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Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs

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Abstract

Study Design

Retrospective review of prospectively collected data.

Objective

To compare the use of spine-based versus rib-based implants for the treatment of early-onset scoliosis (EOS) in the setting of rib fusions.

Summary of Background Data

Treatment for severe early-onset spinal deformity with rib fusions includes growing spine devices with proximal rib or spine anchors. The results of treatment, however, have not been compared between spine-based versus rib-based proximal anchors.

Methods

169 patients with rib fusions treated with rib-based or spine-based constructs and minimum two-year follow-up were included. Sixteen patients were treated with proximal spine-based anchors and 153 with proximal rib-based devices (VEPTRs). Overall, 104 of the patients with rib-based fixation underwent thoracoplasty at the index surgery. We evaluated change in T1–T12 and T1–S1 height, coronal Cobb angle, kyphosis, and number of lengthening/revision surgeries.

Results

Kyphosis increased a mean of 7° in the rib-based group and decreased a mean of 20 degrees in the spine-based group (p = .002). Major Cobb angle decreased in both groups (p < .0001); however, the spine-based group had greater Cobb angle improvement (24 vs. 11 degrees, p = .04). From implant and lengthening of distraction devices, there was a mean 3.3-cm (22%) increase in T1–T12 height and a mean of 8.0 lengthenings in the rib-based group compared with a 5.7-cm increase and 6.3 lengthening surgeries in the spine-based group. Patients with rib-based constructs had a mean of 11 total procedures, whereas spine-based patients had a mean of 8.

Conclusions

Patients underwent a mean of eight lengthening surgeries before final fusion or cessation of lengthening with a modest 2.3-cm increase in T1–T12 height. Compared with proximal rib anchors, proximal spine anchors controlled kyphosis and improved Cobb angle correction for early-onset scoliosis with rib fusions.

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References

  1. Day GA, Upadhyay SS, Ho EK, et al. Pulmonary functions in congenital scoliosis. Spine (Phila Pa 1976) 1994;19:1027–31.

    Article  CAS  Google Scholar 

  2. Campbell Jr RM, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 2003;85:399–408.

    Article  Google Scholar 

  3. Emans JB, Caubet JF, Ordonez CL, et al. The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib. Spine (Phila Pa 1976) 2005;30(17 Suppl):S58–68.

    Article  Google Scholar 

  4. Olson JC, Kurek KC, Mehta HP, et al. Expansion thoracoplasty affects lung growth and morphology in a rabbit model. Clin Orthop Relat Res 2011;469:1375–82.

    Article  Google Scholar 

  5. Mehta HP, Snyder BD, Baldassarri SR, et al. Expansion thoracoplasty improves respiratory function in a rabbit model of postnatal pulmonary hypoplasia. Spine (Phila Pa 1976) 2010;35:153–61.

    Article  Google Scholar 

  6. Corona J, Sanders JO, Luhmann SJ, et al. Reliability of radiographic measures for infantile idiopathic scoliosis. J Bone Joint Surg Am 2012;94:e86.

    Article  Google Scholar 

  7. El-Hawary R, Samdani A, Wade J, et al. Rib-based distraction surgery maintains total spine growth. J Pediatr Orthop 2016;36: 841–6.

    Article  Google Scholar 

  8. Gomez JA, Lee JK, Kim PD, et al. “Growth Friendly” spine surgery: management options for the young child with scoliosis. J Am Acad Orthop Surg 2011;19:722–7.

    Article  Google Scholar 

  9. El-Hawary R, Kadhim M, Vitale M, et al; Children’s Spine Study Group. VEPTR implantation to treat children with early-onset scoliosis without rib abnormalities: early results from a prospective multi-center study. J Pediatr Orthop 2017;37:e599–605.

    Article  Google Scholar 

  10. Tsirikos AI, McMaster MJ. Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine. J Bone Joint Surg Am 2005;87:2523–36.

    PubMed  Google Scholar 

  11. Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (Phila Pa 1976) 2010;35:2193–204.

    Article  Google Scholar 

  12. Murphy RF, Moisan A, Kelly DM, et al. Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the treatment of scoliosis without fused ribs. J Pediatr Orthop 2016;36:329–35.

    Article  Google Scholar 

  13. Waldhausen JHT, Redding G, White K, Song K. Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children. J Pediatr Surg 2016;51:1747–50.

    Article  Google Scholar 

  14. Sankar WN, Skaggs DL, Yazici M, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine (Phila Pa 1976) 2011;36:806–9.

    Article  Google Scholar 

  15. Luhmann SJ, Smith JC, McClung A, et al; Growing Spine Study Group. Radiographic outcomes of Shilla growth guidance system and traditional growing rods through definitive treatment. Spine Deform 2017;5:277–82.

    Article  Google Scholar 

  16. Akbarnia BA, Pawelek JB, Cheung KM, et al; Growing Spine Study Group. Traditional growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a case-matched 2-year study. Spine Deform 2014;2:493–7.

    Article  Google Scholar 

  17. Thompson W, Thakar C, Rolton DJ, et al. The use of magnetically-controlled growing rods to treat children with early-onset scoliosis: early radiological results in 19 children. Bone Joint J 2016;98:1240–7.

    Article  Google Scholar 

  18. Ridderbusch K, Rupprecht M, Kunkel P, et al. Preliminary results of magnetically controlled growing rods for early onset scoliosis. J Pediatr Orthop 2017;37:e575–80.

    Article  Google Scholar 

  19. Cheung JP, Yiu KK, Samartzis D, et al. Rod lengthening with the magnetically controlled growing rod: factors influencing rod slippage and reduced gains during distractions. Spine (Phila Pa 1976) 2018;43:E399–405.

    Article  Google Scholar 

  20. Campbell Jr RM, Hell-Vocke AK. Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am 2003;85:409–20.

    Article  Google Scholar 

  21. 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 

  22. Flynn JM, Emans JB, Smith JT, et al. VEPTR to treat nonsyndromic congenital scoliosis: a multicenter, mid-term follow-up study J Pediatr Orthop 2013;33:679–84.

    Article  Google Scholar 

  23. Spurway AJ, Hurry JK, Gauthier L, et al. Three-dimensional true spine length: a novel technique for assessing the outcomes of scoliosis surgery. J Pediatr Orthop 2017;37:e631–7.

    Article  Google Scholar 

  24. 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 

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Author information

Authors and Affiliations

  1. Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA

    A. Noelle Larson MD & Fady J. Baky MD

  2. Children’s Spine Foundation, P.O. Box 397, Valley Forge, PA, 19481, USA

    Tricia St. Hilaire MPH

  3. Growing Spine Foundation, 555 East Wells Street, Suite 1100, Milwaukee, WI, 53202, USA

    Jeff Pawelek BS

  4. Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA

    David L. Skaggs MD

  5. Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    John B. Emans MD

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

    Joshua M. Pahys MD

Authors
  1. A. Noelle Larson MD
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  2. Fady J. Baky MD
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  3. Tricia St. Hilaire MPH
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  4. Jeff Pawelek BS
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  5. David L. Skaggs MD
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  6. John B. Emans MD
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  7. Joshua M. Pahys MD
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Consortia

Children’s Spine Study Group

Growing Spine Study Group

Corresponding author

Correspondence to A. Noelle Larson MD.

Additional information

Author disclosures: ANL (grants from NIH T32 training grant, during the conduct of the study; other from K2M, Orthopediatrics, outside the submitted work), FJB (none), TSH (none), JP (other from San Diego Spine Foundation, outside the submitted work), DLS (grants from Pediatric Orthopaedic Society of North America & Scoliosis Research Society, paid to Columbia University; Ellipse (co–principal investigator, paid to GSF), personal fees from ZimmerBiomet; Medtronic; Zipline Medical, Inc.; Orthobullets; Grand Rounds (a health care navigation company), Green Sun Medical, other from Zipline Medical, Inc.; Green Sun Medical, from Orthobullets, nonfinancial support from Growing Spine Study Group; Scoliosis Research Society; Growing Spine Foundation , personal fees from ZimmerBiomet; Medtronic; Johnson & Johnson, other from Medtronic & ZimmerBiomet, from Wolters Kluwer Health–Lippincott Williams & Wilkins; Biomet Spine, other from Orthobullets, Co–Editor in Chief, outside the submitted work), JBE (other from Medtronics, J&J, DePuy, Synthes, and Zimmer Biomet, outside the submitted work), JMP (other from DePuy Synthes, Globus, and Zimmer, outside the submitted work), Children’s Spine Study Group (grants from DePuy Synthes Spine, grants from Nuvasive, outside the submitted work), Growing Spine Study Group (grants from Growing Spine Foundation, during the conduct of the study; grants from NuVasive, outside the submitted work; the Growing Spine Foundation financially supports the Growing Spine Study Group, which provided the research data for this study. The GSF receives donations from the study group’s surgeon members, medical device industry, grateful patients, and other donors).

Acknowledgments/Funding: FJB was supposed by an NIH T32 Musculoskeletal Training grant (T32AR056950). ANL was supported by an NIH grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (R03AR66342). Growing Spine Foundation financially supports the Growing Spine Study Group, which provided research data for this study. Children’s Spine Foundation supports Children’s Spine Study Group, which provided research data for this study.

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Larson, A.N., Baky, F.J., St. Hilaire, T. et al. Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs. Spine Deform 7, 152–157 (2019). https://doi.org/10.1016/j.jspd.2018.05.011

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  • DOI: https://doi.org/10.1016/j.jspd.2018.05.011

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