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Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis

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Abstract

Study Design

Prospective cohort.

Objective

To compare preoperative hemoglobin levels to postoperative hemoglobin levels in patients with early-onset scoliosis (EOS).

Summary of Background Data

Elevated hemoglobin (Hgb) may be a marker for preoperative hypoxia in patients with EOS and thoracic insufficiency syndrome (TIS). The changes in Hgb level after treatment may be a surrogate marker for improved oxygenation.

Methods

Because normal levels of Hgb vary with patient age, Hgb z scores were calculated by dividing age-adjusted mean Hgb levels by the age-adjusted standard deviation. Elevated Hgb was defined by a hemoglobin z score >1. Patients with a baseline Hgb value measured before initial implantation with at least one follow-up measurement, at 6, 12, or 18 months, were included in longitudinal analysis. Change in Hgb z score as well as change in curve magnitude over time was assessed using piecewise linear mixed modeling for patients with elevated Hgb and those without.

Results

Two hundred sixty-seven patients with EOS were treated surgically over the study period. Average age at initial implantation was 6.8 years. Forty-eight (18%; 95% confidence interval = 13.7%, 23.2%) subjects had an elevated Hgb (z score > 1) level before implantation procedure. Hgb levels decreased in subjects with elevated Hgb from implantation to 6 months (p < .001) with no change in Hgb from 6 to 12 months (p = .46) or from 12 to 18 months (p = .59), but an overall decrease from preoperative to 18 months (p < .001). There was no change in Hgb levels for subjects without elevated Hgb from implantation to 6 months (p = .94), from 6 to 12 months (p = .61), or from 12 to 18 months (p = .78).

Conclusions

In some patients with EOS and TIS, there appears to be significant positive impact on oxygenation from distraction instrumentation as evidenced by a meaningful proxy measurement: improvement in abnormal preoperative Hgb levels after surgery.

Level of Evidence

III.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Michael Glotzbecker MD, Patricia Miller MPH, Leah DeWitt BA, Alexandra Grzywna BA & John Emans MD

  2. Department of Orthopaedic Surgery, Morgan Stanley Hospital, 3959 Broadway, New York, NY, 10032, USA

    Michael Vitale MD, MPH

  3. Department of Orthopaedic Surgery, Campbell Clinic Orthopaedics, 1211 Union Ave Suite 500, Memphis, TN, 38104, USA

    Jeffrey Sawyer MD

  4. Department of Orthopaedic Surgery, Shriners Hospital for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Joshua Pahys MD

  5. Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Patrick Cahill MD

  6. Department of Orthopaedic Surgery, Harvard Medical School, Children’s Hospital Boston, 300 Longwood Avenue, Hunnewell 2, Boston, MA, 02115, USA

    Michael Glotzbecker MD

Authors
  1. Michael Glotzbecker MD
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  2. Patricia Miller MPH
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  3. Michael Vitale MD, MPH
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  4. Leah DeWitt BA
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  5. Alexandra Grzywna BA
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  6. Jeffrey Sawyer MD
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  7. Joshua Pahys MD
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  8. Patrick Cahill MD
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  9. John Emans MD
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Consortia

Children’s Spine Study Group

Corresponding author

Correspondence to Michael Glotzbecker MD.

Additional information

Author disclosures: MG (other from Biomet/Zimmer and DePuy/-Synthes; personal fees from Orthobullets, the Harms Study Group, Growing Spine Study Group [GSSG], and Children’s Spine Study Group member, outside the submitted work), PM (none), MV (grants from Pe-diatric Orthopaedic Society of North America [POSNA], during the conduct of the study; other from POSNA and Biomet; personal fees from Stryker, Biomet, and Medtronic; other from Wellinks, outside the submitted work), LDW (none), AG (none), JS (none), JP (none), PC (personal fees from Globus Medical and Ellipse Technologies, Inc.; personal fees and other from Medtronic Inc.; other from DePuy Synthes Spine; personal fees from DePuy, a Johnson & Johnson Company, outside the submitted work; American Academy of Orthopaedic Surgeons: board or committee member; Journal of Bone and Joint SurgeryeAmerican: editorial or governing board; POSNA: board or committee member; Scoliosis Research Society: board or committee member; Spine Deformity: editorial or governing board.), JE (other from Medtronics, Synthes/DePuy/J&J, and Zimmer/Biomet, outside the submitted work), Children’s Spine Study Group (grants from DePuy Syn-thes, grants from NuVasive, outside the submitted work).

The study was conducted using the Harms Study Group CP Database. The Harms Study Group receives funding from the Setting Scoliosis Straight Foundation.

No funding was received for this work from any of the following organizations: National Institutes of Health (NIH); Welcome Trust; Howard Hughes Medical Institute (HHM).

IRB approval: Institutional review board approval was received for both the Children’s Spine Study Group (CSSG) and participating sites for the research.

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Glotzbecker, M., Miller, P., Vitale, M. et al. Hemoglobin Levels Pre- and Posttreatment as a Surrogate for Disease Severity in Early-Onset Scoliosis. Spine Deform 7, 641–646 (2019). https://doi.org/10.1016/j.jspd.2018.11.002

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  • DOI: https://doi.org/10.1016/j.jspd.2018.11.002

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