Abstract
Study Design
Retrospective, comparative.
Objectives
To determine if distraction-based surgeries will increase spine length in patients with nonidiopathic EOS and whether etiology affects final spine length.
Summary of Background Data
As early-onset scoliosis (EOS) has many etiologies, it is unclear whether etiology affects the spine length achieved with distraction-based surgeries. Since distraction may produce kyphosis, sagittal spine length (SSL; curved arc length of the spine in the sagittal plane) should be utilized.
Methods
Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, 5 lengthenings) were identified from two EOS registries. Radiographic analysis preoperation, postimplant (L1), and after each lengthening (L2–L5, L6–L10, L11–L15) was performed with primary outcome of T1–S1 SSL.
Results
We identified 126 patients (67 congenital, 38 syndromic, 21 neuromuscular) with a mean preoperative age of 4.6 years, scoliosis 75°, kyphosis 48°, and a mean of 12 lengthenings. After initial correction (p < .05), scoliosis remained constant (58° at L11–L15) and kyphosis increased (38° at L1 to 60° at L11–L15) (p < .05). SSL increased for the entire group from 27.1 cm preoperation to 35.3 cm at L11–L15 (p < .05) and during the distraction phase (29.2 cm at L1 to 35.3 cm at L11–L15) (p < .05). Preoperative SSL was higher in neuromuscular compared with congenital patients and maintained that difference until the 10th lengthening. Preoperative SSL did not differ between syndromic and congenital patients (28.0 cm vs. 25.6 cm); however, syndromic patients had greater SSL after implantation (L1: 30.5 cm vs. 26.8 cm) (p < .05) and maintained that difference until the 15th lengthening (37.1 cm vs. 34.3 cm) (p < .05).
Conclusion
At minimum 5-year follow-up, distraction-based surgeries increased spine length for all patients with nonidiopathic EOS; however, neuromusculars had higher preoperative spine length compared with congenital patients and maintained that difference until the 10th lengthening. Although congenital and syndromic patients had similar preoperative spine length, syndromic patients had greater SSL after implantation (L1) and maintained that difference until the 15th lengthening.
Level of Evidence
Level III.
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Author disclosures: YE (none), JH (none), KP (none), CJ (other from Medtronics and Elsevier, outside the submitted work), AM (none), AS (personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, Misonix, Stryker, and Zimmer Biomet; other from Setting Scoliosis Straight Foundation, Scoliosis Research Society, and Children’s Spine Study Group [CSSG], outside the submitted work), MG (other from Orthobullets, NuVasive, DePuy, Zimmer Biomet, Medtronic, the Global Spine Study Group [GSSG], CSSG, the Harms Study Group [HSG], outside the submitted work), AA (none), TSH (none), REH (personal fees from DePuy Synthes Spine, Medtronic Spine, and Apifix Ltd.; grants from DePuy Synthes Spine, United States and Medtronic Spine, United States; other from Children’s Spine Foundation, United States, Pediatric Orthopedic Society of North America, and Scoliosis Research Society, United States; personal fees from Wishbone Medical, outside the submitted work), Children’s Spine Study Group (none), Growing Spine Study Group (grants from DePuy Synthes Spine and NuVasive, outside the submitted work).
IRB approval: IWK Health Center REB File #1002256.
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ElBromboly, Y., Hurry, J., Padhye, K. et al. Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis—5-Year Follow-up. Spine Deform 7, 822–828 (2019). https://doi.org/10.1016/j.jspd.2019.02.001
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DOI: https://doi.org/10.1016/j.jspd.2019.02.001