smith

  4. Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, USA

    John B. Emans

  5. Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Amer Samdani & Joshua M. Pahys

  6. Children’s Hospital Colorado, 3615 Martin Luther King Blvd, Denver, CO, 80205, USA

    Sumeet Garg

  7. Campbell Clinic, 8000 Centerview Parkway, Suite 500, Memphis, TN, 38018, USA

    Jeffrey R. Sawyer

Authors
  1. Robert F. Murphy
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  2. William R. Barfield
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  3. Tricia St Hilaire
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  4. John T. Smith
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  5. John B. Emans
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  6. Amer Samdani
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  7. Sumeet Garg
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  8. Jeffrey R. Sawyer
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  9. Joshua M. Pahys
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Consortia

Children’s Spine Study Group

Corresponding author

Correspondence to Robert F. Murphy.

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Conflict of interest

RFM (none), WRB (none), TSH (none), JTS (personal fees from Biomet, Ellipse, Globus, Spineguard, and Synthes, outside the submitted work; in addition, he has a patent DePuy with royalties paid), JBE (personal fees from Biomet, Medtronic, and Synthes, outside the submitted work; in addition, he has a patent DePuy with royalties paid), AS (personal fees from DePuy, Ethicon, Globus, NuVasive, Stryker, and Zimmer Biomet, outside the submitted work; in addition, he has a patent NuVasive with royalties paid, and a patent Zimmer Biomet with royalties paid), SG (personal fees from Decision Support in Medicine, Medtronic, and Mighty Oak Medical, outside the submitted work), JRS (personal fees from DePuy and NuVasive; other from Mosby and Wolters Kluwer Health, outside the submitted work), JMP (personal fees from DePuy, NuVasive, and Zimmer, outside the submitted work); Children’s Spine Study Group (none).

Ethical approval

IRB approval: The data used for this study were from the Children’s Spine Foundation Registry. All participating sites in this registry maintain IRB approval for input of patient information.

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Murphy, R.F., Barfield, W.R., St Hilaire, T. et al. Prospectively collected surgeon indications for discontinuation of a lengthening program for early-onset scoliosis. Spine Deform 8, 129–133 (2020). https://doi.org/10.1007/s43390-020-00048-x

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  • DOI: https://doi.org/10.1007/s43390-020-00048-x

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