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Younger age at spinal cord detethering is potentially associated with a reduced risk of curve progression in children with early onset scoliosis

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Abstract

Purpose

In children with early onset scoliosis (EOS) who have tethered spinal cord (TSC), spinal cord detethering is commonly performed prior to spinal deformity correction (SDC). The purpose of this study was to investigate whether age or curve magnitude at the time of detethering is associated with curve progression at a follow-up of at least 2 years. It was hypothesized that patients who undergo detethering at a younger age, or those with a smaller curve magnitude, would experience a reduced rate of curve progression when compared with those who are older or with larger curves.

Methods

Patients with EOS who underwent detethering at least 2 years prior to SDC were identified in a multicenter international registry. Radiographs were assessed just prior to the detethering procedure (pre-detether) and at the most recent visit prior to SDC (most recent post-detether). The rate of curve progression > 10° was examined. Owing to unequal follow-up in individual patients, Cox regression was used to investigate associations between primary variables (age and magnitude of major coronal curve) and rate of curve progression.

Results

37 patients met inclusion criteria and 18 (mean age: 3.7 ± 2.9 years, 66.7% female, mean follow-up: 3.4 ± 1.3 years) had radiographic data available for analysis. Pre-detether and most recent post-detether major coronal curves were 44.8° ± 18.5° and 47.6° ± 23.9°, respectively. 5 (27.8%) patients had curve progression > 10° at a follow-up of 3.2 ± 1.2 years. Patients with progression > 10° were older at the time of detethering when compared with those without (5.6 ± 2.8 vs. 3 ± 2.7 years, p = 0.084). Regression analysis demonstrated that as age at detethering increased by 1 year, the rate of curve progression > 10° increased by 28.6% [95% confidence interval (CI) 0.899; 1.839, p = 0.169]. There was no evidence of an association between pre-detethering curve magnitude and rate of curve progression > 10° [HR: 1.027, 95% CI 0.977; 1.079, p = 0.297].

Conclusion

In a small multicenter cohort of EOS patients with TSC, younger age, but not curve size, at the time of detethering was associated with a lower rate of scoliosis progression. Although these results indicate a potential role for early spinal cord detethering in the EOS population, they require further prospective investigation with a larger number of patients.

Level of evidence

Level II.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This study was supported in part by grants to the Pediatric Spine Foundation in support of Pediatric Spine Study Group research from Zimmer Biomet, OrthoPediatrics, DePuy Synthes Spine, Globus Medical Inc, Medtronic, NuVasive and Stryker.

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Authors and Affiliations

  1. Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah/Primary Children’s Hospital, Salt Lake City, UT, 84113, USA

    Rajiv R. Iyer

  2. Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Adam N. Fano

  3. Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8N, New York, NY, 10032-3784, USA

    Hiroko Matsumoto, Rishi Sinha, Benjamin D. Roye & Michael G. Vitale

  4. Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA

    Hiroko Matsumoto

  5. Department of Orthopaedic Surgery & Sports Medicine, Boston Children’s Hospital, Boston, MA, 02115, USA

    Hiroko Matsumoto

  6. Pediatric Orthopaedic Surgery, New-York Presbyterian, Morgan Stanley Children’s Hospital of New York, New York, NY, 10032, USA

    Benjamin D. Roye & Michael G. Vitale

  7. Division of Pediatric Neurosurgery, Hassenfeld Children’s Hospital at NYU Langone, New York University, New York, NY, 10016, USA

    Richard C. E. Anderson

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  1. Rajiv R. Iyer
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Consortia

Pediatric Spine Foundation

Contributions

RRI, ANF, HM, RS, BDR, MGV, RCEA, Pediatric Spine Study Group: (a) Made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data; or the creation of new software used in the work. (b) Drafted the work or revised it critically for important intellectual content. (c) Approved the version to be published. (d) 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. Permission to Reproduce Copyrighted Materials: No copyrighted materials are included in this manuscript.

Corresponding author

Correspondence to Hiroko Matsumoto.

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Conflict of interest

RRI has no conflicts of interest to disclose. ANF has no conflicts of interest to disclose. HM has received consulting fees from the Pediatric Spine Study Group. RS has no conflicts of interest to disclose. BDR has received grants from Pediatric Orthopaedic Society of North America, Orthopedic Science Research Foundation and Scoliosis Research Society. MGV has received grants from the Pediatric Orthopaedic Society of North America, Orthopedic Science Research Foundation, Pediatric Spine Foundation, Children’s Spine Foundation, OMeGA Medical Grants Association and Setting Scoliosis Straight Foundation and royalties from Biomet. He is a paid consultant for Stryker, Biomet and NuVasive. MGV is on the Board of Directors of Pediatric Spine Foundation. He is former president of Pediatric Orthopaedic Society of North America and is a Board Member, Chair Emeritus of the International Pediatric Orthopaedic Symposium. RCEA has no conflicts of interest to disclose.

Ethics approval

This study was approved by the Columbia University Institutional Review Board (Protocol AAAB5378) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from each subject’s parent upon enrollment into the early onset scoliosis registry.

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Iyer, R.R., Fano, A.N., Matsumoto, H. et al. Younger age at spinal cord detethering is potentially associated with a reduced risk of curve progression in children with early onset scoliosis. Spine Deform 11, 739–745 (2023). https://doi.org/10.1007/s43390-022-00612-7

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