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Can distraction-based surgeries achieve minimum 18 cm thoracic height for patients with early onset scoliosis?

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Abstract

Purpose

Karol et al. introduced the concept that 18 cm thoracic height is the critical point where a patient with early onset scoliosis (EOS) can maintain adequate pulmonary function. Our purpose was to determine if distraction-based surgeries will increase thoracic spine height to at least 18 cm in patients with EOS.

Methods

Patients with EOS treated with distraction-based systems (minimum 5 years follow up, minimum five lengthenings). Radiographic analysis of thoracic spine height (T1–T12) at the last lengthening procedure.

Results

One hundred and fifty-three patients (67 congenital, 21 neuromuscular, 38 syndromic, 27 idiopathic) with pre-operative mean age 4.6 years, scoliosis 75°, kyphosis 47° were evaluated. Their mean age at final lengthening procedure was 11 years (6–16), average number of lengthening procedures was 10.5 (4–21), mean final scoliosis was 53°, and mean final kyphosis was 58°. Final thoracic height was > 18 cm in 65% and was > 22 cm in 31% of patients. Based on etiology, only 48% of the congenital patients reached 18 cm compared to 81% neuromuscular, 84% syndromic and 67% idiopathic. This height gain was closely related to the percentage of scoliosis correction achieved for each etiology. Comparing congenital etiology to other etiologies, there was a lower percentage of patients in the congenital group that passed the 18 cm threshold (48% vs. 78%) (p < 0.05).

Conclusion

At minimum 5 years follow up, distraction-based surgeries increased thoracic height for patients with EOS to greater than 18 cm in 65% of patients; however, only 48% of congenital patients reached this thoracic height threshold.

Design

Retrospective review of prospectively collected registry data. LOI III.

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Data availability

Registry data is available to member institutions. Measurements and analysis done at the IWK Health Centre are on a password-protected server. Access may be arranged through application to the REB.

Code availability

Statistical analysis was conducted using SPSS v25 (IBM Corporation, Armonk, NY, USA).

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Acknowledgements

The members of the Pediatric Spine Study Group are Anna McClung, Tricia St. Hilaire, Tara Flynn.

Funding

No funding was received for the study. The research was supported by the Pediatric Spine Study Group.

Author information

Authors and Affiliations

  1. Zagazig University, Zagazig, Egypt

    Yehia ElBromboly

  2. IWK Health Centre, Halifax, NS, Canada

    Jennifer Hurry & Ron El-Hawary

  3. Texas Scottish Rite Hospital for Children, Dallas, USA

    Charles Johnston

  4. Pediatric Spine Study Group, Valley Forge, USA

    Anna McClung, Tricia St. Hilaire & Tara Flynn

  5. Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA

    Amer Samdani

  6. Rainbow Babies and Children’s Hospital, Cleveland, OH, USA

    Michael Glotzbecker

Authors
  1. Yehia ElBromboly
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  2. Jennifer Hurry
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  4. Anna McClung
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  5. Amer Samdani
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  7. Tricia St. Hilaire
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  8. Tara Flynn
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  9. Ron El-Hawary
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Consortia

Pediatric Spine Study Group

Contributions

Study design: JH, CJ, AMC, AS, MG, TSH, PSSG, REH. Data collection and analysis: YEB, JH, AMC, TSH, TF, PSSG, REH. First draft: YEB. Comment on first draft: JH, AMC, AS, MG, TSH, TF, PSSG, REH. Read and approve final manuscript: YEB, JH, CJ, AMC, AS, MG, TSH, TF, PSSG, REH.

Corresponding author

Correspondence to Ron El-Hawary.

Ethics declarations

Conflict of interest

Dr. Elbromboly, Ms Hurry, Ms McClung, Ms St. Hilaire, and Ms Flynn have nothing to disclose. Dr. Johnston reports other from Medtronic, other from Elsevier, outside the submitted work. Dr. Samdani reports personal fees from DePuy Synthes Spine, personal fees from Ethicon, personal fees from Globus Medical, personal fees from NuVasive, personal fees from Stryker, personal fees from Zimmer Biomet, outside the submitted work; and Executive Committee, Setting Scoliosis Straight Foundation Executive Committee, Children's Spine Study Group. Dr. Glotzbecker reports other from Orthobullets, other from Nuvasive, other from Depuy, other from Zimmer Biomet, other from Medtronic, other from GSSG, CSSG, HSG, outside the submitted work. Pediatric Spine Study Group reports grants from DePuy Synthes Spime, grants from Nuvasive, outside the submitted work. Dr. El-Hawary reports personal fees from Depuy Synthes Spine, personal fees from Medtronic Spine, grants from Depuy Synthes Spine, grants from Medtronic Spine, personal fees from Apifix Ltd., other from Children's Spine Foundation, other from Pediatric Orthopedic Society of North America, other from Scoliosis Research Society, personal fees from Wishbone Medical, outside the submitted work.

Ethical approval

This work is a sub-study of the Pediatric Spine Study Group Registry which was approved by the Research Ethics Board at the IWK Health Centre (#1002256) in accordance with the ethical standards outlined in the Tri-Council Policy Statement and the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

All research participants or their legal guardians provided written consent to be a part of the registry and have the data collected to be used in ongoing research on scoliosis.

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The members of the Pediatric Spine Study Group are mentioned in “Acknowledgements”.

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ElBromboly, Y., Hurry, J., Johnston, C. et al. Can distraction-based surgeries achieve minimum 18 cm thoracic height for patients with early onset scoliosis?. Spine Deform 9, 603–608 (2021). https://doi.org/10.1007/s43390-020-00230-1

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  • DOI: https://doi.org/10.1007/s43390-020-00230-1

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