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Lullo BR, Cahill PJ, Flynn JM, Anari JB. Predicting early return to the operating room in early-onset scoliosis patients using machine learning techniques. Spine Deform 2024; 12:1165-1172. [PMID: 38530612 DOI: 10.1007/s43390-024-00848-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/14/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Surgical treatment of early-onset scoliosis (EOS) is associated with high rates of complications, often requiring unplanned return to the operating room (UPROR). The aim of this study was to create and validate a machine learning model to predict which EOS patients will go on to require an UPROR during their treatment course. METHODS A retrospective review was performed of all surgical EOS patients with at least 2 years follow-up. Patients were stratified based on whether they had experienced an UPROR. Ten machine learning algorithms were trained using tenfold cross-validation on an independent training set of patients. Model performance was evaluated on a separate testing set via their area under the receiver operating characteristic curve (AUC). Relative feature importance was calculated for the top-performing model. RESULTS 257 patients were included in the study. 146 patients experienced at least one UPROR (57%). Five factors were identified as significant and included in model training: age at initial surgery, EOS etiology, initial construct type, and weight and height at initial surgery. The Gaussian naïve Bayes model demonstrated the best performance on the testing set (AUC: 0.79). Significant protective factors against experiencing an UPROR were weight at initial surgery, idiopathic etiology, initial definitive fusion construct, and height at initial surgery. CONCLUSIONS The Gaussian naïve Bayes machine learning algorithm demonstrated the best performance for predicting UPROR in EOS patients. Heavier, taller, idiopathic patients with initial definitive fusion constructs experienced UPROR less frequently. This model can be used to better quantify risk, optimize patient factors, and choose surgical constructs. LEVEL OF EVIDENCE Prognostic: III.
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Affiliation(s)
- Brett R Lullo
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Division of Orthopaedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Patrick J Cahill
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John M Flynn
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason B Anari
- Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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2
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Okuwaki S, Kotani T, Taniguchi Y, Suzuki T, Yamaguchi T, Demura S, Wada K, Sugawara R, Takeshita K, Watanabe K, Akazawa T, Kawakami N. Evaluation of crankshaft phenomenon after posterior fusion for early onset scoliosis using an inverse trigonometric function: a multicenter retrospective cohort study. Spine Deform 2024:10.1007/s43390-024-00900-4. [PMID: 38805146 DOI: 10.1007/s43390-024-00900-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The crankshaft phenomenon (CSP) is a corrective loss after posterior surgery for early onset scoliosis (EOS). However, an accurate method for CSP evaluation has yet to be developed. In this study, we evaluated pedicle screw (PS) length and rotation angle using an inverse trigonometric function and investigated the prevalence of the CSP. METHODS Fifty patients from nine institutions (mean age 10.6 years, male/female ratio 4:46) who underwent early definitive fusion surgery at ≤ 11 years of age were included. The rotation angle was calculated as arctan (lateral/frontal PS length) using radiography. Measurements were taken at the apex and lower instrumented vertebra (LIV) immediate, 2-, and 5-year postoperatively. CSP was defined as a rotation angle progression ≥ 5°. We divided patients into CSP and non-CSP groups and measured the demographic parameters, Risser grade, state of the triradiate cartilage, major coronal Cobb angle, T1-T12 length, T1-S1 length, and presence of distal adding-on (DAO). We compared these variables between groups and investigated the correlation between the measured variables and vertebral rotation. Logistic regression analysis investigated factors associated with CSP. RESULTS The rotation angle progressed by 2.4 and 1.3° over 5 years for the apex and LIV, respectively. CSP occurred in 15 cases (30%), DAO in 11 cases (22%), and CSP and DAO overlapped in 4 cases (8%). In the CSP group, the T1-T12 length was low immediate postoperatively. The rotation angle was negatively correlated with preoperative height (r = - 0.33), T1-T12 length (r = - 0.35), and T1-S1 length (r = - 0.30). A lower preoperative T1-T12 length was associated with CSP (odds ratio: 0.996, p = 0.048). CONCLUSIONS CSP occurred in 30% of patients with EOS who underwent definitive fusion. The presence of CSP was associated with a lower preoperative T1-T12 length. LEVEL OF EVIDENCE Diagnosis, level IV.
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Affiliation(s)
- Shun Okuwaki
- Department of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, Japan.
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan.
- Japan Spinal Deformity Institute, Aichi, Japan.
| | - Toshiaki Kotani
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Teppei Suzuki
- Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Hyogo, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Toru Yamaguchi
- Department of Orthopaedic and Spine Surgery, Fukuoka Children's Hospital, Fukuoka, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Ishikawa, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Aomori, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Ryo Sugawara
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Katsushi Takeshita
- Department of Orthopaedic Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, School of Medicine, Niigata University, Niigata, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
| | - Noriaki Kawakami
- Department of Orthopaedic Surgery, Ichinomiyanishi Hospital, Aichi, Japan
- Japan Spinal Deformity Institute, Aichi, Japan
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Jamnik AA, Grigoriou E, Kadado A, Jo CH, Boes N, Thornberg D, Tran DP, Ramo B. Radiographic and clinical outcomes after definitive spine fusion for skeletally immature patients with idiopathic scoliosis. Spine Deform 2024; 12:149-157. [PMID: 37624555 DOI: 10.1007/s43390-023-00757-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To assess the intermediate-term radiographic and clinical outcomes of skeletally immature idiopathic scoliosis (IS) patients that underwent definitive fusion (DF). METHODS A retrospective review of patients with IS who were Risser 0 with open tri-radiate cartilages at the time of DF with minimum 5-year follow-up. Outcomes included Scoliosis Research Society (SRS)-30 scores, major Cobb angle, pulmonary function tests (PFTs), and unplanned returns to the operating room (UPROR). Adding-on was defined as progression of the major Cobb angle > 5° or tilt of the lowest instrumented vertebra > 5°. RESULTS Thirty-two patients (78% female, mean age 12.2 ± 1.3 years old, mean preoperative major Cobb 64.8° ± 15.9) were included. Of these patients, 20 (62.5%) experienced adding-on and 6 (18.8%) required a revision surgery to correct their progressive spinal deformity. Adding-on was associated with lower 5-year postoperative SRS scores for appearance (3.7 ± 0.7 vs 4.4 ± 0.3, p = 0.0126), mental health (4.2 ± 0.6 vs 4.6 ± 0.3, p = 0.0464), satisfaction with treatment (4.0 ± 0.8 vs 4.7 ± 0.4, p = 0.0140), and total score (4.0 ± 0.4 vs 4.4 ± 0.2, p = 0.0035). The results of the PFTs did not differ between groups. Patients experienced an average of 0.53 UPROR/patient. CONCLUSION DF in skeletally immature patients results in a high rate of adding-on, which adversely affects Health-Related Quality of Life. However, reoperation rates, both planned and unplanned, remain lower when compared to patients undergoing growth-friendly treatment.
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Affiliation(s)
- Adam A Jamnik
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Allen Kadado
- Department of Orthopedic Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Nathan Boes
- Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - David Thornberg
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Dong-Phuong Tran
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Brandon Ramo
- Scottish Rite for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
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Vergillos-Luna M, Alhada T, Oborocianu I, Miladi L, Monticone M, Rampal V, Saint-Pol AL, Bertoncelli CM, Boissière L, Solla F. Bipolar Fusionless Versus Standard Fusion Surgery in Neuromuscular Scoliosis: A Two-center Comparative Study. Clin Spine Surg 2023; 36:444-450. [PMID: 37348070 DOI: 10.1097/bsd.0000000000001472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN Nonrandomized controlled cohort. OBJECTIVE To compare early results between bipolar fusionless construct (BFC) and single posterior fusion (SPF) surgery in neuromuscular scoliosis (NMS). BACKGROUND Surgical treatments for NMS have traditionally been characterized by high complication rates. A mini-invasive BFC was developed to reduce these risks while maintaining adequate curve reduction. There is, however, a current lack of studies comparing clinical and radiologic perioperative outcomes between both techniques. METHODS All patients surgically treated for NMS with to-pelvis construct between 2011 and 2021 at 2 centers were included and divided into 2 groups according to the surgical technique (BFC or SPF). Gender, age, main deformity region, etiology, preoperative and postoperative main curve magnitude and pelvic obliquity, surgery time, estimated blood loss and transfusion rates, length of hospital stay, the magnitude of main curve and pelvic obliquity correction, and early complications were compared. Quantitative data were compared through ANOVA or Mann-Whitney test. Analysis of qualitative outcomes was performed through Fisher exact test and logistic regressions. Kruskal-Wallis test was used to compare complications between groups. RESULTS Eighty-nine NMS patients were included: 48 in the SPF group and 41 in the BFC group. Surgery time (203 vs. 241 min), rate (32 vs. 52%) and severity of complications, unplanned returns to the operating room (15 vs. 39%), estimated blood loss (179 vs. 364 cc), and transfusion rates (27 vs. 73%) were lower in the BFC group ( P <0.05). There were no significant differences in age, maturity stage, preoperative curve magnitude, preoperative pelvic obliquity and postoperative curve, and pelvic obliquity correction between groups. CONCLUSIONS BFC may be a safer and less invasive option for NMS surgical treatment, resulting in similar curve corrections while significantly decreasing the number and severity of complications as well as intraoperative blood loss when compared with SPF. LEVEL OF EVIDENCE Level -lll.
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Affiliation(s)
| | - Toulla Alhada
- Spine Surgery Unit, CHU Bordeaux-Pellegrin, Bordeaux, France
| | - Ioana Oborocianu
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
| | - Lotfi Miladi
- Pediatrics Orthopedics Department, Necker Hospital, Paris, France
| | - Marco Monticone
- Department of Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
| | - Virginie Rampal
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
| | | | - Carlo M Bertoncelli
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
| | - Louis Boissière
- Spine Surgery Unit, CHU Bordeaux-Pellegrin, Bordeaux, France
| | - Federico Solla
- Pediatric Orthopedic and Scoliosis Surgery Unit, Lenval Hospital, Nice, France
- Department of Medical Sciences and Public Health, Physical Medicine and Rehabilitation, University of Cagliari, Cagliari, Italy
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Johnston CE, Thornberg DC, Palmer R. Comparison of treatment outcomes between growth-sparing instrumentation and definitive one-stage fusion for EOS patients ages 6-10 years. Spine Deform 2023; 11:1529-1537. [PMID: 37480508 PMCID: PMC10587013 DOI: 10.1007/s43390-023-00731-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/01/2023] [Indexed: 07/24/2023]
Abstract
PURPOSE To compare objective outcomes for EOS patients age 6-10 years treated by growth-sparing (GS) surgery or definitive one-stage correction and fusion (DF). METHODS We reviewed surgical, radiographic, PFT's, and EOSQ-24 outcomes for EOS patients > age 6 at index surgery treated at a single institution, minimum 2-year follow-up. Neuromuscular diagnoses were excluded. RESULTS 47 patients underwent index surgery between age 6 and 10.9 years. Twenty-one had DF, 26 had GS surgery (13 MCGR, 13 TGR). Diagnoses included 15 congenital, 15 idiopathic, 17 syndromic. Age at index was 9.1 years DF, 7.8 GS (p < .001). Follow-up was 63-78 months. 18/26 GS cases converted to DF, 13 due to complications, which occurred in 8/21 DF cases vs 19/26 GS (p = .016). DF patients had fewer post-index surgeries (0.6 vs 3.7, p < .001). At follow-up there were no differences in curve magnitudes, %correction, T1-12/T1-S1 segment lengths, EOSQ-24 scores or PFTs. 18 patients converting to DF after initial GS had equal outcomes as DF initially. 31 patients > age 8 at index ("tweeners") were studied separately. 13 had GS surgery (7 MCGR), 18 had DF. At > 60 months follow-up, curve magnitudes, spine lengths, PFT's, or EOSQ scores were equivalent. DF patients had fewer procedures and complications. CONCLUSION For patients age 6-10.9 years, outcomes were no different at > 5 year follow-up between DF and GS groups. DF patients had fewer total surgeries and complications. Equal outcomes also occurred for tweeners. As a result, GS treatment does not appear to benefit patients > age 8.
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Affiliation(s)
- Charles E Johnston
- Department of Orthopedics, Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA.
| | - David C Thornberg
- Department of Orthopedics, Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Robert Palmer
- Pediatric Orthopedics of Southwest Florida, 341 Turnbury Way, Naples, FL, 34110, USA
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6
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Quan T, Matsumoto H, Bonsignore-Opp L, Ramo B, Murphy RF, Brooks JT, Welborn MC, Emans JB, Anari JB, Johnston CE, Akbarnia BA, McCarthy R, Flynn J, Sawyer JR, Vitale MG, Roye BD. Definition of Tweener: Consensus Among Experts in Treating Early-onset Scoliosis. J Pediatr Orthop 2023; 43:e215-e222. [PMID: 36729774 DOI: 10.1097/bpo.0000000000002321] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The term "Tweener" is colloquially used to refer to early-onset scoliosis (EOS) patients whose age and development make them candidates for multiple surgical options. The purpose of this study was to establish expert consensus on a definition to formally characterize the Tweener population. METHODS A 3-round survey of surgeons in an international EOS study group was conducted. Surgeons were provided with various patient characteristics and asked if each was part of their definition for Tweener patients. Responses were analyzed for consensus (≥70%), near-consensus (60% to 69%), and no consensus (<60%). RESULTS Consensus was reached (89% of respondents) for including chronological age in the Tweener definition; 8 to 10 years for females and 9 to 11 years for males. Surgeons agreed for inclusion of Sanders score, particularly Sanders 2 (86.0%). Patients who have reached Sanders 4, postmenarche, or have closed triradiate cartilage should not be considered Tweeners. Bone age range of 8 years and 10 months to 10 years and 10 months for females (12 y for males) could be part of the Tweener definition. CONCLUSIONS This study suggests that the Tweener definition could be the following: patients with open triradiate cartilage who are not postmenarche and have not reached Sanders 4, and if they have one of the following: Sanders 2 or chronological age 8 to 10 years for females (9 to 11 y for males) or bone age 8 years and 10 months to 10 years and 10 months for females (12 y for males). This definition will allow for more focused and comparative research on this population. LEVEL OF EVIDENCE Level V-expert opinion.
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Affiliation(s)
- Theodore Quan
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lisa Bonsignore-Opp
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Brandon Ramo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Scottish Rite for Children, Dallas, TX
| | - Robert F Murphy
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC
| | - Jaysson T Brooks
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Scottish Rite for Children, Dallas, TX
| | - Michelle C Welborn
- Department of Orthopaedic Surgery, Shriner's Hospital for Children Portland, Portland, OR
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia
| | - Charles E Johnston
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Scottish Rite for Children, Dallas, TX
| | - Behrooz A Akbarnia
- San Diego Spine Foundation, San Diego.,Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla, CA
| | - Richard McCarthy
- Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR
| | - John Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia
| | - Jeffrey R Sawyer
- Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Germantown, TN
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center
| | - Benjamin D Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center
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Definitive fusions are better than growing rod procedures for juvenile patients with cerebral palsy and scoliosis: a prospective comparative cohort study. Spine Deform 2023; 11:145-152. [PMID: 36156790 DOI: 10.1007/s43390-022-00577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE This study compared the outcomes of juvenile patients with cerebral palsy (CP) and scoliosis who underwent spinal fusion (SF) versus growing rod (GR) surgery. METHODS Two prospective multicenter registries were queried for patients 8-10 years old with minimum 2-year follow-up who underwent SF or GR surgery (no MCGR). Demographics, radiographs, complications, and outcome scores were recorded. RESULTS There were 35 patients in the SF and 15 in the GR group. The mean age at surgery was 10 and 9.3 years in the SF and GR groups, respectively (p = 0.004). In the SF group preoperatively, the major curve measured 86° and 80° in the GR group (p = 0.40). "Definitive" surgery in the GR group consisted of SF in 10, implant retention in three, and implant removal in two. The SF group had 60.8% and the GR group had 45.0% correction following "definitive" surgery (p = 0.03). In the SF group, 8 patients and in the GR group, 9 patients (SF = 22.9%, GR = 60.0%) had a complication (p = 0.01). In the SF group, two patients (5.7%) had reoperations for infection; eight patients (53.3%) in the GR group had reoperations for infection and implant complications (p < 0.001). In the SF group, 23/30 parents (76.6%) noted that the child's life "improved a lot." In the GR group, 3/6 parents (50.0%) noted they were "neutral" about their child's ability to do things, 2/6 (33.3%) were "very dissatisfied." CONCLUSIONS SF treatment for juvenile patients with CP and scoliosis resulted in fewer complications and unplanned reoperations and better radiographic outcomes compared with GR. Quality of life improvements were also better in the SF group. LEVEL OF EVIDENCE Level III.
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Tsukahara K, Mayer OH. Thoracic insufficiency syndrome: Approaches to assessment and management. Paediatr Respir Rev 2022; 44:78-84. [PMID: 35339395 PMCID: PMC9448829 DOI: 10.1016/j.prrv.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
Thoracic insufficiency syndrome (TIS) was described in 2003 as the inability of the thorax to support normal respiration or lung growth. TIS includes a broad and disparate group of typically degenerative thoracospinal conditions. Although TIS arises due to a heterogeneous group of disorders and thus its incidence is not well quantified, general approaches to management and treatment exist. Evolving imaging techniques and measurements of health-related quality of life augment tests of pulmonary function to quantify disease burden, longitudinally and pre- and post-intervention. Intervention is primarily via growth-sparing surgery, for which several device options exist, to preserve vertical growth prior to a definitive spinal fusion at skeletal maturity.
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Affiliation(s)
- Katharine Tsukahara
- The Children's Hospital of Philadelphia, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, United States.
| | - Oscar Henry Mayer
- Perelman School of Medicine at The University of Pennsylvania, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104, United States
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9
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Pelvic fixation is not always necessary in children with cerebral palsy scoliosis treated with growth-friendly instrumentation. Spine Deform 2022; 10:925-932. [PMID: 35066795 DOI: 10.1007/s43390-022-00474-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE A previous study showed that patients with neuromuscular scoliosis who underwent fusion to L5 had excellent coronal curve correction and improvement in pelvic obliquity (PO) when preoperative L5 tilt was < 15°. Our purpose was to identify indications to exclude the pelvis in children with cerebral palsy (CP) scoliosis treated with growing-friendly instrumentation. METHODS In a retrospective cohort study, children with CP scoliosis treated with TGR, MCGR, or VEPTR with minimum 2-year follow-up were identified from a multicenter database. RESULTS 27 patients with distal spine anchors (DSA) and 71 patients with distal pelvic anchors (DPA) placed at the index surgery were analyzed. The DSA group had a lower pre-index PO (9° vs 16°, P = 0.0001). Most recent radiographic data were similar except the DSA patients had a smaller major curve (47° vs 58°, P = 0.038). 6 (22%) DSA patients underwent extension of the instrumentation to the pelvis (DSA-EXT), most commonly at final fusion (5 patients). DSA-EXT patients had a higher pre-index L5 tilt than patients who did not require extension (DSA-NO EXT) (19° vs 10°, P = 0.009). Sub-analysis showed a lower major curve at most recent follow-up in the DSA-EXT group compared to the DPA group (33° vs 58°, P = 0.021). The DSA-EXT group had a higher number of complications per patient compared to the DSA-NO EXT group (2.3 vs 1.1, P = 0.029). CONCLUSION Pre-index L5 tilt ≤ 10° and PO < 10° may be indications to exclude the pelvis in children with CP scoliosis treated with growth-friendly instrumentation. DSA may provide better long-term control of the major curve than DPA.
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10
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Keil LG, Nash AB, Stürmer T, Golightly YM, Lin FC, Stone JD, Sanders JO, Louer CR. When Is a Growth-friendly Strategy Warranted? A Matched Comparison of Growing Rods Versus Primary Posterior Spinal Fusion in Juveniles With Early-onset Scoliosis. J Pediatr Orthop 2021; 41:e859-e864. [PMID: 34411054 DOI: 10.1097/bpo.0000000000001926] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 7 to 11-year-old juveniles with severe early-onset scoliosis (EOS) the optimal surgical option remains uncertain. This study compares growing rods (GRs) followed by definitive posterior spinal fusion (PSF) versus primary PSF in this population. We hypothesized that the thoracic height afforded by GRs would be offset by increased rigidity, more complications, and more operations. METHODS This retrospective comparative study included EOS patients aged 7.0 to 11.9 years at index surgery treated with GR→PSF or primary PSF during 2013 to 2020. Primary outcomes were thoracic height gain (ΔT1-12H), major curve, complications, and total operations. Primary PSFs were matched with replacement 1-to-n to GR→PSFs by age at index, etiology, and major curve. RESULTS Twenty-eight GR→PSFs met criteria: 19 magnetically controlled GRs and 9 traditional GRs. Three magnetically controlled GRs were definitively explanted without PSF due to complications. The remaining 25 GR→PSFs were matched to 17 primary PSFs with 100% etiology match, mean Δ major curve 1 degree, and mean Δ age at index 0.5 years (PSFs older). Median ΔT1-12H pre-GR to post-PSF was 4.7 cm with median deformity correction of 37%. Median ΔT1-12H among primary PSFs was 1.9 cm with median deformity correction of 62%. GR→PSFs had mean 1.8 complications and 3.4 operations. Primary PSFs had mean 0.5 complications and 1.3 operations. Matched analysis showed adjusted mean differences of 2.3 cm greater ΔT1-12H among GR→PSFs than their matched primary PSFs, with 25% less overall coronal deformity correction, 1.2 additional complications, and 2.2 additional operations per patient. CONCLUSIONS In juveniles aged 7 to 11 with EOS, on average GRs afford 2 cm of thoracic height over primary PSF at the cost of poorer deformity correction and additional complications and operations. Primary PSF affords an average of 2 cm of thoracic height gain; if an additional 2 cm will be impactful then GRs should be considered. However, in most juveniles the height gained may not warrant the iatrogenic stiffness, complications, and additional operations. Surgeons and families should weigh these benefits and harms when choosing a treatment plan. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Lukas G Keil
- Department of Orthopaedic Surgery, University of North Carolina
| | - Alysa B Nash
- Department of Orthopaedic Surgery, University of North Carolina
| | | | | | - Feng-Chang Lin
- Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Joseph D Stone
- Department of Orthopaedic Surgery, University of North Carolina
| | - James O Sanders
- Department of Orthopaedic Surgery, University of North Carolina
| | - Craig R Louer
- Department of Orthopaedic Surgery, University of North Carolina
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