Skip to main content

Advertisement

SpringerLink
Log in

Complications and Radiographic Outcomes of Posterior Spinal Fusion and Observation in Patients Who Have Undergone Distraction-Based Treatment for Early Onset Scoliosis

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Study Design

Retrospective, multicenter.

Objectives

To compare surgical and radiographic outcomes of early-onset scoliosis (EOS) patients who had stopped lengthening for ≥2 years without additional surgery to those who had posterior spinal fusion (PSF) at the end of lengthening.

Summary of Background Data

Because of the risk of significant complications with PSF in patients with EOS, “watchful waiting” at the end of lengthening has been suggested as a viable alternative.

Methods

Retrospective review of the Children’s Spine Study Group (CSSG) database identified all patients with the diagnosis of EOS who had distraction-based treatment, who were ≥2 years from their last distraction, and who had complete records. Radiographic measures were obtained by a single unbiased trained observer. Treatment outcomes including curve correction, height and length gain, as well as complications were recorded.

Results

The 37 patients (21 females and 16 males) had a mean age of 7.2 years; 12 were in the observation (OBS) and 25 in the PSF group. The PSF group had a slightly greater coronal Cobb angle and maximal kyphosis at the end of distraction. Although there was some correction of the coronal Cobb angle and maximal kyphosis following PSF, the differences between the two groups were not statistically significant at final follow-up. At final follow-up, the OBS group obtained 88% of T1–T12 height and 90% of T1–L1 length of that obtained by the PSF group. Twenty-six complications occurred in 15 patients, all in the PSF group.

Conclusions

Observation may be a viable alternative to PSF after distraction-based treatment in a subset of patients with EOS. PSF was found to provide no significant curve correction or gains in spine height and length compared to observation and carries a significant risk of complications.

Level of Evidence

Level III, therapeutic

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ghandehari H, Mahabadi MA, Mahdavi SM, et al. Evaluation of patient outcome and satisfaction after surgical treatment of adolescent idiopathic scoliosis using Scoliosis Research Society-30. Arch Bone Jt Surg 2015;3:109–13.

    PubMed  PubMed Central  Google Scholar 

  2. Flynn JM, Tomlinson LA, Pawelek J, et al. Growing-rod graduates: lessons learned from ninety-nine patients who completed lengthening. J Bone Joint Surg Am 2013;93:1745–50.

    Article  Google Scholar 

  3. Jain SP, Flynn JM, Shah SA, et al. Can a “final” surgical fusion be avoided in patients with early-onset scoliosis who reach skeletal maturity after growing-rod treatment? J Bone Joint Surg Am 2016;98:1073–8.

    Article  Google Scholar 

  4. Sankar WN, Skaggs DL, Yazici M, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine 2011;36:106–9.

    Article  Google Scholar 

  5. Corona J, Matsumoto H, Roye DP, et al. Measuring quality of life in children with early onset scoliosis: development and initial validation of the early onset scoliosis questionnaire. J Pediatr Orthop 2011;31:180–5.

    Article  Google Scholar 

  6. Vitale MG, Corona J, Matsumoto H, et al. Development and initial validation of a disease specific outcome measure for early onset scoliosis. Stud Health Technol Inform 2010;158:172–6.

    PubMed  Google Scholar 

  7. Williams BA, Matsumoto H, McCalla DJ, et al. Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am 2014;96:1359–67.

    Article  Google Scholar 

  8. Spurway AJ, Chukwunyerenwa CK, Kishta WE, et al. Sagittal spine length measurement: a novel technique to assess growth of the spine. Spine Deform 2016;4:331–7.

    Article  Google Scholar 

  9. Smith JT, Johnston C, Skaggs D, et al. A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 2015;35:798–803.

    Article  Google Scholar 

  10. Skaggs DL, Guillaume T, El-Hawary R, et al. SRS Growing Spine Early Onset Scoliosis Consensus Statement. SRS Growing Spine Committee, 2015. Spine Deform 2015;3:107.

    Article  Google Scholar 

  11. de Mendonca RG, Sawyer JR, Kelly DM. Complications after surgical treatment of adolescent idiopathic scoliosis. Orthop Clin North Am 2016;47:395–403.

    Article  Google Scholar 

  12. Astur N, Flynn JM, Ramirez N, et al. The efficacy of rib-based distraction with VEPTR in the treatment of early-onset scoliosis in patients with arthrogryposis. J Pediatr Orthop 2014;34:8–13.

    Article  Google Scholar 

  13. Dreimann M, Hoffmann M, Kossow K, et al. Scoliosis and chest cage deformity measures predicting impairments in pulmonary function: a cross-sectional study of 492 patients with scoliosis to improve the early identification of patients at risk. Spine 2014;39:2024–33.

    Article  Google Scholar 

  14. Dede O, Motoyama EK, Yang CI, et al. Pulmonary and radiographic outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) treatment in early onset scoliosis. J Bone Joint Surg Am 2014;96:1295–302.

    Article  Google Scholar 

  15. Myung KD, Skaggs DL, Thompson GH, et al. Nutritional improvement following growing rod surgery in children with early onset scoliosis. J Child Orthop 2014;8:251–6.

    Article  Google Scholar 

  16. Cahill PJ, Marvil S, Cuddihy L, et al. Autofusion in the immature spine treated with growing rods. Spine (Phila Pa 1976) 2010;35:E1199–203.

    Article  Google Scholar 

  17. Canavese F, Dimeglio A. Normal and abnormal spine and thoracic cage development. World J Orthop 2013;34:167–74.

    Article  Google Scholar 

  18. Karol LA, Johnston C, Mladenov K, et al. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am 2008;90:1272–81.

    Article  Google Scholar 

  19. Latalski M, Fatyga M, Gregosiewicz A. Problems and complications in VEPTR-based treatment. Ortop Traumatol Rehabil 2011;13:449–55.

    Article  Google Scholar 

  20. Murphy RF, Moisan A, Kelly DM, et al. Use of vertical expandable prosthetic titanium rib (VEPTR) in the treatment of congenital scoliosis without fused ribs. J Pediatr Orthop 2016;36:329–35.

    Article  Google Scholar 

  21. Parnell SE, Effmann EL, Song K, et al. Vertical expandable prosthetic titanium rib (VEPTR): a review of indications, normal radiographic appearance and complications. Pediatr Radiol 2015;45:606–16.

    Article  Google Scholar 

  22. Upasani VV, Miller PE, Emans JB, et al. VEPTR implantation after age 3 is associated with similar radiographic outcomes with fewer complications. J Pediatr Orthop 2016;36:219–25.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. LeBonheur Children’s Hospital, University of Tennessee-Campbell Clinic, Memphis, TN, USA

    Jeffrey R. Sawyer MD, Rodrigo Góes Medéa de Mendonça MD, Stephen J. Soufleris BS & Ryan P. Murphy BS

  2. Philadelphia Shriners Children’s Hospital, Philadelphia, PA, USA

    Amer F. Samdani MD

  3. IWK Health Centre, Halifax, Nova Scotia, Canada

    Ron El-Hawary MD & Alan J. Spurway MASc

  4. Salt Lake Primary Children’s Hospital, Salt Lake City, UT, USA

    John T. Smith MD

  5. Boston Children’s Hospital, Boston, MA, USA

    John B. Emans MD

  6. Children’s Spine Study Group, Aurora, USA

    Tara S. Flynn BA & Tricia A. St. Hilaire MPH

Authors
  1. Jeffrey R. Sawyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodrigo Góes Medéa de Mendonça MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tara S. Flynn BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amer F. Samdani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ron El-Hawary MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alan J. Spurway MASc
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John T. Smith MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John B. Emans MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tricia A. St. Hilaire MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stephen J. Soufleris BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ryan P. Murphy BS
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Children’s Spine Study Group

Corresponding author

Correspondence to Jeffrey R. Sawyer MD.

Additional information

Author disclosures: JRS (personal fees from DePuy, grants from Medicrea Spine, personal fees from Nuvasive, personal fees from Elsevier, personal fees from Wolters-Kluwer, outside the submitted work); RGMM (none); TSF (none); AFS (personal fees from DePuy, personal fees from Ethicon, personal fees from Globus Medical, from Stryker, personal fees from Zimmer, outside the submitted work); REH (grants and personal fees from DePuy, grants and personal fees from Medtronic, outside the submitted work); AJS (none); JTS (personal fees from Biomet, personal fees from Ellipse Technologies, personal fees from Globus Medical, personal fees from Spineguard, personal fees from Synthes, outside the submitted work); JBE (personal fees from Medtronic Sofamor Danek, personal fees from Synthes, outside the submitted work); TSH (none); SJS (none); RPM (none).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sawyer, J.R., de Mendonça, R.G.M., Flynn, T.S. et al. Complications and Radiographic Outcomes of Posterior Spinal Fusion and Observation in Patients Who Have Undergone Distraction-Based Treatment for Early Onset Scoliosis. Spine Deform 4, 407–412 (2016). https://doi.org/10.1016/j.jspd.2016.08.007

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2016.08.007

Keywords

Search

Navigation