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Surgical outcomes of severe spinal deformities exceeding 100° or treated by vertebral column resection (VCR). Does implant density matter?: an observational study of deformity groupings

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Abstract

Study design

Prospective multicenter international observational study.

Objective

To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction.

Summary of background data

Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR).

Methods

250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5–2).

Results

250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34–53.32). There was significant improvement in SRS scores in all Grps at 2-year FU.

Conclusion

Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.

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Funding

Washington University Fox funds were received to support this work. This work was also partially funded with a grant from K2M (Grant No: K2M/FC/060216).

Author information

Authors and Affiliations

  1. FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana

    Oheneba Boachie-Adjei, Henry Ofori Duah, Arthur Sackeyfio & Kwadwo Poku Yankey

  2. New York Presbyterian/The Allen Hospital, New York, USA

    Lawrence G. Lenke

  3. The Johns Hopkins Hospital, Baltimore, MD, USA

    Paul D. Sponseller

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

    Amer F. Samdani

  5. Scottish Rite Hospital for Children, Dallas, TX, USA

    Daniel J. Sucato

  6. Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA

    Brenda A. Sides & Munish C. Gupta

  7. Rady Children’s Hospital-San Diego, San Diego, CA, USA

    Peter O. Newton

  8. Spine and Scoliosis Center, Nemours/Alfred I. du Pont Pediatrics, Wilmington, DE, USA

    Suken A. Shah

  9. Korle-Bu Teaching Hospital, Accra, Ghana

    Harry Akoto

Authors
  1. Oheneba Boachie-Adjei
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  2. Henry Ofori Duah
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  3. Arthur Sackeyfio
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  4. Kwadwo Poku Yankey
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  5. Lawrence G. Lenke
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  6. Paul D. Sponseller
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  7. Amer F. Samdani
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  8. Daniel J. Sucato
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  9. Brenda A. Sides
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  11. Suken A. Shah
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  12. Harry Akoto
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  13. Munish C. Gupta
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Consortia

Fox Pediatric Spinal Deformity Study

  • Richard McCarthy
  • , David Bumpass
  • , Paul Sponseller
  • , John Emans
  • , Peter Sturm
  • , Viral Jain
  • , Lawrence Lenke
  • , Dan Sucato
  • , Suken Shah
  • , Mark Erickson
  • , Sumeet Garg
  • , Oheneba Boachie-Adjei
  • , David Skaggs
  • , Baron Lonner
  • , Harry Shufflebarger
  • , Jahangir John Asghar
  • , David Polly
  • , Han Jo Kim
  • , Amer Samdani
  • , Peter Newton
  • , Burt Yaszay
  • , Munish Gupta
  • , Michael Kelly
  •  & Pat Cahil

Contributions

Conceptualization and design: All authors. Data collection: All authors. Data cleaning and preparation: HOD, KPY, AS, Brenda A. Sides. Data Analysis and interpretation: HOD, OB-A. Writing—Initial draft preparation: OB-A, HOD. Writing -Critical Review for important intellectual content: All authors. Final Approval: All authors. Funding acquisition: Fox Pediatric Spinal Deformity Study, MCG, OB-A, BAS. Resources: OB-A, MCG, BAS. Supervision: OB-A, MCG.

Corresponding author

Correspondence to Oheneba Boachie-Adjei.

Ethics declarations

Conflict Of Interest

Dr. Boachie-Adjei reports grants, personal fees and other from K2M, personal fees and other from WEIGAO, outside the submitted work. Dr. Lenke reports personal fees and other from Medtronic, personal fees and other from broadwater, personal fees and other from EOS Imaging, personal fees and other from EOS Imaging, personal fees and other from Quality Medical Publishing, personal fees and other from Stryker Spine, outside the submitted work. Dr. Sponseller reports grants, personal fees and other from DePuy Synthes, personal fees and other from JBJS, personal fees and other from Globus Medical, personal fees and other from OrthoPediatrics, outside the submitted work. Dr. Samdani reports personal fees and other from DePuy Synthes, personal fees and other from Globus Medical, personal fees and other from NuVasive, personal fees and other from Ethicon, personal fees and other from Stryker Spine, personal fees and other from Zimmer Biomet, outside the submitted work. Dr. Sucato reports personal fees and other from Globus Medical, outside the submitted work. Dr. Newton reports grants from Alphatec Spine, grants, personal fees and other from DePuy Synthes, personal fees and other from Electrocore, grants from EOS Imaging, grants, personal fees and other from K2M, grants from Mazor Robotics, grants from Medtronic, grants from NuVasive, grants from OrthoPediatrics, grants, personal fees and other from Thieme Publishing, outside the submitted work. Dr. Shah reports grants, personal fees and other from DePuy Synthes, other from K2M, other from Globus Medical, other from NuVasive, outside the submitted work. Dr. Gupta reports grants from AOSpine, personal fees and other from DePuy Synthes, other from Innomed, other from Johnson & Johnson, personal fees and other from Medtronic, grants from OMeGA, personal fees and other from perForm Biologics, other from Proctor & Gamble, outside the submitted work. For the remaining authors none was declared.

IRB approval statement

Central Institutional Review Board (IRB) approval was obtained by the main Principal Investigator of the FOX Pediatric Spinal Deformity Study. Additional IRB approvals were obtained from all investigational sites that enrolled patients into the Fox Pediatric Spinal Deformity Study.

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Boachie-Adjei, O., Duah, H.O., Sackeyfio, A. et al. Surgical outcomes of severe spinal deformities exceeding 100° or treated by vertebral column resection (VCR). Does implant density matter?: an observational study of deformity groupings. Spine Deform 10, 595–606 (2022). https://doi.org/10.1007/s43390-021-00460-x

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  • DOI: https://doi.org/10.1007/s43390-021-00460-x

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