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The Effect of Expansion Thoracostomy on Spine Growth in Patients with Spinal Deformity and Fused Ribs Treated with Rib-Based Growing Constructs

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Abstract

Study Design

Retrospective review of prospective registries.

Objectives

We hypothesized that patients with congenitally fused ribs who underwent thoracostomy upon implantation of rib-based distraction devices would achieve improved spine growth compared with those who did not undergo thoracostomy.

Summary of Background Data

Patients with fused ribs may develop thoracic insufficiency syndrome. Treatment for severe early-onset spinal deformity with rib fusions often includes the placement of rib-based expansion devices with surgical division of the fused ribs (thoracostomy). The effect of thoracostomy on spinal growth has not been fully examined.

Methods

Two multicenter registries of primarily prospectively collected data were searched. Patients with fused ribs and implantation of a rib-based device were identified. A total of 151 patients with rib fusions treated with rib-based constructs and minimum two-year follow-up were included. Among those, 103 patients were treated with expansion thoracostomy at the time of implantation, whereas 48 patients received device implantation alone. We evaluated change in T1–T12 and T1–S1 height, coronal Cobb angle, kyphosis, and number of surgeries. Preoperative deformity was similar between the two groups. Only 19% of patient underwent final fusion, with similar numbers fused in each group.

Results

At latest follow-up, the expansion thoracostomy group had a greater total improvement in T1–S1 height (7.2 cm vs. 4.8 cm, p = .004). There was no difference between the two groups for change in spinal height at each lengthening procedure. Interestingly, thoracostomy patients also underwent more total surgeries (11.5 vs. 9.6, p = .031) and more lengthening procedures (8.3 vs. 6.6, p = .017) than the comparison group despite similar length of follow-up.

Conclusions

Patients who underwent expansion thoracostomy at the time of rib expansion device implantation achieved greater improvement in T1–S1 height than those who underwent implantation of rib expansion device alone. Further work is needed to evaluate whether expansion thoracostomy impacts pulmonary function.

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Author information

Authors and Affiliations

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

    Fady J. Baky MD & A. Noelle Larson MD

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

    Tricia Hilaire MPH

  3. Growing Spine Foundation, 555 E. Wells St., 53202, Milwaukee, WI, USA

    Jeff Pawelek MD

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

    David L. Skaggs MD

  5. Boston Children’s Hospital, Harvard Medical School, 25 Shattuck Street, 02115, Boston, MA, USA

    John B. Emans MD

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

    Joshua M. Pahys MD

Authors
  1. Fady J. Baky MD
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  2. A. Noelle Larson MD
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  3. Tricia Hilaire MPH
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  4. Jeff Pawelek MD
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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: FJB (none), ANL (grants from Orthopediatrics and K2M, outside the submitted work), TSH (none), JP (other from San Diego Spine Foundation, outside the submitted work), DLS (grants from Pediatric Orthopaedic Society of North America, United States and Scoliosis Research Society, United States, paid to Columbia University; Ellipse [co-PI, paid to GSF]; personal fees from ZimmerBiomet, Medtronic; Zipline Medical, Inc., Orthobullets, Grand Rounds (a healthcare navigation company), and Green Sun Medical; other from Zipline Medical, Inc, Green Sun Medical, and 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, Wolters Kluwer Health–Lippincott Williams & Wilkins, Biomet Spine, and Orthobullets [co-editor in chief], outside the submitted work), JBE (personal fees from Zimmer/Biomet; personal fees and other from J&J/DePuy/Synthes, outside the submitted work), JMP (personal fees from DePuy Synthes, NuVasive, and Zimmer Biomet, outside the submitted work), Children’s Spine Study Group (grants from DePuy Synthes Spine, United States, NuVasive, United States, and Biomet, United States, outside the submitted work; and the Children’s Spine Study Group is supported by the Children’s Spine Foundation, United States; the Children’s Spine Foundation receives donations from the public, from clinical members, and from corporations as disclosed above), Growing Spine Study Group (other from Growing Spine Foundation [GSF], during the conduct of the study; grants from Pediatric Orthopaedic Society of North America, grants from US Food and Drug Administration, grants from NuVasive, outside the submitted work; and the GSF 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).

IRB approval: IRB approval was obtained for all aspects of this study.

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Baky, F.J., Larson, A.N., Hilaire, T. et al. The Effect of Expansion Thoracostomy on Spine Growth in Patients with Spinal Deformity and Fused Ribs Treated with Rib-Based Growing Constructs. Spine Deform 7, 836–841 (2019). https://doi.org/10.1016/j.jspd.2019.01.004

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  • DOI: https://doi.org/10.1016/j.jspd.2019.01.004

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