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McFadden RJ, Hauth L, Gregoski M, Anari JB, Brooks JT, Sawyer JR, Marshall M, Murphy RF. A multicenter evaluation of the time and travel burden on families with children treated for early-onset scoliosis. Spine Deform 2024; 12:1453-1458. [PMID: 38796814 DOI: 10.1007/s43390-024-00895-y] [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: 02/20/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Patients who undergo growth-friendly (GF) treatment for early-onset scoliosis (EOS) undergo multiple clinical and surgical encounters. We sought to quantify the associated temporal and travel burden and estimate subsequent cost. METHODS Four centers in an international study group combined data on EOS patients who underwent surgical GF treatment from 2006 to 2021. Data collected included demographics, scoliosis etiology, GF implant, encounter type, and driving distance. We applied 2022 IRS and BLS data or $0.625/mile and $208.2/day off work to calculate a relative financial burden. RESULTS A total of 300 patients were analyzed (55% female). Etiologies were: congenital (33.3%), idiopathic (18.7%), neuromuscular (30.7%), and syndromic (17.3%). The average age at the index procedure was 5.5 years. For the 300 patients, 5899 encounters were recorded (average 18 encounters/patient). Aggregate encounter types were 2521 clinical office encounters (43%), 2045 surgical lengthening encounters (35%), 1157 magnetic lengthening encounters (20%), 149 spinal fusions (3%), and 27 spinal fusion revisions (0.5%). When comparing patients by scoliosis etiology or by GF implant type, no significant differences were noted in the total number of encounters or average travel distance. Patients traveled a median round trip distance of 158 miles/encounter between their homes and treating institutions (range 2.4-5654 miles), with a cumulative median distance of 2651 miles for the entirety of their treatment (range 29-90,552 miles), at an estimated median cost of $1656.63. The mean number of days off work was 18 (range 3-75), with an associated loss of $3643.50 in income. CONCLUSION Patients with EOS averaged 18 encounters for GF surgical treatment. These patients and their families traveled a median distance of 158 miles/encounter, with an estimated combined mileage and loss of income of $5300.
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Affiliation(s)
- Ryan J McFadden
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 708, Charleston, SC, 29425, USA
| | - Lucas Hauth
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mathew Gregoski
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 708, Charleston, SC, 29425, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jaysson T Brooks
- Department of Orthopaedics, Scottish Rite for Children, Dallas, TX, USA
| | | | - Maxwell Marshall
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 708, Charleston, SC, 29425, USA
| | - Robert F Murphy
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 708, Charleston, SC, 29425, USA.
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Gupta A, Srivastava A, Pandita N, Goswami A, Vijayaraghavan GP, Jayaswal A. Comparison of traditional growth rods and magnetically controlled growing rods in early-onset scoliosis: a case-matched mid term follow-up study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2704-2712. [PMID: 38748221 DOI: 10.1007/s00586-024-08301-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/21/2024] [Accepted: 05/02/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE Early-onset scoliosis (EOS) has always been a challenging situation for spine surgeons. The aim of treatment is to control the direction of curve progression to allow for the complete development of lungs. Among all the growth constructs available, traditional growth rods (TGR) and magnetically controlled growth rods (MCGR) are most widely used. The MCGR has been introduced a few years back and there is a dearth of long-term follow-up studies. The purpose of this study is to compare the effectiveness of TGR and MCGR for the treatment of EOS. METHODS All patients of EOS managed with either TGR or MCGR were included in the study. The patients managed with other methods or having follow-up < 2-years were excluded from the study. A total of 20 patients were recruited in the MCGR group and 28 patients were recruited in the TGR group. Both groups were matched by etiology, gender, pre-operative radiological parameters, and complications including unplanned surgeries. RESULTS The mean age in our study was 7.90 years in the MCGR group and 7.46 years in the TGR group. The mean duration of follow-up in the MCGR group was 50.89 months and in the TGR group 94.2 months. Pre-operative cobb's angle in the coronal plane and T1-S1 were comparable in both groups with a mean cobb's angle of 65.4 in MCGR and 70.5 in TGR. The mean T1-S1 length in the MCGR group was 36.1cms and in the TGR group was 35.2 cms (p = 0.18). The average increase in T1-S1 length was 1.3 cm/year in the TGR group and 1.1 cm/year in the MCGR group (p > 0.05). The TGR patients underwent 186 open lengthening surgeries and 11 unplanned surgeries for various complications. The MCGR group has 180 non-invasive lengthening with only 4 unplanned returns to OT for various causes. CONCLUSION The curve correction was similar in both TGR and MCGR groups. The average T1-S1 length achieved on final follow-up was similar in both groups. The MCGR patients have attained similar correction with fewer invasive procedures and lesser complications compared to the TGR group.
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Affiliation(s)
- Anuj Gupta
- Department of Spine Surgery, Max Superspeciality Hospital, Vaishali, Ghaziabad, India.
| | - Abhishek Srivastava
- Department of Spine Surgery, Max Superspeciality Hospital, Vaishali, Ghaziabad, India
| | | | - Ankur Goswami
- Department of Spine Surgery, Queens Medical Center. Nottingham University Hospitals, Nottingham, UK
| | | | - Arvind Jayaswal
- Department of Spine Surgery, Max Superspeciality Hospital, Vaishali, Ghaziabad, India
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Matsumoto H, Fano AN, Quan T, Akbarnia BA, Blakemore LC, Flynn JM, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, McCarthy RE, Sturm PF, Roye DP, Emans JB, Vitale MG. Re-evaluating consensus and uncertainty among treatment options for early onset scoliosis: a 10-year update. Spine Deform 2023; 11:11-25. [PMID: 35947359 DOI: 10.1007/s43390-022-00561-1] [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: 04/11/2022] [Accepted: 07/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago. METHODS 11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described. RESULTS Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves. CONCLUSION Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| | - Adam N Fano
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
| | - Theodore Quan
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
| | - Behrooz A Akbarnia
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, 92037, USA
| | | | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - John T Smith
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84113, USA
| | - Brian D Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul D Sponseller
- Division of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Richard E McCarthy
- Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA
| | - Peter F Sturm
- Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA
| | - David P Roye
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
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Matsumoto H, Sinha R, Roye BD, Ball JR, Skaggs KF, Brooks JT, Welborn MC, Emans JB, Anari JB, Johnston CE, Akbarnia BA, Vitale MG, Murphy RF. Contraindications to magnetically controlled growing rods: consensus among experts in treating early onset scoliosis. Spine Deform 2022; 10:1289-1297. [PMID: 35780448 DOI: 10.1007/s43390-022-00543-3] [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: 02/02/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to describe contraindications to the magnetically controlled growing rod (MCGR) in patients with early onset scoliosis (EOS) by establishing consensus amongst expert surgeons who treat these patients frequently. METHODS Nine pediatric spine surgeons from an international EOS study group participated in semi-structured interviews via email to identify factors that influence decision making in the use of MCGR. A 39-question survey was then developed to specify these factors as contraindications for MCGR-these included patient age and size, etiology, medical comorbidities, coronal and sagittal curve profiles, and skin and soft tissue characteristics. Pediatric spine surgeons from the EOS international study group were invited to complete the survey. A second 29-item survey was created to determine details and clarify results from the first survey. Responses were analyzed for consensus (> 70%), near consensus (60-69%), and no consensus/variability (< 60%) for MCGR contraindication. RESULTS 56 surgeons of 173 invited (32%) completed the first survey, and 64 (37%) completed the second survey. Responders had a mean of over 15 years in practice (range 1-45) with over 6 years of experience with using MCGR (range 2-12). 71.4% of respondents agreed that patient size characteristics should be considered as contraindications, including BMI (81.3%) and spinal height (84.4%), although a specific BMI range or a specific minimum spinal height were not agreed upon. Among surgeons who agreed that skin and soft tissue problems were contraindications (78.6%), insufficient soft tissue (98%) and skin (89%) to cover MCGR were specified. Among surgeons who reported curve stiffness as a contraindication (85.9%), there was agreement that this curve stiffness should be defined by clinical evaluation (78.2%) and by traction films (72.3%). Among surgeons who reported sagittal curve characteristics as contraindications, hyperkyphosis (95.3%) and sagittal curve apex above T3 (70%) were specified. Surgeons who indicated the need for repetitive MRI as a contraindication (79.7%) agreed that image quality (72.9%) and not patient safety (13.6%) was the concern. In the entire cohort, consensus was not achieved on the following factors: patient age (57.4%), medical comorbidities (46.4%), etiology (53.6%), and coronal curve characteristics (58.9%). CONCLUSION Surgeon consensus suggests that MCGR should be avoided in patients who have insufficient spinal height to accommodate the MCGR, have potential skin and soft tissue inadequacy, have too stiff a spinal curve, have too much kyphosis, and require repetitive MRI, particularly of the spine. Future data-driven studies using this framework are warranted to generate more specific criteria (e.g. specific degrees of kyphosis) to facilitate clinical decision making for EOS patients. LEVEL OF EVIDENCE Level V-expert opinion.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Kira F Skaggs
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jaysson T Brooks
- Scottish Rite for Children/UT-Southwestern, Dallas, TX, 75219, USA
| | - Michelle C Welborn
- Department of Orthopaedic Surgery, Shriner's Hospital for Children Portland, Portland, OR, 97229, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | | | - Behrooz A Akbarnia
- San Diego Spine Foundation, San Diego, CA, 92121, USA
- Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Robert F Murphy
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29492, USA
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