1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Conry KT, Floccari LV, Morscher M, Brown MF, Ritzman TF. Safety and efficacy of waterproof casting for early onset scoliosis. Spine Deform 2024; 12:1459-1466. [PMID: 38613737 DOI: 10.1007/s43390-024-00868-1] [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: 11/27/2023] [Accepted: 03/21/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE The efficacy of traditional Mehta casting in the treatment of early onset scoliosis (EOS) is well-established. However, waterproof casting has not been previously described. Inherent advantages of waterproof casting include clearance for bathing/swimming, avoiding cast holidays, and improved family satisfaction. The purpose of this study was to assess the safety and efficacy of waterproof serial casting at controlling curve progression in EOS. METHODS The current study is an IRB-approved Level IV retrospective consecutive cohort of EOS patients who underwent a serial 75% body weight traction-elongation-flexion Mehta cast protocol with waterproof cast padding. The addition of 3-point apical translation with stockinettes was utilized during casting. Bracing was initiated after correction < 15° or 1 year of serial casting. RESULTS Seventeen patients at mean age 21.6 months, with pre-cast Cobb angle 52.3° (R: 35°-82°), underwent serial waterproof casting. In-cast correction index was 64%; for post-cast, Cobb angle was 18.6°. At mean 5.6 years follow-up (R: 2.3-8.9 years), 82% successfully avoided surgical intervention, 53% maintained correction < 25°, and 29% are considered "cured". 3/17 (18%) underwent a 2nd round of casting, and a total of 3/17 (18%) ultimately required surgery at 6.2 years post-casting. No major cast-related complications, decubiti, or cast holidays were encountered. CONCLUSION Serial waterproof casting is safe and efficacious in EOS when compared to published results of traditional Mehta casting. Of 17 patients with mean pre-cast Cobb 52.3°, 82% successfully avoided surgery and 53% maintained mild curves < 25° magnitude at 5.6 years follow-up. No major complications or skin decubiti occurred, and advantages include clearance for bathing and avoidance of need for cast holidays during treatment. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Keegan T Conry
- Department of Orthopaedic Surgery, Cleveland Clinic Akron General, Akron, OH, USA
| | - Lorena V Floccari
- Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA
| | - Melanie Morscher
- Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA
| | - Miraides F Brown
- Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA
| | - Todd F Ritzman
- Department of Orthopaedics, Akron Children's Hospital, 215 West Bowery Street, Akron, OH, 44308, USA.
| |
Collapse
|
3
|
Johnson AN, Lark RK. Current Concepts in the Treatment of Early Onset Scoliosis. J Clin Med 2024; 13:4472. [PMID: 39124741 PMCID: PMC11313220 DOI: 10.3390/jcm13154472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Despite many surgical advances in the treatment of early onset scoliosis (EOS) over the past two decades, this condition remains a challenge to address. While otherwise healthy children can have EOS, many of these patients have complicated comorbidities making proper treatment algorithms extraordinarily difficult. Non-operative measures can be successful when initiated early, but are many times utilized as a delay tactic until growth-friendly operative procedures can be safely performed. This article will summarize the current concepts in the treatment of EOS with a focus on the surgical advances that have recently been made.
Collapse
Affiliation(s)
| | - Robert K. Lark
- Department of Orthopaedics, Duke University Medical Center, Durham, NC 27701, USA;
| |
Collapse
|
4
|
Glowka P, Grabala P, Gupta MC, Pereira DE, Latalski M, Danielewicz A, Grabala M, Tomaszewski M, Kotwicki T. Complications and Health-Related Quality of Life in Children with Various Etiologies of Early-Onset Scoliosis Treated with Magnetically Controlled Growing Rods-A Multicenter Study. J Clin Med 2024; 13:4068. [PMID: 39064107 PMCID: PMC11277853 DOI: 10.3390/jcm13144068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Early-onset scoliosis (EOS) refers to spinal deformities that develop and are diagnosed before the age of 10. The most important goals of the surgical treatment of EOS are to stop the progression of curvature, achieve the best possible correction, preserve motion, and facilitate spinal growth. The objectives of this multicenter study were to analyze the risk of complications among patients with EOS treated using magnetically controlled growing rods (MCGRs) and assess the patients' and their parents' quality of life after diagnosis and treatment with a minimum two-year follow-up. Methods: Patients given an ineffective nonoperative treatment qualified for surgery with MCGRs. This study involved 161 patients (90 females and 71 males) who were classified according to the etiology of curvature. The intraoperative and postoperative complications and those that occurred during the continuation of treatment with MCGRs were recorded and analyzed. The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to evaluate the patients' quality of life and satisfaction with the treatment. Results: Implant-related complications requiring instrumentation revision were recorded in 26% of the patients. Medical complications occurred in 45% of the population. The EOSQ-24 revealed a significant improvement in the average scores during the follow-up. Conclusions: The treatment of early-onset scoliosis with MCGRs carries 66% risks of incurring medical and mechanical complications, the latter 26% of patients requiring revision procedures. Children with neuromuscular scoliosis, females, and with curvature greater than 90 degrees are at a higher risk of developing complications. Limiting the number of elective surgeries necessitated to prolong the instrumentation and treatment process for patients with MCGRs can greatly enhance their quality of life and satisfaction throughout the follow-up period.
Collapse
Affiliation(s)
- Pawel Glowka
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| | - Pawel Grabala
- Department of Pediatric Orthopedic Surgery and Traumatology, University Children’s Hospital, Waszyngtona 17, 15-274 Bialystok, Poland
- Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland
| | - Munish C. Gupta
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave., St. Louis, MO 63110, USA; (M.C.G.); (D.E.P.)
| | - Daniel E. Pereira
- Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S Euclid Ave., St. Louis, MO 63110, USA; (M.C.G.); (D.E.P.)
| | - Michal Latalski
- Paediatric Orthopaedic Department, Medical University of Lublin, Gebali 6, 20-093 Lublin, Poland; (M.L.); (A.D.)
| | - Anna Danielewicz
- Paediatric Orthopaedic Department, Medical University of Lublin, Gebali 6, 20-093 Lublin, Poland; (M.L.); (A.D.)
| | - Michal Grabala
- 2nd Clinical Department of General and Gastroenterogical Surgery, The Medical University of Bialystok Clinical Hospital, Medical University of Bialystok, M. Skłodowskiej-Curie 24a, 15-276 Bialystok, Poland;
| | - Marek Tomaszewski
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopaedics, Poznań University of Medical Sciences, 28 Czerwca 1956 r. Street, no. 135/147, 61-545 Poznań, Poland; (P.G.); (M.T.); (T.K.)
| |
Collapse
|
5
|
Haapala H, Salonen A, Suominen E, Syvänen J, Repo J, Matsumoto H, Ahonen M, Helenius I, Saarinen A. Reliability and validity of the adapted Finnish version of the early onset scoliosis questionnaire (EOSQ-24). Spine Deform 2024; 12:1137-1143. [PMID: 38578600 PMCID: PMC11217041 DOI: 10.1007/s43390-024-00861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND EOSQ-24 is a disease specific patient-reported outcome score used to assess the quality of life in patients with early-onset scoliosis. The aim of this study was to translate and cross-culturally adapt the English version of the EOSQ-24 to Finnish language and to assess the reliability and validity of the translation. METHODS Cross-cultural adaptation and cross-cultural validation were performed to the Finnish translation of the EOSQ-24. Patients and/or their caretakers were then recruited to assess the psychometric properties of the translation. We assessed the internal consistency, test-retest reliability, floor and ceiling effects, and discriminative abilities. One-hundred-and-three patients filled the questionnaire. RESULTS EOSQ-24 was successfully translated into Finnish. The translation showed excellent internal consistency (Cronbach alpha 0.94), satisfactory item-total correlations ranging from 0.6 to 0.9, and moderate to strong inter item correlations. Test-retest reliability ranged from 0.7 to 0.96 indicating good to excellent agreement. Patients with neuromuscular and syndromic scoliosis reported lower EOSQ-24 scores when compared to patients' idiopathic and congenital scoliosis. There was a significant negative correlation between major curve and EOSQ-24 scores in patients with idiopathic early onset scoliosis. CONCLUSION The internal consistency and test-retest reliability of the measure were found to be satisfactory. A marked ceiling effect was observed, indicating a potential source of error.
Collapse
Affiliation(s)
- Hermanni Haapala
- Department of Paediatric Surgery, Orthopaedics and Traumatology, New Children's Hospital, Helsinki, Finland
| | - Anne Salonen
- Department of Paediatric Surgery, Tampere University Hospital, Tampere, Finland
| | - Eetu Suominen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Johanna Syvänen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Repo
- Department of Orthopaedics and Traumatology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Matti Ahonen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, New Children's Hospital, Helsinki, Finland
| | - Ilkka Helenius
- Department of Paediatric Surgery, Orthopaedics and Traumatology, New Children's Hospital, Helsinki, Finland
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Saarinen
- Department of Paediatric Surgery, Orthopaedics and Traumatology, University of Turku and Turku University Hospital, Turku, Finland.
- Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Welborn MC, Redding G, Evers P, Nicol L, Bauer DF, Iyer RR, Poon S, Hwang S. Pre-op considerations in neuromuscular scoliosis deformity surgery: proceedings of the half day course at the 58th annual meeting of the Scoliosis Research Society. Spine Deform 2024; 12:867-876. [PMID: 38634998 DOI: 10.1007/s43390-024-00865-4] [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: 01/22/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024]
Abstract
Scoliosis is a common complication of neuromuscular disorders. These patients are frequently recalcitrant to nonoperative treatment. When treated surgically, they have the highest risk of complications of all forms of scoliosis. While recent studies have shown an improvement in the rate of complications, they still remain high ranging from 6.3 to 75% depending upon the underlying etiology and the treatment center (Mohamad et al. in J Pediatr Orthop 27:392-397, 2007; McElroy et al. in Spine, 2012; Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Cognetti et al. in Neurosurg Focus 43:E10, 2017). For those patients who are able to recover from the perioperative period without major complications, several recent studies have shown decreased long-term mortality and improved health-related quality of life in neuromuscular patients who have undergone spine fusion (Bohtz et al. in J Pediatr Orthop 31:668-673, 2011; Ahonen et al. in Neurology 101:e1787-e1792, 2023; Jain et al. in JBJS 98:1821-1828, 2016). It is critically important to optimize patients preoperatively to minimize the risk of post-operative complications and maximize long-term outcomes. In order to do so, one must familiarize themselves with the common complications and their treatment. The most common complications are pulmonary in nature. With reported rates as high as 23-29%, pre-operative optimization should be employed for these patients to minimize the risk of post-operative complications (Sharma et al. in Eur Spine J 22:1230-1249, 2013; Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). The next most common cause of complications are implant related, with 13-23% of patients experiencing an implant-related complication that may require a second procedure (Toll et al. in J Neurosurg Pediatr 22:207-213, 2018; Sharma et al. in Eur Spine J 22:1230-1249, 2013) Therefore optimization of bone quality prior to surgical intervention is important to help minimize the risk of instrumentation failure. Optimization of muscle tone and spasticity may help to decrease the risk of instrumentation complications, but may also contribute to the progression of scoliosis. While only 3% of patients have neurologic complication, significant equipoise remains regarding whether or not patients should undergo prophylactic detethering procedures to minimize those risks (Sharma et al. in Eur Spine J 22:1230-1249, 2013). Although only 1.8% of complications are classified as cardiac related, they can be among the most devastating (Rumalla et al. in J Neurosurg Spine 25:500-508, 2016). Simply understanding the underlying etiology and the potential risks associated with each condition (i.e., conduction abnormalities in a patient with Rett syndrome or cardiomyopathies patients with muscular dystrophy) can be lifesaving. The following article is a summation of the half day course on neuromuscular scoliosis from the 58th annual SRS annual meeting, summarizing the recommendations from some of the world's experts on medical considerations in surgical treatment of neuromuscular scoliosis.
Collapse
Affiliation(s)
- Michelle C Welborn
- Shriners Children's Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA.
| | - Gregory Redding
- Pulmonary and Sleep Medicine Division, Seattle Children's Hospital, Room O.C. 7.730, 4800 Sand Point Way N E, Seattle, WA, 98105, USA
| | - Patrick Evers
- Doernbecher Children's Hospital, 700 SW Campus Dr, Portland, OR, 97239, USA
| | - Lindsey Nicol
- Shriners Children's Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA
- Doernbecher Children's Hospital, 700 SW Campus Dr, Portland, OR, 97239, USA
| | - David F Bauer
- Texas Children's Hospital, 6701 Fannin St., Suite 1230.01, Houston, TX, USA
| | - Rajiv R Iyer
- , 100 N. Mario Capecchi Drive, Suite 3850, Salt Lake City, UT, 84113, USA
| | - Selina Poon
- Shriners Children's Southern California, 909 S. Fair Oaks Ave, Pasadena, CA, 91105, USA
| | - Steven Hwang
- Shriners Children's Philadelphia, 3551 N Broad St., Philadelphia, PA, 19140, USA
| |
Collapse
|
9
|
McIntosh AL, Booth A, Oetgen ME. Unplanned return to the operating room (UPROR) occurs in 40% of MCGR patients at an average of 2 years after initial implantation. Spine Deform 2024:10.1007/s43390-024-00911-1. [PMID: 38862739 DOI: 10.1007/s43390-024-00911-1] [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: 08/25/2023] [Accepted: 05/26/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE This study calculated the rates of Unplanned Return to the Operating Room (UPROR) in early-onset scoliosis patients who had no previous spine surgery and underwent Magnetically Controlled Growing Rod (MCGR) implantation. METHODS We reviewed surgical, radiographic, and UPROR outcomes for EOS patients treated with the MCGR implant < 12 years + 11 months of age, had complete preop/postop major curve measurements, and had complete MCGR details. RESULTS 376 patients underwent MCGR implantation at a mean age of 7.7 years (1.8-12.9). Diagnoses included 106 (28%) idiopathic, 84 (22%) syndromic, 153 (41%) neuromuscular, and 33 (9%) congenital. The mean preop-cobb was 76.7° (9-145°), and an immediate postop correction was 41% (0-84%). We found that 38% (142/376) of patients experienced an UPROR prior to the maximal actuator length being achieved. UPROR occurred at mean 2 years (3 days-5 years) after initial implantation. Of the 142 patients who experienced UPROR there were 148 complications that lead to an UPROR. The most common reason for UPROR was anchor (55/148: 37%) or MCGR implant related (33/148: 22%). Wound related (22/148:15%), Neuro related 4/148: 3%), and other (34/148: 23%) accounted for the remaining UPROR occurrences. CONCLUSION In conclusion, the MCGR UPROR rate was 142/376 (38%) after an average of 2 years post implantation. At 2-year follow-up, only 20% of MCGR patients had experienced an UPROR. However, between 2 and 5 years, the development of an UPROR increased precipitously with only 39% of MCGR patients remaining UPROR free at 5 years post MCGR implantation. The most common reason for UPROR was related to anchor or MCGR implant-related complications. This information can be utilized to set realistic expectations about the need and timing of future surgical procedures with patients and their families.
Collapse
Affiliation(s)
- Amy L McIntosh
- Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, USA.
| | - Anna Booth
- Scottish Rite for Children, Dept of Orthopedics, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Matthew E Oetgen
- Department of Pediatric Orthopaedic Surgery, Children's National Hospital, 111 Michigan Avenue, Washington, DC, 20010, USA
| |
Collapse
|
10
|
Saarinen AJ, Sponseller P, Thompson GH, White KK, Emans J, Cahill PJ, Hwang S, Helenius I. Outcomes after completing growth-friendly surgical treatment for early-onset scoliosis in patients with skeletal dysplasia. Bone Joint J 2024; 106-B:596-602. [PMID: 38821501 DOI: 10.1302/0301-620x.106b6.bjj-2023-1417.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims The aim of this study was to compare outcomes after growth-friendly treatment for early-onset scoliosis (EOS) between patients with skeletal dysplasias versus those with other syndromes. Methods We retrospectively identified 20 patients with skeletal dysplasias and 292 with other syndromes (control group) who had completed surgical growth-friendly EOS treatment between 1 January 2000 and 31 December 2018. We compared radiological parameters, complications, and health-related quality of life (HRQoL) at mean follow-up of 8.6 years (SD 3.3) in the dysplasia group and 6.6 years (SD 2.6) in the control group. Results Mean major curve correction per patient did not differ significantly between the dysplasia group (43%) and the control group (28%; p = 0.087). Mean annual spinal height increase was less in the dysplasia group (9.3 mm (SD 5.1) than in the control group (16 mm (SD 9.2); p < 0.001). Mean annual spinal growth adjusted to patient preoperative standing height during the distraction period was 11% in the dysplasia group and 14% in the control group (p = 0.070). The complication rate was 1.6 times higher (95% confidence interval (CI) 1.3 to 2.0) in the dysplasia group. The following complications were more frequent in the dysplasia group: neurological injury (rate ratio (RR) 5.1 (95% CI 2.3 to 11)), deep surgical site infection (RR 2.2 (95% CI 1.2 to 4.1)), implant-related complications (RR 2.0 (95% CI 1.5 to 2.7)), and unplanned revision (RR 1.8 (95% CI 1.3 to 2.5)). Final fusion did not provide additional spinal height compared with watchful waiting (p = 0.054). There were no significant differences in HRQoL scores between the groups. Conclusion After growth-friendly EOS treatment, patients with skeletal dysplasias experienced a higher incidence of complications compared to those with other syndromes. Surgical growth-friendly treatment for skeletal dysplasia-associated EOS should be reserved for patients with severe, progressive deformities that are refractory to nonoperative treatment.
Collapse
Affiliation(s)
- Antti J Saarinen
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Paul Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - George H Thompson
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Klane K White
- Department of Orthopaedics and Sports Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - John Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Steven Hwang
- Department of Neurosurgery, Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA
| | - Ilkka Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
11
|
Tong Y, Udupa JK, McDonough JM, Xie L, Wu C, Akhtar Y, Hosseini M, Alnoury M, Shaghaghi S, Gogel S, Biko DM, Mayer OH, Torigian DA, Cahill PJ, Anari JB. Do Rib-Based Anchors Impair Chest Wall Motion in Early Onset Scoliosis (EOS)? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.01.24306556. [PMID: 38746195 PMCID: PMC11092725 DOI: 10.1101/2024.05.01.24306556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Purpose There is a concern in pediatric surgery practice that rib-based fixation may limit chest wall motion in early onset scoliosis (EOS). The purpose of this study is to address the above concern by assessing the contribution of chest wall excursion to respiration before and after surgery. Methods Quantitative dynamic magnetic resonance imaging (QdMRI) is performed on EOS patients (before and after surgery) and normal children in this retrospective study. QdMRI is purely an image-based approach and allows free breathing image acquisition. Tidal volume parameters for chest walls (CWtv) and hemi-diaphragms (Dtv) were analyzed on concave and convex sides of the spinal curve. EOS patients (1-14 years) and normal children (5-18 years) were enrolled, with an average interval of two years for dMRI acquisition before and after surgery. Results CWtv significantly increased after surgery in the global comparison including all EOS patients (p < 0.05). For main thoracic curve (MTC) EOS patients, CWtv significantly improved by 50.24% (concave side) and 35.17% (convex side) after age correction (p < 0.05) after surgery. The average ratio of Dtv to CWtv on the convex side in MTC EOS patients was not significantly different from that in normal children (p=0.78), although the concave side showed the difference to be significant. Conclusion Chest wall component tidal volumes in EOS patients measured via QdMRI did not decrease after rib-based surgery, suggesting that rib-based fixation does not impair chest wall motion in pediatric patients with EOS.
Collapse
|
12
|
Mehta JS, Pahys JM, Saad A, Sponseller P, Andras L, Marks D, Poon S, Klineberg E, White KK, Helenius I, Welborn M, Redding G. Paediatric syndromic scoliosis: proceedings of the half-day course at the 57th annual meeting of the Scoliosis Research Society. Spine Deform 2024; 12:523-543. [PMID: 38366266 DOI: 10.1007/s43390-024-00822-1] [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: 09/04/2023] [Accepted: 12/30/2023] [Indexed: 02/18/2024]
Abstract
There are some syndromes that present with unique manifestations pertaining to the spinal column. A good working understanding of these common syndromes is useful for the spinal deformity surgeons and related healthcare providers. This review attempts to encompass these unique features and discuss them in three broad groups: hypermobility syndromes, muscle pathology-related syndromes, and syndromes related to poor bone quality. This review explores the features of these syndromes underpinning the aspects of surgical and medical management. This review represents the proceedings of the Paediatric Half-Day Course at the 57th Annual Meeting of the Scoliosis Research Society.
Collapse
Affiliation(s)
| | | | - Ahmed Saad
- Royal Orthopaedics Hospital, Birmingham, England
| | - Paul Sponseller
- Division of Paediatric Orthopaedics, Johns Hopkins Medical Centre, Baltimore, USA
| | - Lindsay Andras
- Spine Surgery, Childrens' Hospital Los Angeles, Los Angeles, USA
| | - David Marks
- Birmingham Childrens' Hospital, Birmingham, England
| | | | - Eric Klineberg
- Orthopaedics and Spinal Surgery, UT Health, Houston, USA
| | - Klane K White
- Pediatric Orthopaedics, Childrens' Hospital Colorado, Aurora, USA
| | - Ilkka Helenius
- Paeditric Orthoapedics, University of Turku, Helsinki, Finland
| | | | - Greg Redding
- Paediatric Pulmonology, Seattle Childrens' Hospital, Seattle, USA
| |
Collapse
|
13
|
Studer D, Hasler CC. Diagnostic and therapeutic strategies in early onset scoliosis: A current concept review. J Child Orthop 2024; 18:113-123. [PMID: 38567043 PMCID: PMC10984154 DOI: 10.1177/18632521241228141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 04/04/2024] Open
Abstract
Substantial advances in the treatment of early onset scoliosis (EOS) over the past two to three decades have resulted in significant improvements in health-related quality of life of affected children. In addition to classifications that address the marked heterogeneity of this patient population, increasing understanding of the natural history of the disease, and new implants and treatment techniques have resulted in innovations unlike any other area of pediatric orthopedics. The growing understanding of the interaction between spinal and thoracic growth, as well as dependent lung maturation, has had a lasting impact on the treatment strategy of this potentially life-threatening disease. The previous treatment approach with early corrective fusion gave way to a growth-friendly concept. Despite the steady development of new growth-friendly surgical treatment options, whose efficacy still needs to be validated, as well as a revival of conservative growth control with serial casts and/or braces, the psychosocial burden of the long lasting and complication-prone treatments remains high. As a consequence, EOS still represents one of the greatest pediatric orthopedic challenges.
Collapse
Affiliation(s)
- Daniel Studer
- Orthopaedic Department, University Children’s Hospital Basel UKBB, Basel, Switzerland
| | - Carol Claudius Hasler
- Orthopaedic Department, University Children’s Hospital Basel UKBB, Basel, Switzerland
| |
Collapse
|
14
|
Chehrassan M, Nikouei F, Shakeri M, Moeini J, Jafari B, Mahabadi EA, Ghandhari H. Factors Related to Proximal Junctional Kyphosis and Device Failure in Patients with Early-Onset Scoliosis Treated with a Traditional Dual Growing Rod: A Single Institution Study. Asian Spine J 2024; 18:236-243. [PMID: 38454749 PMCID: PMC11065516 DOI: 10.31616/asj.2023.0286] [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: 08/24/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 03/09/2024] Open
Abstract
STUDY DESIGN Observational study. PURPOSE Investigation of factors related to proximal junctional kyphosis (PJK) and device failure in patients with early-onset scoliosis. OVERVIEW OF LITERATURE The use of growth-friendly devices, such as traditional dual growing rod (TDGR) for the treatment of earlyonset scoliosis (EOS), may be associated with important complications, including PJK and device failure. METHODS Thirty-five patients with EOS and treated with TDGR from 2014 to 2021 with a minimum follow-up of 2 years were retrospectively evaluated. Potential risk factors, including demographic factors, disease etiology, radiological measurements, and surgical characteristics, were assessed. RESULTS PJK was observed in 19 patients (54.3%), and seven patients (20%) had device failure. PJK was significantly associated with global final kyphosis change (p=0.012). No significant correlation was found between the rod angle contour, type of implant, connector design, and the risk of PJK or device failure. CONCLUSIONS Treatment of EOS with TDGR is associated with high rates of complications, particularly PJK and device failure. The device type may not correlate with the risk of PJK and device failure. The progression of thoracic kyphosis during multiple distractions is an important risk factor for PJK.
Collapse
Affiliation(s)
| | - Farshad Nikouei
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran,
Iran
| | - Mohammadreza Shakeri
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran,
Iran
| | | | - Behnam Jafari
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran,
Iran
| | - Ebrahim Ameri Mahabadi
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran,
Iran
| | - Hasan Ghandhari
- Bone and Joint Reconstruction Research Center, Shafa Orthopaedic Hospital, Iran University of Medical Sciences, Tehran,
Iran
| |
Collapse
|
15
|
Asma A, Fralinger D, da Silva LCA, Mackenzie WGS, Gabos PG, Mackenzie WG, Shah SA. Predictors of Rod Length Gain and Sagittal Alignment Change After Magnetically Controlled Growing Rod Lengthening. Spine (Phila Pa 1976) 2024; 49:349-355. [PMID: 36856517 DOI: 10.1097/brs.0000000000004616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE There are preoperative characteristics that predict rod lengthening of magnetically controlled growing rods (MCGR). The lengthening of MCGR will lead to increased kyphosis. SUMMARY OF BACKGROUND DATA The amount of length gained by MCGR is variable, and predictors are lacking. Similarly, sagittal plane changes over the MCGR lengthening period have not been investigated. MATERIALS AND METHODS Patients with MCGR and a minimum 2-year follow-up were identified and those with previous spine surgery were excluded. Preimplantation, postimplantation, and last follow-up postlengthening radiographs were examined. Multiple linear regression analyses were used for rod length gain predictors. RESULTS Fifty-six patients with early-onset scoliosis met inclusion criteria: nine idiopathic, five congenital, 14 neuromuscular, 20 syndromic, and eight skeletal dysplasia patients. No difference was seen between subtypes of early-onset scoliosis for rod length gain ( P =0.62). Shorter preoperative T1-T12 height and higher curve correction rate after implantation were significant predictors for rod length gain ( P <0.001). Preoperative major curve magnitude and kyphosis were not significant predictors. Flattening of the spine around the actuator and compensative increase in T1-T5 kyphosis were seen secondarily after MCGR implantation. Maximum sagittal kyphosis, T1-T5 kyphosis, and T5-T12 kyphosis did not change during lengthening. Lumbar lordosis significantly decreased postimplantation (first erect) but then increased during lengthening. Pelvic incidence and sacral slope both increased during lengthening, but this may be age related. CONCLUSION Patients who gained the most rod length with MCGR were those with an initially shorter T1-T12 height and better initial curve correction at implantation, likely representing that implants work best in small patients with flexible curves. Diagnosis, preoperative curve magnitude, and thoracic kyphosis were not related to rod length gain. Thoracic kyphosis did not deteriorate over the lengthening phase. LEVEL OF EVIDENCE Level III-retrospective cohort study.
Collapse
Affiliation(s)
- Ali Asma
- Nemours Children's Health, Delaware Valley, Wilmington, DE
| | | | | | | | | | | | | |
Collapse
|
16
|
Heemskerk JL, Willigenburg NW, Veraart BEEMJ, Bakker EW, Castelein RM, Altena MC, Kempen DHR. Heath-related quality of life and functional outcomes in patients with congenital or juvenile idiopathic scoliosis after an average follow-up of 25 years: a cohort study. Spine J 2024; 24:462-471. [PMID: 38029931 DOI: 10.1016/j.spinee.2023.11.012] [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: 08/13/2022] [Revised: 10/01/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND CONTEXT Congenital and juvenile scoliosis are both early-onset deformities that develop before the age of 10. Children are treated to prevent curve progression and problems in adulthood such as back pain and a decreased quality of life but literature on long-term outcomes remains scarce. PURPOSE To evaluate the health-related quality of life (HRQoL) and potential disability of children with congenital scoliosis (CS) or juvenile idiopathic scoliosis (JIS) after a minimum of 20 years follow-up. STUDY DESIGN Comparative cohort study. PATIENT SAMPLE A consecutive cohort of CS and JIS patients were retrospectively identified from a single-center scoliosis database. Patients born between 1968 and 1981 and treated during skeletal growth were eligible for participation. OUTCOME MEASURES HRQoL (SF-36, SRS-22r, ODI). METHODS The primary aim was to evaluate the HRQoL of CS and JIS patients using the general SF-36 questionnaire. Both patient cohorts were compared with age-matched national norms. The secondary aim was to analyze the differences between conservatively and surgically treated patients using the scoliosis-specific Scoliosis Research Society-22r questionnaire (SRS-22r) and the Oswestry Disability Index (ODI). T-tests were used for statistical comparison. RESULTS In total, 114 patients (67% of the eligible patients) completed the questionnaire, with a mean follow-up of 25.5±5.5 years after their final clinical follow-up. Twenty-nine patients with CS were included with a mean age of 44.4±3.8 years (79.3% female), and 85 patients with JIS with a mean age of 43.7±4.2 years (89.4% female). Of the SF-36 domains, only the vitality score (60.6±18.0 for CS and 58.1±17.6 for JIS cohort) and mental health score (70.0±18.4 for CS and 72.1±18.1 for JIS cohort) were significantly lower compared with the general population (68.6±19.3 for vitality, and 76.8±17.4 for mental health). These decreased scores were larger than the determined minimum clinically important difference threshold of 4.37. Surgically treated JIS patients had a significantly lower score on the SRS-22r pain domain than their nonsurgically treated peers (3.6±0.9 vs 4.1±0.7l p=.019). Surgically treated CS patients had a significantly higher score on the SRS-22r mental health domain than their nonsurgically treated peers (4.3±0.5 vs 3.5±1.0; p=.023). No significant differences were found in the other domains. CONCLUSIONS Except for vitality and mental health domains, congenital and juvenile idiopathic scoliosis patients treated during skeletal growth had similar HRQoL on most SF-36 domains in adulthood compared with national norms. Surgical treated JIS patients experienced more pain compared with brace treated patients, while braced CS patients had a significantly lower mental scores compared with surgical treated patients. These long-term outcomes are essential to inform patients and can guide shared decision-making between clinicians and patients.
Collapse
Affiliation(s)
- Johan L Heemskerk
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| | - Nienke W Willigenburg
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Ben E E M J Veraart
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Eric W Bakker
- Department of Clinical Epidemiology and biostatistics, Meibergdreef 9, 1105 AZ, Amsterdam Medical Center location AMC, Amsterdam, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX , The Netherlands
| | - Mark C Altena
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Diederik H R Kempen
- Department of Orthopedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Zapata KA, Devkumar D, Ma Y, Jo CH, Ramo BA. Back pain and disability according to early onset scoliosis etiology in children younger than 10 years. Spine Deform 2024; 12:481-488. [PMID: 37938517 DOI: 10.1007/s43390-023-00783-x] [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: 08/26/2023] [Accepted: 10/14/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To determine caregiver-reported back pain prevalence, disability, pain interference, and associations with curve magnitude in early onset scoliosis (EOS) using the Oswestry Disability Index (ODI) and Patient Reported Outcome Measurement Information Systems (PROMIS) measures. METHODS A single-center, retrospective review was performed in children below 10 years of age according to EOS etiology. Caregiver-reported back pain prevalence, ODI, PROMIS Pain Interference, Mobility, and Anxiety measures, and curve magnitude were recorded as part of routine clinic appointments. RESULTS A total of 1212 patients with EOS (588 idiopathic, 295 congenital, 217 neuromuscular, 112 syndromic) ages 6.6 ± 2.7 were included; 23% had caregiver-reported back pain. Neuromuscular EOS patients had the highest prevalence of back pain (29%). ODI scores were higher in neuromuscular (48%) and syndromic (35%) patients than congenital (20%, p < 0.05) and idiopathic (16%, p < 0.01) patients. Neuromuscular patients also had higher PROMIS Pain Interference scores (53.3) compared to idiopathic (41.6, p < 0.001) and syndromic (45.0, p = 0.016) patients. A higher curve was associated with the presence of back pain (39° vs. 30°, p < 0.001) and had positive correlations with ODI scores (r = 0.38, p < 0.001) and PROMIS Pain Interference scores (r = 0.34, p < 0.001). CONCLUSION Approximately one in five children with EOS under the age of 10 have caregiver-reported back pain, with the neuromuscular EOS type exhibiting higher pain prevalence, interference, and disability scores. Larger curve magnitude is associated with an increased prevalence of caregiver-reported back pain, increased disability, and increased pain interference. LEVEL OF EVIDENCE 3 - case-control study.
Collapse
Affiliation(s)
- Karina A Zapata
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA.
| | - Devan Devkumar
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Yuhan Ma
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Chan-Hee Jo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Brandon A Ramo
- Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| |
Collapse
|
18
|
Handa M, Demura S, Yokogawa N, Hinoi E, Hiraiwa M, Kato S, Shinmura K, Annen R, Kobayashi M, Yamada Y, Nagatani S, Kurokawa Y, Tsuchiya H. Characteristics of Scoliosis in Mice Induced by Chondrocyte-specific Inactivation of L-type Amino Acid Transporter 1. Spine (Phila Pa 1976) 2024; 49:285-293. [PMID: 37796156 DOI: 10.1097/brs.0000000000004842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023]
Abstract
STUDY DESIGN A mouse study of the Slc7a5 gene using conditional knockout to assess the effects of its inactivation on spinal deformity. OBJECTIVES This study aimed to investigate whether the mice with scoliosis [induced by chondrocyte-specific inactivation of L-type amino acid transporter 1 (LAT1)] show a developmental process similar to that of pediatric scoliosis and to examine the relationship between reduced bone mineral density (BMD) and scoliosis. Furthermore, we aimed to obtain insights into elucidating the etiology and pathophysiology of scoliosis. SUMMARY OF BACKGROUND DATA The etiology and pathogenesis of scoliosis are not fully understood despite substantial investigative efforts. LAT1 is an amino acid transporter that mediates the cellular uptake of large neutral amino acids. A recent study revealed that chondrocyte-specific inactivation of LAT1 in mice results in scoliosis (Col2a1-Cre;Slc7a5fl/fl mice: "Sko mice"). MATERIALS AND METHODS Body length, body weight, Cobb angle, vertebral body rotation angle, and BMD at 1, 2, 4, 6, and 8 weeks of age were examined and statistically compared with those of normal control mice. Pathologic and morphologic evaluation was performed on specimens from 10-week-old euthanized mice. RESULTS The Sko mice developed thoracic scoliosis in infancy without congenital malformations. This spinal deformity progressed rapidly during growth, with diverse curve patterns and hypoplastic vertebral bodies. Pathologic examination revealed thickening of the growth plates and decreased osteoblasts, suggesting that impaired endochondral ossification was the cause of the scoliosis. Sko mice were also observed to have decreased BMD and degraded bone microstructure. Reduced BMD and bone quality may not be the causes of the onset and progression of scoliosis in the Sko mice. CONCLUSIONS In Sko mice, the characteristics of scoliosis and vertebral pathology showed many similarities with syndromic scoliosis in humans. Endochondral ossification defects may impair growth, leading to scoliosis and decreased BMD.
Collapse
Affiliation(s)
- Makoto Handa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Eiichi Hinoi
- Department of Bioactive Molecules, Pharmacology, Gifu Pharmaceutical University, Gifu, Japan
| | - Manami Hiraiwa
- Department of Bioactive Molecules, Pharmacology, Gifu Pharmaceutical University, Gifu, Japan
| | - Satoshi Kato
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Kazuya Shinmura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Ryohei Annen
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Motoya Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yohei Yamada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Satoshi Nagatani
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Yuki Kurokawa
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| |
Collapse
|
19
|
Gurel R, Elbaz E, Sigal A, Gigi R, Otremski H, Lebel DE, Ovadia D. Magnetically Controlled Growing Rods Graduation: Lessons From a Single-center Series of 48 Patients. J Pediatr Orthop 2024; 44:e157-e162. [PMID: 37937343 DOI: 10.1097/bpo.0000000000002560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Magnetically controlled growing rod (MCGR) treatment for early-onset scoliosis (EOS) has become a widely utilized method of deformity control, but long-term follow-up reports are sparse. We evaluated the outcomes of a large group of consecutive pediatric patients diagnosed with EOS who were treated by MCGR to the endpoint of definitive spinal fusion in a single center. We hypothesized that lessons learned from treating a large volume of MCGR patients would lower the complication rate in comparison to what was previously reported by other studies. METHODS The records of 48 EOS patients with varied etiologies who were treated by MCGR between 2012 and 2022 and reached the end of treatment were analyzed retrospectively for baseline and final radiographic measurements and surgery-related complications. RESULTS The mean percent of improvement in the major coronal deformity was 51.7±25.0% and the mean T1 to T12 total growth was 52.9±21.9 mm. The total complication rate was 22.9% of which 12.5% required a single unplanned surgery, 6.3% required multiple unplanned surgeries, and 4% did not require any unplanned surgery. CONCLUSION MCGR treatment provides adequate control of EOS, enabling satisfactory growth of the thoracic spine. The complication rate in a single large volume center is moderate. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Ron Gurel
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Etay Elbaz
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Sigal
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Gigi
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Otremski
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David E Lebel
- Hospital for Sick Children, Toronto, Canada Affiliated to the Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dror Ovadia
- Department of Orthopedic Surgery and Pediatric Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
20
|
Moreno Mateo F, Bovonratwet P, Peiró García A. Early-onset scoliosis. Curr Opin Pediatr 2024; 36:105-111. [PMID: 37991009 DOI: 10.1097/mop.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide the reader with the most updated available information so that it can be helpful in the approach of patients with early-onset scoliosis (EOS). RECENT FINDINGS While confirming the efficacy and safety of classic techniques for the treatment of EOS such as traditional growing rods or Mehta casting, recent research suggests that there is room for improvement with less invasive techniques. SUMMARY The most important goal when treating patients with EOS should be to promote rib cage expansion and lung development. Different techniques have been described and may be used depending on the specific patient's characteristics.
Collapse
|
21
|
Lau RWL, Hung ALH, Kee HM, Wong LCH, Chan VKW, Chung DWY, Chan JKT, Chau BKP, Leung SHF, Cheng JCY, Lam TP, Lau AYC. Clinical Outcomes of 111 Patients with Early Onset Idiopathic Scoliosis (EOIS) Receiving Brace Treatment: A Longitudinal Retrospective Cohort Study. J Clin Med 2024; 13:767. [PMID: 38337461 PMCID: PMC10856002 DOI: 10.3390/jcm13030767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Introduction: Bracing is one of the first-line treatment for early-onset idiopathic scoliosis (EOIS) to control curves from progression. This study aimed to explore the determinants that govern bracing effectiveness in EOIS. Methods: One hundred and eleven patients with EOIS (mean age of 8.6 ± 1.25 at diagnosis) received bracing treatment and had a final follow-up beyond skeletal maturity were identified from records between 1988 and 2021. Demographic data and clinical features of spinal curvature were obtained for correlation analyses to determine the associations between curve outcomes and clinical features. Results: Most patients were female (85.6%) and had a major curve on the left side (67%). The mean baseline Cobb angle of major curves was 21.73 ± 7.92°, with a mean Cobb angle progression of 18.05 ± 19.11°. The average bracing duration was 5.3 ± 1.9 years. Only 26 (23.4%) of them underwent surgery. The final Cobb angle and curve progression at the final follow-up with a Cobb angle of ≥50° were positively correlated with the initial Cobb angle (r = 0.206 and r = 0.313, respectively) and negatively correlated with maturity parameters. The lumbar curve type was found to correlate with a smaller final Cobb angle. Conclusions: The majority of patients had a final Cobb angle < 50°, which was considered a successful bracing outcome. The final Cobb angle correlated with the initial Cobb angle and curve types observed in EOIS.
Collapse
Affiliation(s)
- Rufina Wing-Lum Lau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China;
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Alec Lik-Hang Hung
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Ho-Man Kee
- Department of Prosthetics and Orthotic, Prince of Wales Hospital, Hospital Authority, Hong Kong SAR, China
| | - Leo Chung-Hei Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Victor Kin-Wai Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Derek Wai-Yin Chung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Jerry Kwok-To Chan
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Bosco Kin-Pok Chau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Stanley Ho-Fung Leung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| | - Jack Chun-Yiu Cheng
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Tsz-Ping Lam
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
| | - Adam Yiu-Chung Lau
- SH Ho Scoliosis Research Lab, Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China (J.C.-Y.C.); (T.-P.L.)
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China; (L.C.-H.W.); (D.W.-Y.C.); (J.K.-T.C.); (B.K.-P.C.)
| |
Collapse
|
22
|
Hammad AM, Emar M, Shahin F, Aljuba A, Hasani A, Awad M, Abdelnabi S, Gayaswal D, Armouti M, Shekhar S, Garg B, Ahmad AA. A Prospective Multicenter ≥2 Years Clinical Study of the Active Apex Correction (APC) Technique in Early Onset Scoliosis (EOS) Patients. Global Spine J 2024:21925682241229677. [PMID: 38266098 DOI: 10.1177/21925682241229677] [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] [Indexed: 01/26/2024] Open
Abstract
STUDY DESIGN prospective multicenter study. OBJECTIVES Active apex correction (APC) is posterior tethering technique for correction of early onset scoliosis (EOS) via reverse modulation at the apex. Active apex correction has been increasingly used worldwide. This study aimed to assess short-term outcomes of multicenter study with ≥2 years of APC on spine length, curve correction, complications, unplanned surgeries, and proposed low crankshaft phenomena incidence. METHODS Prospective multicenter study including 24 EOS patients treated by APC; involves inserting and compressing pedicle screws on convex side of apex proximal and distal to most wedged vertebra allowing apex modulation according to Hueter-Volkmann law. Excluded patients with <2 years follow-up whom APC was not primary surgery. RESULTS Mean age 85.97 ± 32.43 months, 71% congenital scoliosis, mean follow-up 35.54 ± 12.36 months. At final follow-up, statistically significant improvement in Cobbs angle (∆ = 23.96%, P < .0001), spinal length T1-T12 (∆ = 12.83%, P < .0001), T1-L5 (∆ = 13.41%, P < .0001) but not in apical vertebral translation (AVT) albeit clinical improvement (∆ = 7.9%, P = .36) compared to preoperative measurements. Comparing immediate postoperative measurements to >2 years follow-up, statistically significant improvement in spinal length T1-T12 (∆ = 6.03%, P = .0002) and T1-L5 (∆ = 6.26%, P < .0001) but not in Cobbs angle (∆ = 4.93%, P = .3) or AVT (∆ = 14.77%, P = .25). 9 complications requiring 3 unplanned surgeries recorded in all patients including 2 broken rods, 2 adding-on and 4 screw dislodgement. CONCLUSION Active apex correction is a novel technique that has been incorporated in several countries as treatment modality for EOS. Short-term outcomes are promising in terms of clinical improvement, complication rates and decreased need for multiple operations or unplanned surgeries.
Collapse
Affiliation(s)
- Ahmad M Hammad
- Department of Orthopedics Surgery, American University of Beirut (AUB), Beirut, Lebanon
| | - Mohammad Emar
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Farah Shahin
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Ayat Aljuba
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Asala Hasani
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Mohammad Awad
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Siraj Abdelnabi
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
| | - Daksh Gayaswal
- Department of Orthopedics Surgery, University of Toledo, Toledo, OH, USA
| | - Mohammad Armouti
- Department of Orthopedics Surgery, Abdali Hospital, Amman, Jordan
| | - Shubhankar Shekhar
- Department of Orthopedics Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhavuk Garg
- Department of Orthopedics Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Alaaeldin A Ahmad
- Department of Orthopedics Surgery, Palestine Polytechnic University (PPU), Hebron, Palestine
- Department of Orthopedics Surgery, University of Toledo, Toledo, OH, USA
- Department of Orthopedics Surgery, Abdali Hospital, Amman, Jordan
| |
Collapse
|
23
|
Brown JD, Hurry J, El-Hawary R. Growth friendly surgeries increase 3D true spine length at two-years post-operative. Spine Deform 2023; 11:1503-1508. [PMID: 37468764 DOI: 10.1007/s43390-023-00738-2] [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: 04/08/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Traditional coronal-plane vertical spine height measurements, such as T1-T12 and T1-S1 spine height, are influenced by 3-dimensional spinal deformity. Therefore, they are unreliable indicators of true spine growth. The novel 3D true spine length (3D-TSL) technique assesses spine growth regardless of the presence of 3D spinal deformity. This study evaluates the effect of growth friendly surgery on spine growth using the 3D-TSL technique at two years follow-up. METHODS Radiographs of early onset scoliosis (EOS) participants undergoing growth friendly surgery at a single institution were evaluated at pre-index, post-index, and at 2-year follow-up. Scoliosis, kyphosis, traditional coronal height and 3D-TSL were measured. RESULTS Twenty-four EOS patients (14 female) with a mean age of 6.3 years were included. Scoliosis improved from 77.8 ± 18.7° pre-index to 56.0 ± 17.8° post-index (p < 0.001); but increased at 2 years to 65.9 ± 20.1° (p < 0.05). Kyphosis improved from 56.0 ± 20.7° pre-index to 39.3 ± 13.8° post-index (p < 0.001); and increased again at 2 years to 48.6 ± 16.4° (p < 0.05). Traditional T1-S1 height increased from pre-index to post-index, to 2-year follow-up (245.5 ± 37.2 mm to 275.8 ± 42.7 mm; p < 0.001, to 288.0 ± 41.7 mm; p = 0.005). As expected, T1-S1 3D-TSL did not change from pre to immediately post-index (305.6 ± 43.9 mm vs 306.5 ± 44.0 mm); there was a significant change from post-index to 2-year follow-up (334.1 ± 48.0 mm; p < 0.001). CONCLUSIONS Out of plane changes in scoliosis and kyphosis over time justify the use of the 3D-TSL for this cohort of patients. There was no significant change in 3D-TSL from pre-index to post-operatively; however, during the growth phase of treatment 3D-TSL increased significantly by 27.6 mm.
Collapse
Affiliation(s)
- John-David Brown
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Orthopedic Surgery, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K6R8, Canada
| | - Jennifer Hurry
- Division of Orthopedic Surgery, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K6R8, Canada
| | - Ron El-Hawary
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
- Division of Orthopedic Surgery, IWK Health Centre, 5850 University Avenue, P.O. Box 9700, Halifax, NS, B3K6R8, Canada.
| |
Collapse
|
24
|
Ugur F, Topal K, Albayrak M, Topal M. Is Obstructive Sleep Apnea-Associated Adenoid Hypertrophy Linked to Scoliotic Attitudes in Children? Cureus 2023; 15:e47307. [PMID: 37869050 PMCID: PMC10585604 DOI: 10.7759/cureus.47307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Scoliosis, a multifaceted spinal deformity commonly affecting pediatric and adolescent populations, has spurred extensive scientific inquiry to understand its origins and impacts. Early-onset scoliosis (EOS), characterized by spinal curvature exceeding 10° before the age of 10, presents a unique challenge necessitating a comprehensive understanding of its etiological factors. Within this context, the potential role of hypoxia-induced by adenoid hypertrophy in contributing to the pathogenesis of EOS has emerged as an intriguing avenue of investigation. Materials and methods This retrospective study was conducted focusing on radiological and clinical data pertaining to children below 10 years of age who underwent isolated adenoidectomy for adenoid hypertrophy. Preoperative posteroanterior standing chest radiographs were utilized for scoliosis assessment, with Cobb angles serving as the primary measurement metric. To ensure accuracy and reliability, Cobb angle measurements were independently performed by two experienced observers. Statistical analyses encompassed the Mann-Whitney U test, Spearman correlation analysis, and intraclass correlation coefficient calculations to evaluate interobserver agreement. Results Among the cohort of 218 pediatric adenoidectomy patients, 177 individuals had radiographs suitable for EOS evaluation. The mean age of the participants was 5.72±2 years, with a nearly equal distribution of 52.5% male and 47.5% female patients. Strikingly, the study identified a 10.2% prevalence of coronal plane curvatures exceeding the critical threshold of 10°, indicative of EOS. The robust interobserver reliability was demonstrated by a commendable mean interclass correlation coefficient (ICC) value of 0.926, affirming consistent and accurate Cobb angle measurements between the observers. Conclusion In light of the heightened prevalence of EOS observed in children undergoing adenoidectomy, this study provides a compelling impetus for exploring the potential interrelationship between adenoid hypertrophy, hypoxia, and the emergence of early-onset scoliosis. The study underscores the importance of prospective research to elucidate the complex mechanisms connecting these factors, offering insights into potential risk factors and underlying pathogenic pathways associated with the development of early-onset scoliosis.
Collapse
Affiliation(s)
- Fatih Ugur
- Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, TUR
| | - Kubra Topal
- Otolaryngology - Head and Neck Surgery, Private Practice, Kastamonu, TUR
| | - Mehmet Albayrak
- Orthopedics and Traumatology, Ozel Tekirdag Yasam Hospital, Tekirdag, TUR
| | - Murat Topal
- Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, TUR
| |
Collapse
|
25
|
Ashebo L, Anari JB, Cahill PJ. Update on the Diagnosis and Management of Early-onset Scoliosis. Curr Rev Musculoskelet Med 2023; 16:447-456. [PMID: 37615932 PMCID: PMC10497459 DOI: 10.1007/s12178-023-09848-w] [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] [Accepted: 05/30/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW In this article, we review the most recent advancements in the approaches to EOS diagnosis and assessment, surgical indications and options, and basic science innovation in the space of early-onset scoliosis research. RECENT FINDINGS Early-onset scoliosis (EOS) covers a diverse, heterogeneous range of spinal and chest wall deformities that affect children under 10 years old. Recent efforts have sought to examine the validity and reliability of a recently developed classification system to better standardize the presentation of EOS. There has also been focused attention on developing safer, informative, and readily available imaging and clinical assessment tools, from reduced micro-dose radiographs, quantitative dynamic MRIs, and pulmonary function tests. Basic science innovation in EOS has centered on developing large animal models capable of replicating scoliotic deformity to better evaluate corrective technologies. And given the increased variety in approaches to managing EOS in recent years, there exist few clear guidelines around surgical indications across EOS etiologies. Despite this, over the past two decades, there has been a considerable shift in the spinal implant landscape toward growth-friendly instrumentation, particularly the utilization of MCGR implants. With the advent of new biological and basic science treatments and therapies extending survivorship for disease etiologies associated with EOS, the treatment for EOS has steadily evolved in recent years. With this has come a rising volume and variation in management options for EOS, as well as the need for multidisciplinary and creative approaches to treating patients with these complex and heterogeneous disorders.
Collapse
Affiliation(s)
- Leta Ashebo
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA
| | - Patrick J Cahill
- Division of Orthopaedics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19142, USA.
| |
Collapse
|
26
|
Chen P, Zhou Y, Tan Z, Lin Y, Lin DLL, Wu J, Li Z, Shek HT, Wu J, Hu Y, Zhu F, Chan D, Cheung KMC, To MKT. Scoliosis in osteogenesis imperfecta: identifying the genetic and non-genetic factors affecting severity and progression from longitudinal data of 290 patients. Orphanet J Rare Dis 2023; 18:295. [PMID: 37730650 PMCID: PMC10510243 DOI: 10.1186/s13023-023-02906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Scoliosis is widely prevalent among osteogenesis imperfecta (OI) patients, and is progressive with age. However, factors affecting scoliosis in OI are not well known. METHODS We retrospectively retrieved longitudinal radiographic and clinical records of consecutive OI patients seeking treatments at our hospital from 2014 to 2022, graded their pre-operative spinal conditions into four outcome groups, estimated their progression rates, and descriptively and inferentially analyzed the genetic and non-genetic factors that may affect the outcomes and progression rates. RESULTS In all, 290 OI patients met the inclusion criteria, where 221 had genetic records. Of these 221, about 2/3 had mutations in COL1A1 or COL1A2, followed by mutations in WNT1 (9.0%), IFITM5 (9.0%) and other OI risk genes. With an average age of 12.0 years (interquartile range [IQR] 6.9-16.1), 70.7% of the cohort had scoliosis (Cobb angle > 10°), including 106 (36.5%) mild (10°-25°), 40 (13.8%) moderate (25°-50°), and 59 (20.3%) severe (> 50°) scoliosis patients. Patients with either COL1A1 and COL1A2 were strongly biased toward having mild or no scoliosis, whereas patients with mutations in IFITM5, WNT1 and other recessive genes were more evenly distributed among the four outcome grades. Lower-limb discrepancy, bone mineral density (BMD) and age of first drug used were all significantly correlated with severity outcomes. Using multivariate logistic regression, we estimated that each year older adds an odds ratio of 1.13 (95% confidence interval [CI] 1.07-1.2) in progression into advanced stages of scoliosis. We estimated a cohort-wide progression rate of 2.7 degrees per year (95% CI 2.4-3.0). Early-onset patients experienced fast progressions during both infantile and adolescent stages. Twenty-five of the 59 (42.8%) patients with severe scoliosis underwent spinal surgeries, enjoying an average Cobb angle reduction of 33° (IQR 23-40) postoperatively. CONCLUSION The severity and progression of scoliosis in osteogenesis imperfecta were affected by genetic factors including genotypes and mutation types, and non-genetic factors including age and BMD. As compared with COL1A1, mutations in COL1A2 were less damaging while those on IFITM5 and other recessive genes conferred damaging effects. Progression rates were the fastest in the adolescent adult age-group.
Collapse
Affiliation(s)
- Peikai Chen
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China.
- School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong.
- The Artificial Intelligence and Big Data (AIBD) Lab, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, Guangdong, China.
| | - Yapeng Zhou
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Zhijia Tan
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Yunzhi Lin
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Daniel Li-Liang Lin
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Jingwei Wu
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Zeluan Li
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Hiu Tung Shek
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Jianbin Wu
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
| | - Yong Hu
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
- The Artificial Intelligence and Big Data (AIBD) Lab, The University of Hong Kong - Shenzhen Hospital, Shenzhen, 518053, Guangdong, China
| | - Feng Zhu
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Danny Chan
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
- School of Biomedical Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kenneth Man-Chee Cheung
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Michael Kai-Tsun To
- Department of Orthopedics and Traumatology, The University of Hong Kong - Shenzhen Hospital (HKU-SZH), Shenzhen, 518053, Guangdong, China.
- Department of Orthopedics and Traumatology, The University of Hong Kong, Pok Fu Lam, Hong Kong.
| |
Collapse
|
27
|
Fano AN, Quan T, Bonsignore-Opp L, Roye BD, Vitale MG, Matsumoto H. Evaluating consensus and uncertainty among treatment options for early-onset scoliosis: new generation and international perspectives. Spine Deform 2023; 11:1271-1282. [PMID: 37278970 DOI: 10.1007/s43390-023-00713-x] [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: 12/25/2022] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE It is currently unknown how treatment preferences differ between a senior group of U.S. spinal surgeons, a new generation of U.S. surgeons, and non-U.S. surgeons with regard to the treatment of early-onset scoliosis (EOS). The purpose of this study was to evaluate clinical consensus and uncertainty among treatment options for patients with EOS to understand how they compare between these three cohorts. METHODS 11 senior pediatric spinal deformity surgeons in the U.S., 12 "junior" surgeons in the U.S., and 7 surgeons practicing in non-U.S. countries were invited to complete a survey of 315 idiopathic and neuromuscular EOS case scenarios. Treatment options included: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Chi-squared and multiple regression analyses were performed to evaluate the associations between case characteristics and consensus for different treatments. RESULTS Although all 3 cohorts of surgeons chose conservative management most frequently, the non-U.S. cohort of surgeons chose distraction-based methods more often, particularly for neuromuscular cases. In both U.S. surgeon cohorts, there was consensus for conservative management in idiopathic patients aged 3 or younger regardless of other factors, whereas non-U.S. surgeons selected distraction-based methods for some of these patients. CONCLUSION Just as research studies are being conducted to find approaches to optimally manage the EOS population, future research efforts should focus on identifying the reasoning behind treatment preferences in different cohort of surgeons, as this will allow the interexchange of information which can ultimately improve EOS care. LEVEL OF EVIDENCE V.
Collapse
Affiliation(s)
- Adam N Fano
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA.
| | - Lisa Bonsignore-Opp
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Benjamin D Roye
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| |
Collapse
|
28
|
Wang S, Zhao Y, Lin G, Du Y, Yang Y, Zhang J. Traditional Dual Growing Rods With 2 Different Apical Control Techniques in the Treatment of Early-Onset Scoliosis. Neurospine 2023; 20:1061-1072. [PMID: 37798998 PMCID: PMC10562217 DOI: 10.14245/ns.2346406.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Based on traditional dual growing rods (TDGR), apical control techniques (ACTs) were introduced as adjuvant procedures to improve deformity correction at the apex segment in the treatment of early-onset scoliosis (EOS). We aimed to explore whether TDGR+ ACTs have different indications, attain more deformity correction, have negative effects on spinal growth, and have different complications. METHODS Between 2004 and 2019, a retrospective study of EOS patients treated with TDGR with or without ACTs was conducted and divided into 3 groups: TDGR group; hybrid technique (HT) group: Vertebrectomy/hemivertebrectomy with short fusion and TDGR; ACPS group: apical convex control pedicle screws (ACPS) and TDGR. Demographic, radiographic parameters, clinical outcomes, complications, and revisions were analyzed and compared. RESULTS Seventy-eight EOS patients were enrolled. The preoperative main curve was the largest in the HT group. ACPS group had the smallest residual curve (19° ± 8.9°) and apical vertebral translation (12.0 ± 9.0 mm) at the latest follow-up, followed by the HT group (30° ± 17.4°, 22.1 ± 13.4 mm) and TDGR group (30° ± 13.2°, 32.8 ± 17.1 mm). ACPS group had the largest T1-12 height and T1-S1 height after index surgery. Complications and revisions in the ACTs groups was lower than the TDGR group. Scoliosis Research Society-22 self-image questionnaire was superior in the ACPS group. CONCLUSION According to our intermediate results, TDGR+ACTs could improve correction ability of apex deformity. ACTs had little deleterious effects on spinal height during the lengthening procedures, with a lower complication rate than TDGR. TDGR+ACTs might be a supplemental option for suitable EOS patients.
Collapse
Affiliation(s)
- Shengru Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiwei Zhao
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guanfeng Lin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - You Du
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Yang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
29
|
Deveza LR, Chhabra BN, Heydemann J, Hung C, Vanorny D, Birhiray D, Dahl B. Comparison of baseline characteristics and postoperative complications in neuromuscular, syndromic and congenital scoliosis. J Pediatr Orthop B 2023; 32:350-356. [PMID: 35762668 DOI: 10.1097/bpb.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nonidiopathic scoliosis encompasses a group of diagnoses, including neuromuscular scoliosis, syndromic scoliosis and congenital scoliosis. The objective of this study was to compare the preoperative and postoperative clinical differences in pediatric nonidiopathic scoliosis patients with neuromuscular scoliosis vs. syndromic scoliosis/congenital scoliosis. This is a single-center retrospective review of all pediatric patients undergoing spinal instrumentation for nonidiopathic scoliosis during a 5-year period. Neuromuscular scoliosis patients ( n = 144), syndromic scoliosis patients ( n = 44) and congenital scoliosis patients ( n = 52) were compared. Demographics, patient characteristics and outcomes were compared. Neuromuscular scoliosis patients had lower BMI z-scores and were more likely to have pulmonary disease, technology dependence and seizure disorder. Additionally, neuromuscular scoliosis patients underwent bigger procedures with more levels fused and a higher rate of pelvis fixation. By direct comparison, neuromuscular scoliosis patients tended to have more complications including deep surgical site infections, readmission in 30 days, return to operating room in 90 days and emergency care visits in 90 days. When controlling for the differences in their preexisting conditions and surgical procedure, we found that pelvic fixation was a major confounding factor, whereas the others had no effect. We further subanalyzed cerebral palsy patients and found this group to exhibit no difference in complications compared to other neuromuscular scoliosis subtypes. Neuromuscular scoliosis patients have different characteristics and subsequent postoperative complications than those with syndromic scoliosis and congenital scoliosis. The difference in complication profile is mainly due to differences in surgical procedure and a higher rate of pelvic fixation. This should be considered when planning nonidiopathic scoliosis surgery among multidisciplinary teams.
Collapse
Affiliation(s)
| | - Barkha N Chhabra
- Division of Orthopaedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - John Heydemann
- Division of Orthopaedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Chun Hung
- Department of Orthopaedic Surgery, Baylor College of Medicine
| | - Dallas Vanorny
- Department of Orthopaedic Surgery, Baylor College of Medicine
| | - Dion Birhiray
- Division of Orthopaedic Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Benny Dahl
- Department of Orthopaedic Surgery, Baylor College of Medicine
- Division of Orthopaedic Surgery, Texas Children's Hospital, Houston, TX, USA
- Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
30
|
Haapala H, Heiskanen S, Syvänen J, Raitio A, Helenius L, Ahonen M, Diarbakerli E, Gerdhem P, Helenius I. Surgical and Health-related Quality of life Outcomes in Children With Congenital Scoliosis During 5-year Follow-up. Comparison to Age and Sex-matched Healthy Controls. J Pediatr Orthop 2023; 43:e451-e457. [PMID: 36998176 DOI: 10.1097/bpo.0000000000002408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Congenital spinal anomalies represent a heterogeneous group of spinal deformities, of which only progressive or severe curves warrant surgical management. Only a limited number of studies have investigated the impact of surgery on the health-related quality of life and very limited data exists comparing these outcomes to healthy controls. METHODS A single surgeon series of 67 consecutive children with congenital scoliosis (mean age at surgery 8.0 y, range: 1.0 to 18.3 y, 28 girls) undergoing hemivertebrectomy (n = 34), instrumented spinal fusion (n = 20), or vertical expandable prosthetic titanium rib procedure (n = 13) with a mean follow-up of 5.8 years (range: 2 to 13 y). The comparison was made to age and sex-matched healthy controls. Outcome measures included the Scoliosis Research Society questionnaire both pre and postoperatively, radiographic outcomes, and complications. RESULTS The average major curve correction was significantly better in the hemivertebrectomy (60%) and instrumented spinal fusion (51%) than in the vertical expandable prosthetic titanium rib group (24%), respectively ( P < 0.001). Complications were noted in 8 of 67 (12%) children, but all patients recovered fully during follow-up. Pain, self-image, and function domains improved numerically from preoperative to final follow-up, but the pain score was the only one with a statistically significant change ( P = 0.033). The Scoliosis Research Society pain, self-image, and function domain scores remained at a significantly lower level at the final follow-up than in the healthy controls ( P ≤ 0.05), while activity scores improved to a similar level. CONCLUSIONS Surgery for congenital scoliosis improved angular spinal deformities with a reasonable risk of complications. Health-related quality of life outcomes improved from preoperative to final follow-up, but especially pain and function domains remained at a significantly lower level than in the age and sex-matched healthy controls. LEVEL OF EVIDENCE Level III, therapeutic.
Collapse
Affiliation(s)
- Hermanni Haapala
- Department of Pediatric Surgery, Pediatric Orthopaedics, and Traumatology
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki
| | | | | | | | - Linda Helenius
- Department of Anesthesia and Intensive Care, University of Turku and Turku University Hospital, Turku, Finland
| | - Matti Ahonen
- Department of Pediatric Surgery, Pediatric Orthopaedics, and Traumatology
| | - Elias Diarbakerli
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm
| | - Paul Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute
- Department of Hand Surgery and Orthopaedics, Uppsala University Hospital, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki
| |
Collapse
|
31
|
Farivar D, Parent S, Miyanji F, Heffernan MJ, El-Hawary R, Larson AN, Andras LM, Skaggs DL. Concave and convex growth do not differ over tethered vertebral segments, even with open tri-radiate cartilage. Spine Deform 2023; 11:881-886. [PMID: 37004694 PMCID: PMC10261211 DOI: 10.1007/s43390-023-00683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To assess the following hypotheses related to vertebral body tethering (VBT): 1. VBT is associated with asymmetric (concave > convex) increases in height over the instrumented vertebra. 2. The instrumented Cobb angle improves following VBT surgery with growth. METHODS This is a retrospective case series of pediatric patients from a multicenter scoliosis registry treated with VBT between 2013 to 2021. INCLUSION CRITERIA patients with standing radiographs at < 4 months and ≥ 2 years after surgery. Distances between the superior endplate of the UIV and the inferior endplate of the LIV were measured at the concave corner, mid-point, and convex corner of the endplates. The UIV-LIV angle was recorded. Subgroup analyses included comparing different Risser scores and tri-radiate cartilage (TRC) closed versus open using student t-tests. RESULTS 83 patients met inclusion criteria (92% female; age at time of surgery 12.5 ± 1.4 years) with mean follow-up time of 3.8 ± 1.4 years. Risser scores at surgery were: 0 (n = 33), 1 (n = 12), 2 (n = 10), 3 (n = 11), 4 (n = 12), and 5 (n = 5). Of the 33 Risser 0 patients, 17 had an open TRC, 16 had a closed TRC. The UIV-LIV distance at concave, middle, and convex points significantly increased from immediate post-op to final-follow-up for Risser 0 patients, but not for Risser 1-5 patients. Increases in UIV-LIV distance were not significantly different between concave, middle, and convex points for all groups. There was no significant improvement or worsening in UIV-LIV angle for any group. CONCLUSION At a mean of 3.8 years following VBT, 33 Risser 0 patients demonstrated significant growth in the instrumented segment, though there was no difference between concave or convex growth, even for patients with open TRC.
Collapse
Affiliation(s)
- Daniel Farivar
- Cedars-Sinai Spine, 444 S San Vicente Blvd, Ste 901, Los Angeles, CA, 90048, USA
| | - Stefan Parent
- Department of Surgery, Université de Montréal, Montreal, QC, Canada
| | - Firoz Miyanji
- Department of Orthopedics, BC Children's Hospital, Vancouver, BC, Canada
| | - Michael J Heffernan
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ron El-Hawary
- Orthopedics, Izaak Walton Killam (IWK) Health Centre, Halifax, Canada
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David L Skaggs
- Cedars-Sinai Spine, 444 S San Vicente Blvd, Ste 901, Los Angeles, CA, 90048, USA.
| |
Collapse
|
32
|
Braun S, Brenneis M, Schönnagel L, Caffard T, Diaremes P. Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients. Life (Basel) 2023; 13:1341. [PMID: 37374124 DOI: 10.3390/life13061341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Scoliosis and Scheuermann's disease are common spinal deformities that affect a substantial population, particularly adolescents, often impacting their quality of life. This comprehensive review aims to present a detailed understanding of these conditions, their diagnosis, and various treatment strategies. Through an extensive exploration of current literature, the review discusses the etiology of these spinal deformities and the use of diagnostic tools such as X-rays and MRI. It further delves into the range of treatment options available, from conservative approaches such as physiotherapy and bracing to more invasive surgical interventions. The review underscores the necessity of an individualized treatment approach, taking into account factors such as the patient's age, the severity of the curvature, and overall health. This all-encompassing perspective on scoliosis and Scheuermann's disease will aid in evidence-based decision making in their management with the goal of improving patient outcomes.
Collapse
Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Marco Brenneis
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Lukas Schönnagel
- Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, 10117 Berlin, Germany
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
| | - Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, University of Ulm, 89075 Ulm, Germany
| | - Panagiotis Diaremes
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany
| |
Collapse
|
33
|
Balioğlu MB, Abul K, Akpolat AO, Özlük AV, Saçık N, Aksay MF, Çetinkaya M. Implant-Related Complications Do Not Interfere with Corrections with the Shilla Technique in Early Onset Scoliosis: Preliminary Results. CHILDREN (BASEL, SWITZERLAND) 2023; 10:947. [PMID: 37371179 DOI: 10.3390/children10060947] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
Growth-preservation techniques are utilized in early onset scoliosis (EOS) cases requiring surgical intervention. The Shilla technique corrects the deformity by reducing additional surgeries with its growth-guidance effect. As with other techniques, various problems can be encountered following the administration of the Shilla technique. The aim of this study was to examine the effect of complications encountered with the Shilla treatment on correction and growth. Sixteen patients with a follow-up period of at least one year after receiving Shilla growth guidance for EOS were included in this retrospective study. No complications occurred, and no unplanned surgery was required in 50% of the cases. Of the remaining eight patients with postoperative implant-related complications (50%), six (37.5%) required unplanned surgery; this consequently caused implant failure in the proximal region in five cases (31.25%) and deep tissue infection around the implant in one case (6.25%). Deformity correction, spine length, and quality-of-life scores significantly improved in EOS through Shilla growth guidance. In terms of spinal growth and deformity correction, there were no significant differences between patients with implant-related problems and individuals without occurrences. Although implant-related problems were detected in our dataset and corresponding unexpected surgeries were necessary, these complications had no significant unfavorable influence on correction and spine growth.
Collapse
Affiliation(s)
- Mehmet Bülent Balioğlu
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Kadir Abul
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Ahmet Onur Akpolat
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, 34752 Istanbul, Turkey
| | - Ali Volkan Özlük
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Nurullah Saçık
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| | - Mehmet Fatih Aksay
- Department of Orthopedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, 34752 Istanbul, Turkey
| | - Mehmet Çetinkaya
- Department of Orthopedics and Traumatology, Başakşehir Pine and Sakura City Hospital, 34480 Istanbul, Turkey
| |
Collapse
|
34
|
Viraraghavan G, Cahill PJ, Vitale MG, Williams BA, Balasubramanian S. Automated Clustering Technique (ACT) for Early Onset Scoliosis: A preliminary report. Spine Deform 2023; 11:723-731. [PMID: 36701107 PMCID: PMC10147803 DOI: 10.1007/s43390-022-00634-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/10/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE While the C-EOS system helps organize and classify Early Onset Scoliosis (EOS) pathology, it is not data-driven and does not help achieve consensus for surgical treatment. The current study aims to create an automated method to cluster EOS patients based on pre-operative clinical indices. METHODS A total of 1114 EOS patients were used for the study, with the following distribution by etiology: congenital (240), idiopathic (217), neuromuscular (417), syndromic (240). Pre-operative clinical indices used for clustering were age, major curve (Cobb) angle, kyphosis, number of levels involved in a major curve (Cobb angle) and kyphosis along with deformity index (defined as the ratio of major Cobb angle and kyphosis). Fuzzy C-means clustering was performed for each etiology individually, with one-way ANOVA performed to assess statistical significance (p < 0.05). RESULTS The automated clustering method resulted in three clusters per etiology as the optimal number based on the highest average membership values. Statistical analyses showed that the clusters were significantly different for all the clinical indices within and between etiologies. Link to the ACT-EOS web application: https://biomed.drexel.edu/labs/obl/toolkits/act-eos-application . CONCLUSION An automated method to cluster EOS patients based on pre-operative clinical indices was developed identifying three unique, data-driven subgroups for each C-EOS etiology category. Adoption of such an automated clustering framework can help improve the standardization of clinical decision-making for EOS.
Collapse
Affiliation(s)
- Girish Viraraghavan
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bossone 718, Philadelphia, PA, 19104, USA
| | - Patrick J Cahill
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, Columbia University, New York, NY, USA
| | - Brendan A Williams
- Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3141 Chestnut Street, Bossone 718, Philadelphia, PA, 19104, USA.
| |
Collapse
|
35
|
Wang Y, Wang D, Zhang G, Ma B, Ma Y, Yang Y, Xing S, Kang X, Gao B. Effects of spinal deformities on lung development in children: a review. J Orthop Surg Res 2023; 18:246. [PMID: 36967416 PMCID: PMC10041811 DOI: 10.1186/s13018-023-03665-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 03/01/2023] [Indexed: 03/28/2023] Open
Abstract
Scoliosis before the age of 5 years is referred to as early-onset scoliosis (EOS). While causes may vary, EOS can potentially affect respiratory function and lung development as children grow. Moreover, scoliosis can lead to thoracic insufficiency syndrome when aggravated or left untreated. Therefore, spinal thoracic deformities often require intervention in early childhood, and solving these problems requires new methods that include the means for both deformity correction and growth maintenance. Therapeutic strategies for preserving the growing spine and thorax include growth rods, vertically expandable titanium artificial ribs, MAGEC rods, braces and casts. The goals of any growth-promoting surgical strategy are to alter the natural history of cardiorespiratory development, limit the progression of underlying spondylarthrosis deformities and minimize negative changes in spondylothorax biomechanics due to the instrumental action of the implant. This review further elucidates EOS in terms of its aetiology, pathogenesis, pathology and treatment.
Collapse
Affiliation(s)
- Yonggang Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Dongmin Wang
- Medical College of Northwest Minzu University, No. 1 Northwest Xincun, Lanzhou, 730030, Gansu Province, China
| | - Guangzhi Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Bing Ma
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Yingping Ma
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Yong Yang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Shuai Xing
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Xuewen Kang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Lanzhou, 730030, Gansu Province, China.
| |
Collapse
|
36
|
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.
Collapse
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
| | | |
Collapse
|
37
|
Demura S, Ohara T, Tauchi R, Takimura K, Watanabe K, Suzuki S, Uno K, Suzuki T, Yanagida H, Yamaguchi T, Kotani T, Nakayama K, Watanabe K, Yokogawa N, Oku N, Tsuchiya H, Yamamoto T, Kawamura I, Taniguchi Y, Takeshita K, Sugawara R, Kikkawa I, Sato T, Fujiwara K, Akazawa T, Murakami H, Kawakami N. Incidence and causes of instrument-related complications after primary definitive fusion for pediatric spine deformity. J Neurosurg Spine 2023; 38:192-198. [PMID: 36461844 DOI: 10.3171/2022.8.spine22729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Various complications have been reported in the treatment of pediatric spinal deformities. Among these, instrument-related complications could be critical concerns and risks of reoperation. This study aimed to identify the incidence and causes of complications after primary definitive fusion for pediatric spine deformities. METHODS The authors retrospectively collected data from 14 institutions about patients who underwent primary definitive fusion between 2015 and 2017. There were 1490 eligible patients (1184 female and 306 male), with a mean age of 13.9 years. The incidence, causes, and reoperation rates were analyzed according to 4 etiologies of pediatric spine deformity (congenital, neuromuscular, syndromic, idiopathic). The complications were also categorized as screw-, hook-, or rod-related complications, implant loosening or backout, and junctional problems. RESULTS The incidence of overall instrument-related complications was 5.6% (84 cases). Regarding etiology, the incidence rates were 4.3% (idiopathic), 6.8% (syndromic), 7.9% (congenital), and 10.4% (neuromuscular) (p < 0.05). The most common causes were pedicle screw malposition (60.7%), followed by implant backout or loosening (15.4%), junctional problems (13.1%), rod breakage (4.8%), and other complications (6.0%). Univariate analysis showed that etiology, type of deformity (kyphosis), surgical procedure, operation time, and estimated blood loss were significant factors. Multivariate analysis revealed that etiology (neuromuscular), surgical procedure (combined approach), and operation time (> 5 hours) remained as significant risk factors. Among all patients with instrument-related complications, 45% (38/84) required revision surgery. Of these cases, > 50% were related to pedicle screw malposition. Medial breach was the most common complication regardless of location, from upper thoracic to lumbar spine. CONCLUSIONS Pedicle screw malposition was the primary cause of overall complications and subsequent reoperation. In addition to more precise screw insertion techniques, meticulous confirmation of pedicle screw placement, especially of medial breach, may reduce the overall instrument-related complications and revision rates.
Collapse
Affiliation(s)
- Satoru Demura
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Tetsuya Ohara
- 2Department of Orthopaedic Surgery, Meijo Hospital, Nagoya
| | - Ryoji Tauchi
- 2Department of Orthopaedic Surgery, Meijo Hospital, Nagoya
| | | | - Kota Watanabe
- 3Department of Orthopaedic Surgery, Keio University, Tokyo
| | - Satoshi Suzuki
- 3Department of Orthopaedic Surgery, Keio University, Tokyo
| | - Koki Uno
- 4Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe
| | - Teppei Suzuki
- 4Department of Orthopaedic Surgery, National Hospital Organization, Kobe Medical Center, Kobe
| | - Haruhisa Yanagida
- 5Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Toru Yamaguchi
- 5Department of Orthopaedic Surgery, Fukuoka Children's Hospital, Fukuoka
| | - Toshiaki Kotani
- 6Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba
| | - Keita Nakayama
- 6Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba
| | - Kei Watanabe
- 7Department of Orthopedic Surgery, Niigata University, Niigata
| | - Noriaki Yokogawa
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Norihiro Oku
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Hiroyuki Tsuchiya
- 1Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa
| | - Takuya Yamamoto
- 8Department of Orthopaedic Surgery, Kagoshima Red Cross Hospital, Kagoshima
| | - Ichiro Kawamura
- 9Department of Orthopaedic Surgery, Kagoshima University, Kagoshima
| | - Yuki Taniguchi
- 10Department of Orthopaedic Surgery, The University of Tokyo, Tokyo
| | | | - Ryo Sugawara
- 11Department of Orthopedic Surgery, Jichi Medical University, Tochigi
| | - Ichiro Kikkawa
- 12Department of Pediatric Orthopedics, Jichi Children's Medical Center, Tochigi
| | - Tatsuya Sato
- 13Department of Orthopaedics, Juntendo University School of Medicine, Tokyo
| | - Kenta Fujiwara
- 14Department of Orthopaedics, Osaka Medical and Pharmaceutical University, Osaka
| | - Tsutomu Akazawa
- 15Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kanagawa
| | - Hideki Murakami
- 16Department of Orthopaedic Surgery, Iwate Medical University, Iwate; and
| | - Noriaki Kawakami
- 17Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | | |
Collapse
|
38
|
Tan Z, Shek HT, Chen P, Dong Z, Zhou Y, Yin S, Qiu A, Dong L, Gao B, To MKT. Clinical features and molecular characterization of Chinese patients with FKBP10 variants. Mol Genet Genomic Med 2023; 11:e2122. [PMID: 36655627 PMCID: PMC10094084 DOI: 10.1002/mgg3.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Osteogenesis imperfecta (OI) is a group of rare skeletal dysplasia. Long bone deformity and scoliosis are often associated with progressively deforming types of OI. FKBP65 (encoded by FKBP10, OMIM *607063) plays a crucial role in the processing of type I procollagen. Autosomal recessive variants in FKBP10 result in type XI osteogenesis imperfecta. METHODS Patients diagnosed with OI were recruited for a genetic test. RT-PCR and Sanger sequencing were applied to confirm the splicing defect in FKBP10 mRNA with the splice-site variant. The bone structure was characterized by Goldner's trichrome staining. Bioinformatic analyses of bulk RNA sequencing data were performed to examine the effect of the FKBP10 variant on gene expression. RESULTS Here we reported three children from a consanguineous family harboured a homozygous splice-site variant (c.918-3C > G) in FKBP10 intron and developed long bone deformity and early onset of scoliosis. We also observed frequent long bone fractures and spinal deformity in another 3 OI patients with different FKBP10 variants. The homozygous splicing variant identified in the fifth intron of FKBP10 (c.918-3C > G) led to abnormal RNA processing and loss of FKBP65 protein and consequently resulted in aberrant collagen alignment and porous bone morphology. Analysis of transcriptomic data indicated that genes involved in protein processing and osteoblast differentiation were significantly affected in the patient-derived osteoblasts. CONCLUSION Our study characterized the clinical features of OI patients with FKBP10 variants and revealed the pathogenesis of the c.918-3C > G variant. The molecular analyses helped to gain insight into the deleterious effects of FKBP10 variants on collagen processing and osteoblast differentiation.
Collapse
Affiliation(s)
- Zhijia Tan
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Hiu Tung Shek
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Peikai Chen
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Zhongxin Dong
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yapeng Zhou
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shijie Yin
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Anmei Qiu
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lina Dong
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Bo Gao
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Michael Kai Tsun To
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| |
Collapse
|
39
|
Shaw KA, Ramo B, McClung A, Thornberg D, Yazsay B, Sturm P, Jo CH, Oetgen ME. Impact of surgical treatment on parent-reported health related quality of life measures in early-onset scoliosis: stable but no improvement at 2 years. Spine Deform 2023; 11:213-223. [PMID: 36181618 DOI: 10.1007/s43390-022-00572-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/13/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE The etiology of early-onset scoliosis (EOS) has been shown to significantly influence baseline parent-reported health-related quality of life (HRQoL) measures as assessed by the Early Onset Scoliosis Questionnaire (EOSQ). We sought to assess the influence of distraction-based surgery and scoliosis etiology on EOSQ 2 years following surgical intervention remains unclear. METHODS A retrospective review of a multi-center prospective EOS database was performed. Children untreated with distraction-based, growth friendly instrumentation for EOS with completed baseline and 2-year post-surgical EOSQ were included. Children were subdivided by curve etiology individually and in combined cohorts (congenital/idiopathic [C/I], neuromuscular/syndromic [NMS]). EOSQ domains and compositive HRQoL score at presentation and 2-year follow-up were compared across C-EOS etiologies. Minimal clinically important difference (MCID) was defined as ≥ 20% change in domain score and compared across etiologies. RESULTS 150 children with EOS met inclusion criteria (mean 7.09 ± 2.6 years, 58.9% female). There were no differences in EOSQ domains between Congenital vs. Idiopathic nor NM vs. Syndromic etiologies at any timepoint. Combined C/I children demonstrated significantly higher EOSQ scores than combined NMS at initial and 2-years post-treatment. Etiology remained the only independent predictor of 2-year EOSQ composite HRQoL score. Overall, the vast majority of children demonstrated stable HRQoL composite scores, with a trend toward more positive MCID in NMS etiologies. CONCLUSION EOS etiology remains the most significant influence on EOSQ scores 2 years following surgical intervention. However, the majority of patients, regardless of etiology, maintain stable HRQoL scores suggesting that surgery may only serve to stabilize HRQoL at 2 years.
Collapse
Affiliation(s)
- K Aaron Shaw
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA.
| | - Brandon Ramo
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Anna McClung
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - David Thornberg
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Burt Yazsay
- Division of Orthopaedics and Sports Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Peter Sturm
- Department of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Chan-Hee Jo
- Department of Pediatric Orthopaedic Surgery, Scottish Rite for Children Hospital, Dallas, TX, USA
| | - Matthew E Oetgen
- Department of Pediatric Orthopaedic Surgery, Children's National Hospital, Washington, DC, USA
| |
Collapse
|
40
|
Roye BD, Fano AN, Quan T, Matsumoto H, Garg S, Heffernan MJ, Poon SC, Glotzbecker MP, Fletcher ND, Sturm PF, Ramirez N, Vitale MG, Anari JB. Modified Clavien-Dindo-Sink system is reliable for classifying complications following surgical treatment of early-onset scoliosis. Spine Deform 2023; 11:205-212. [PMID: 36053431 DOI: 10.1007/s43390-022-00573-x] [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: 06/17/2022] [Accepted: 08/13/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Appropriately measuring and classifying surgical complications is a critical component of research in vulnerable populations, including children with early-onset scoliosis (EOS). The purpose of this study was to assess the inter- and intra-rater reliability of a modified Clavien-Dindo-Sink system (CDS) classification system for EOS patients among a group of pediatric spinal deformity surgeons. METHODS Thirty case scenarios were developed and presented to experienced surgeons in an international spine study group. For each case, surgeons were asked to select a level of severity based on the modified CDS system to assess inter-rater reliability. The survey was administered on two occasions to allow for assessment of intra-rater reliability. Weighted Kappa values were calculated, with 0.61 to 0.80 considered substantial agreement and 0.81 to 1.00 considered nearly perfect agreement. RESULTS 11/12 (91.7%) surgeons completed the first-round survey and 8/12 (66.7%) completed the second. Inter-observer weighted kappa values for the first and second survey were 0.75 [95% CI 0.56-0.94], indicating substantial agreement, and 0.84 [95% CI 0.70-0.98], indicating nearly perfect agreement, respectively. Intra-observer reliability was 0.86 (range 0.74-0.95) between the first and second surveys, indicating nearly perfect agreement . CONCLUSION The modified CDS classification system demonstrated substantial to nearly perfect agreement between and within observers for the evaluation of complications following the surgical treatment of EOS patients. Adoption of this reliable classification system as a standard for reporting complications in EOS patients can be a valuable tool for future research endeavors, as we seek to ultimately improve surgical practices and patient outcomes. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
- Benjamin D Roye
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Adam N Fano
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Theodore Quan
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA.
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Sumeet Garg
- Department of Orthopaedic Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, USA
| | - Michael J Heffernan
- Department of Orthopaedic Surgery, Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Selina C Poon
- Department of Orthopaedic Surgery, Shriners Children's Southern California, 909 S Fair Oaks Ave, Pasadena, CA, 91105, USA
| | - Michael P Glotzbecker
- Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Nicholas D Fletcher
- Department of Orthopedic Surgery, Children's Healthcare of Atlanta, 1400 Tullie Rd NE 2nd Floor, Atlanta, GA, 30329, USA
| | - Peter F Sturm
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Norman Ramirez
- Department of Orthopaedic Surgery, Hospital de la Concepción, CARR 2 KM 173, San Germán, PR, 00683, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, Suite 800 North, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Jason B Anari
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | | |
Collapse
|
41
|
Deriving a Novel Score for the Stratification of Risk Progression in Early-onset Scoliosis: A Multicenter Initiative. Spine (Phila Pa 1976) 2023; 48:67-72. [PMID: 36007127 DOI: 10.1097/brs.0000000000004462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/24/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This was a retrospective multicenter study. OBJECTIVE To develop a novel progression risk stratification scoring system for early-onset scoliosis. SUMMARY OF BACKGROUND DATA There is a lack of investigations into variables affecting the risk of curve progression in early-onset scoliosis, which prevents stratification. A novel risk score system is needed to help in progression risk estimation. METHODS A retrospective analysis was done at three centers, from 1995 to 2020. Scoliosis cases before the age of 10 years, were included. Medical identifier, date of birth, sex, primary diagnosis, curve type, date/modality of treatment, date of follow-up appointments, and Cobb angles, were collected. Five ranks were selected for stratification. Categories with the same ranks were discarded. Point scores started at 0, for the lowest risk, and ended at 4, for highest risk. Iterations of variable combinations were conducted and clinical relevance was determined by evaluating sensitivity, specificity, positive predictive value, and negative predictive value based on score ranges for low and high risk of progression. RESULTS A total of 476 (230 males, 246 females) early-onset scoliosis patients were collected. The average age at diagnosis was 4.8 years (SD±2.8 yr). The average follow-up duration was 9.3 years (SD±6.9 yr, range: 5 mo-38 yr). Appointments totaled 2911, giving 2182 observations for the analysis. Patient observations numbered: 800 (36.7%) ending in progression, 1265 (58.0%) for nonprogression, 117 (5.4%) for inadequate follow-up, and 368 (16.9%) for rapid progression. The risk scoring system contained four categories: etiology, age, curve magnitude, and curve type. Categorized point combinations totaled 755, giving 1975 iterations. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to be 85.8%, 96.5%, 89.7%, and 95.1%, respectively. CONCLUSION A novel progression risk score for early-onset scoliosis was derived. The system can reliably differentiate between low and high-risk cases in clinical settings. Further validation in other regions may be important for verifying clinical relevance. LEVEL OF EVIDENCE Level 3.
Collapse
|
42
|
Fedorak GT, MacWilliams BA, Stasikelis P, Szczodry M, Lerman J, Pahys JM, D'Astous J. Age-Stratified Outcomes of Mehta Casting in Idiopathic Early-Onset Scoliosis: A Multicenter Review. J Bone Joint Surg Am 2022; 104:1977-1983. [PMID: 36137064 DOI: 10.2106/jbjs.22.00344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study provides age-stratified outcomes of cast treatment for idiopathic early-onset scoliosis. METHODS This is a multicenter, retrospective review of patients with idiopathic early-onset scoliosis treated with Mehta casting at 4 tertiary children's hospitals between 2001 and 2016. The inclusion criteria were idiopathic early-onset scoliosis and a minimum follow-up of 2 years after casting ended. The exclusion criteria were <2 casts, >3 casts at an outside facility, and a major curve of <20° pre-treatment. Subjects were grouped by age at first cast: <18 months, 18 to <24 months, 2 to <3 years, 3 to <4 years, and ≥4 years. RESULTS There were 134 patients with a mean follow-up of 5.2 years (95% confidence interval [CI], 4.8 to 5.5 years) after casting. Prior to treatment, the major curve was not significantly different between the various age groups and was a mean of 50.4° (95% CI, 48.0° to 52.8° [range, 22° to 109°]). Of the <18-month group (n = 59), at the final follow-up at a mean of 7.4 years (95% CI, 6.8 to 8.1 years) of age, 75% had scoliosis of <15°, and 6.8% had undergone a surgical procedure or had a major curve of ≥50°. The results declined in the 18 to <24-month group (n = 30), with a major curve of <15° at the final follow-up at 8.5 years (95% CI, 7.3 to 9.7 years) of age in 33% (p < 0.001), and 17% having undergone a surgical procedure or had a major curve of ≥50°, with results nearly identical in the 2 to <3-year group (n = 21). The results continued to decline with increasing age; 23% of the 3 to <4-year group had a major curve of <15° at the final follow-up, and 31% had undergone a surgical procedure or had scoliosis of ≥50°. Of the ≥4-year group, just 9.1% had scoliosis of <15° (p < 0.0001 compared with the <18-month group), and 64% had undergone a surgical procedure or had scoliosis of ≥50°. CONCLUSIONS Children who underwent casting prior to 18 months of age were more likely to have a major curve of <15° at a minimum 2-year follow-up after casting. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Graham T Fedorak
- Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | | | | | | | - Joel Lerman
- Shriners Hospitals for Children, Northern California, Sacramento, California
| | - Joshua M Pahys
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | | |
Collapse
|
43
|
Montgomery BK, Tileston K, Kaur J, Kym D, Segovia NA, Imrie M, Policy J, Rinsky L, Vorhies J. Innovative technique for early-onset scoliosis casting using Jackson table. Spine Deform 2022; 10:1461-1466. [PMID: 35776363 DOI: 10.1007/s43390-022-00526-4] [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: 05/05/2021] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Early-onset scoliosis (EOS) can have harmful effects on pulmonary function. Serial elongation, derotation, and flexion (EDF) casting can cure EOS or delay surgical intervention. Most described casting techniques call for specialized tables, which are not available at many institutions. We describe an innovative technique for EDF casting utilizing a modified Jackson table (MJ) and compare results to a Risser frame (RF). METHODS All patients who underwent EDF casting at our institution between January 2015 and January 2019 were identified and retrospectively reviewed. Patients were stratified by type of table used and clinical and radiographic outcomes were compared. Standard descriptive statistics were calculated. RESULTS We identified 25 patients who underwent 77 casting events, 11 on an MJ table and 14 on a RF. Mean follow-up was 32 months (range 11-61 months). 28% of patients had idiopathic scoliosis. There was no significant difference in age at initiation of casting (P = 0.3), initial Cobb angle (equivalence, P = 0.009), or rate of idiopathic scoliosis between the MJ and RF groups. There was no significant difference in initial coronal Cobb angle percent correction (equivalence, P = 0.045) or percent correction at 1-year follow-up (equivalence, P = 0.010) between the two groups. There was no difference in cast related complications. There was a significant difference in surgical time, with the MJ group 11 min shorter than the RF (P = 0.005). CONCLUSION The MJ table is a safe and effective alternative for applying EDF casts under traction without the need for a specialized table. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Blake K Montgomery
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
| | - Kali Tileston
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Japsimran Kaur
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Dan Kym
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Nicole A Segovia
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Meghan Imrie
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - James Policy
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - Lawrence Rinsky
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA
- Lucile Packard Children's Hospital, Palo Alto, CA, USA
| | - John Vorhies
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA.
- Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| |
Collapse
|
44
|
Nematian H, Clarke A, Hedayat E, Vahdati Z, Milan N, Mehrpour SR, Nabian MH, Mazda K. Complications of single growing rod constructs in the treatment of severe early-onset scoliosis: a lesson relearned. Spine Deform 2022; 10:1481-1490. [PMID: 35881332 DOI: 10.1007/s43390-022-00554-0] [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: 03/01/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Early-onset scoliosis (EOS) is one of the most challenging areas of orthopedic management. Previous studies have reported that EOS patients were associated with high risk of complications following growth-friendly surgery. This study was performed to evaluate the complications of single traditional growing rods (TGRs) in the treatment of EOS. METHODS In a retrospective chart review study, medical records of all EOS patients treated with single TGRs between 2006 and 2018 were analyzed. Patients under the age of 10 at the time of surgery who had at least 24 months of follow-up were included. Intra- and post-operative complications included both device-related and disease-related complications. Statistical analysis was performed with SPSS. RESULTS A total of 35 patients with a mean age of 5.7 ± 2.1 years with the mean follow-up duration of 33.3 ± 9.1 months were included in the final analysis. Of the 35 participants, 27 children (77.1%) experienced at least one complication. A total of 61 complications were observed, giving rise to 1.7 complications per patient. An unplanned surgical procedure was needed to manage 42 of the 61 complications (68.8%). Thirty-five cases of implant failure, 11 cases of deep infection, and 2 cases of junctional kyphosis were identified. CONCLUSION It seems that even in the setting that the use of dual TGRs is not possible, the use of single TGRs as the only therapeutic modality should be minimized due to high rate of complications even as a bridge treatment. LEVEL OF EVIDENCE Therapeutic level III.
Collapse
Affiliation(s)
- Hossein Nematian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Center of Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Andrew Clarke
- Consultant Spine Surgeon, Princess Elizabeth Orthopaedic Centre, Exeter, EX2 5DW, UK
| | - Ehsan Hedayat
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahdati
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nesa Milan
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Center of Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Reza Mehrpour
- Department of Orthopaedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nabian
- Center of Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris Diderot University, Paris, France.
| | - Keyvan Mazda
- Department of Pediatric Orthopaedics, Robert Debré Hospital, Paris Diderot University, Paris, France
| |
Collapse
|
45
|
Cao J, Zhang X, Cao J, Gao R, Guo D. Efficacy of the growing rod technique on kyphotic early-onset scoliosis. Front Pediatr 2022; 10:982295. [PMID: 36275065 PMCID: PMC9584627 DOI: 10.3389/fped.2022.982295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the application of the growing rod (GR) technique in the treatment of kyphotic early-onset scoliosis (KEOS) and analyze its surgical efficacy and safety. Methods The clinical data of 30 children with KEOS who received GR treatment at our department between January 2016 and December 2019 were analyzed retrospectively. There were 18 cases with normal kyphosis (normal kyphosis group) and 12 cases with excessive kyphosis (excessive kyphosis group). Both groups received GR treatment, and all patients received anteroposterior and lateral spine X-ray examinations before, after the initial surgery, and at the final follow-up. The surgical conditions and imaging parameters of the two groups were compared, and the complications were recorded. Results There was no statistical difference in the Cobb angle of the major curve, apical vertebral translation (AVT), and trunk shift (TS) between the two groups before, after the first surgery, and at the final follow-up (P > 0.05). The Cobb angle of the major curve, the AVT, and the TS in both groups after the first surgery were lower than before the first surgery (P < 0.05), but there was no statistical difference between the two groups (P > 0.05). At the final follow-up, there were increases in both the Cobb angle and the AVT (P < 0.05), while the TS decreased in comparison with findings after the first surgery (P < 0.05). Before and after the first surgery and at the final follow-up appointment, there was a statistical difference in the degree of thoracic kyphosis (TK) between the two groups (P < 0.05), while there was no statistical difference in terms of lumbar lordosis (LL), the proximal junctional angle (PJA), and the distal junctional angle (DJA) (P > 0.05). After the first surgery, TK and LL showed a significant moderate response in both groups (P < 0.05), while there was no significant difference in TK, LL, PJA, and DJA compared with the results at the final follow-up (P > 0.05). Conclusions The use of the GR technique can improve kyphosis in KEOS treatment.
Collapse
Affiliation(s)
- Jiang Cao
- Guizhou Children's Hospital, Zunyi, China
- Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xuejun Zhang
- Department of Pediatric Orthopedics, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jun Cao
- Department of Pediatric Orthopedics, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Rongxuan Gao
- Department of Pediatric Orthopedics, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Dong Guo
- Department of Pediatric Orthopedics, Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
46
|
The incidence and prevalence of early-onset scoliosis: a regional multicenter epidemiological study. Spine J 2022; 22:1540-1550. [PMID: 35381360 DOI: 10.1016/j.spinee.2022.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the many advances in understanding and treating early-onset scoliosis, the incidence and prevalence of this disease in the population remains unknown. Such knowledge is important for guiding clinical practice, directing research and raising awareness. PURPOSE To identify the incidence and prevalence of early-onset scoliosis, including all categories, within the population. STUDY DESIGN A regional multicenter retrospective cohort study PATIENT SAMPLE: All patients diagnosed with early-onset scoliosis in the region, who were followed-up between January 2000 and December 2020. OUTCOME MEASURES Frequency distributions for early-onset scoliosis subtypes, demographics, curve patterns and progression statuses. METHODS Relevant population data, for children under 10 years old, was extracted from the official government census for the years 2000 to 2020. Identification of cases was carried out by pediatricians at mandatory government funded regular child wellness check-up visits. Outpatient records were reviewed for all included patients, with extraction of the following: Medical identifier, date of birth, date of initial visit, sex, primary diagnosis, length of follow-up, curve pattern, initial cobb angle, and final cobb angle. Incidence and prevalence values were calculated using population figures and case numbers. Kaplan-Meier survival analysis and Log-rank testing was performed on curve progression data. RESULTS The regional population of children, under the age of 10 years, included a total of 2,295,929 children, 1,170,149 (51.0%) males and 1,125,780 (49.0%) females, between the years 2000 and 2020. Early-onset scoliosis cases followed within the same timeframe, totaled 469 patients, 227 (48.4%) males and 242 (51.6%) females. The annual incidence of early-onset scoliosis was found to be 0.019% (95% CI: 0.015%-0.023%), and the prevalence was 0.077% (95% CI: 0.059%-0.096%). The most common age at first presentation was 6 years old. More females (51.6%) than males (48.4%) were observed, and more left-sided curves (54.2%) than right-sided curves (45.8%) were encountered, with the majority being single thoracic curves (38.2%). Scoliosis curves did not progress in 44.3% of cases, while they progressed in 38% of them. Follow-up was inadequate to determine progression status in 17.7% of cases. Neuromuscular etiologies were the most common, at 40.1%, of which 83.5% had cerebral palsy. CONCLUSIONS Based on the regional population included in this study, the annual incidence of early-onset scoliosis in children under 10 years old was calculated to be 0.019%, while the prevalence of early-onset scoliosis in children under 10 years old was found to be 0.077%.
Collapse
|
47
|
Ruiz G, Torres-Lugo NJ, Marrero-Ortiz P, Guzmán H, Olivella G, Ramírez N. Early-onset scoliosis: a narrative review. EFORT Open Rev 2022; 7:599-610. [PMID: 35924646 PMCID: PMC9458941 DOI: 10.1530/eor-22-0040] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Early-onset scoliosis (EOS) is defined as any spinal deformity that is present before 10 years old, regardless of etiology. Deformity must be evaluated based on the intercorrelation between the lungs, spine, and thorax. Curvatures of early-onset have increased risk of progression, cardiorespiratory problems, and increased morbidity and mortality. Progression of the deformity may produce thoracic insufficiency syndrome, where a distorted thorax is unable to support normal respiratory function or lung growth. Management and treatment of EOS should pursue a holistic approach in which the psychological impact and quality of life of the patient are also taken into consideration. Growth-friendly surgical techniques have not met the initial expectations of correcting scoliotic deformity, promoting thoracic growth, and improving pulmonary function.
Collapse
Affiliation(s)
- Geovanny Ruiz
- Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico
| | - Norberto J Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Pablo Marrero-Ortiz
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Humberto Guzmán
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico
| |
Collapse
|
48
|
Matsumoto H, Boby AZ, Sinha R, Campbell ML, Hung CW, Gbolo FC, Marciano GF, Levine S, Fano AN, Simhon ME, Quan T, Bainton NM, George A, Mizerik AS, Roye BD, Roye DP, Vitale MG. Development and Validation of a Health-Related Quality-of-Life Measure in Older Children and Adolescents with Early-Onset Scoliosis: Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). J Bone Joint Surg Am 2022; 104:1393-1405. [PMID: 35726883 DOI: 10.2106/jbjs.21.01508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The 24-question Early-Onset Scoliosis Questionnaire (EOSQ-24) is a proxy measure assessing health-related quality of life (HRQoL) among patients with early-onset scoliosis (EOS). There exists an increasing need to assess HRQoL through a child's own perspective, particularly for older children and adolescents with EOS. The purpose of this study was to develop and validate a self-reported questionnaire, the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF), to assess HRQoL in older children and adolescents with EOS. METHODS A literature review, an expert focus group, and patient interviews were used to generate a preliminary survey of appropriate domains and question items. This survey was provided to English-speaking patients with EOS who were 8 to 18 years of age and capable of answering survey questions. Content validity was assessed for clarity and relevance of questions. Confirmatory factors analysis was performed to reduce the number of items and determine domains that fit items. Reliability was evaluated by measuring the internal consistency of items and test-retest reliability. Construct validity was evaluated by convergent, discriminant, and known-group validity. RESULTS The literature review, expert focus group, and patient interviews identified 59 questions in 14 domains. Psychometric analysis reduced these to 30 questions across 12 domains: General Health, Pain/Discomfort, Pulmonary Function, Transfer, Physical Function/Daily Living, Participation, Fatigue/Energy Level, Sleep, Appearance, Relationships, Emotion, and Satisfaction. The final questionnaire was found to have good content and construct validity and adequate reliability. CONCLUSIONS The EOSQ-SELF is a valid and reliable instrument for measuring self-reported HRQoL among older children and adolescents with EOS (ages 8 to 18 years). This will serve as an important research outcome measure and enhance clinical care by providing a better understanding of HRQoL for these patients. LEVEL OF EVIDENCE Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Afrain Z Boby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan L Campbell
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Fay C Gbolo
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Gerard F Marciano
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Sonya Levine
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Adam N Fano
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Matthew E Simhon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Theodore Quan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicole M Bainton
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Ameeka George
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Amber S Mizerik
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - David P Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| |
Collapse
|
49
|
Taniguchi Y, Matsubayashi Y, Ikeda T, Kato S, Doi T, Oshima Y, Okazaki H, Tanaka S. Clinical Feasibility of Completely Autologous Fibrin Glue in Spine Surgery. Spine Surg Relat Res 2022; 6:388-394. [PMID: 36051679 PMCID: PMC9381088 DOI: 10.22603/ssrr.2021-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Fibrin glue is widely used in spine surgery. Nevertheless, no report has demonstrated the feasibility of completely autologous fibrin glue (CAFG) in spine surgery. This study aims to investigate the safety, efficacy, and effect of bone fusion of CAFG on spine surgery. Methods We retrospectively extracted data of patients who underwent primary spine surgery with preoperatively prepared CAFG. Primary outcomes were the incidence of wound-related unplanned reoperations within 90 days following primary surgery and the occurrence of reoperation for the management of cerebrospinal fluid (CSF) leakage in patients who had been treated with CAFG used as dural sealants. The effect of CAFG on bone fusion was also assessed by detecting implant failure at one year postoperatively in patients aged 25 years or less undergoing primary fusion for idiopathic scoliosis. Results We identified 131 eligible patients (47 males and 84 females) with a mean age of 32.3 years. CAFG was used most frequently as an adhesive for fixation of graft bone (110 patients), followed by as a dural sealant for CSF leakage in 17 patients, and as a local hemostatic agent in four patients. Wound-related reoperations were identified in four patients (3.1%), which included three for surgical site infection, and one for postoperative epidural hematoma. There was no reoperation required for the management of CSF leakage among 17 patients with dural incision or incidental durotomy. Compared with the control cohort, the use of CAFG was not associated with early wound-related reoperations or implant failure in patients with spinal deformity. Conclusions We demonstrated the clinical feasibility of CAFG in spine surgery. The use of CAFG was not associated with the incidence of reoperations for wound-related complications. CAFG worked effectively as a dural sealant for preventing CSF leakage. CAFG had no beneficial or adverse effect on spinal bone fusion.
Collapse
Affiliation(s)
- Yuki Taniguchi
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | | | - Toshiyuki Ikeda
- Department of Blood Transfusion, The University of Tokyo Hospital
| | - So Kato
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | - Toru Doi
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| | - Hitoshi Okazaki
- Department of Blood Transfusion, The University of Tokyo Hospital
| | - Sakae Tanaka
- Department of Orthopedic Surgery, The University of Tokyo Hospital
| |
Collapse
|
50
|
Bowker R, Morash K, Mishreky A, Yaszay B, Andras L, Sturm P, Sponseller PD, Thompson GH, El-Hawary R. Scoliosis flexibility correlates with post-operative outcomes following growth friendly surgery. Spine Deform 2022; 10:933-941. [PMID: 35147914 DOI: 10.1007/s43390-022-00481-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to determine the relationship between pre-operative scoliosis flexibility and post-operative outcomes, including curve correction and complications, for patients who have been treated with growth friendly surgery (GFS) for early onset scoliosis (EOS). METHODS The study was conducted as a retrospective review of prospectively collected data from an international, multicenter, EOS database. EOS patients with pre-operative flexibility radiographs (traction or bending) were identified. Pre-operative flexibility and immediate post-operative correction were calculated for each patient. Post-operative complications were recorded at final follow-up. Pearson correlations were determined for flexibility vs correction for all patients and were compared between etiologies and between device types (MCGR, TGR, VEPTR). RESULTS 107 patients (14 congenital, 43 neuromuscular, 31 syndromic, 19 idiopathic) with mean age 7.1 years at index surgery were identified. Mean pre-operative scoliosis was 77°. Mean flexibility of 36% was not significantly different between etiologies. Mean immediate post-operative scoliosis was 46° (p < 0.001 vs. pre-operative) with mean correction of 38%. Correction rate was not significantly different between etiologies; however, correction rate was different between device types (MCGR 45%, TGR 40%, VEPTR 14%; p = < 0.001). Pearson correlation for flexibility vs correction was fair (r = 0.37, p < 0.001). This correlation was observed for idiopathic (r = 0.53, p = 0.020) and neuromuscular (r = 0.46, p = 0.0020) scoliosis, but not for congenital or syndromic scoliosis. At a mean of 6.1 year follow-up (minimum 2 years to 15.5 years), 60 of 81patients (74%) experienced at least one complication. Odds ratio for developing a complication was 3.00 (1.03-8.76) for patients with pre-operative flexibility < 45% (p < 0.05). CONCLUSIONS As lower pre-operative flexibility was associated with less scoliosis correction and with a higher risk of post-operative complications, curve flexibility should be considered when deciding upon the timing of growth friendly surgery. LEVEL OF EVIDENCE Level III-retrospective comparative study.
Collapse
Affiliation(s)
- Riley Bowker
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada
| | - Kevin Morash
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada
| | - Amir Mishreky
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada
| | - Burt Yaszay
- University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Lindsay Andras
- Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Peter Sturm
- Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Paul D Sponseller
- Johns Hopkins University, 601 N Caroline St 5th Floor, Baltimore, MD, 21287, USA
| | - George H Thompson
- Rainbow Babies and Children's Hospital, 2500 Metrohealth Dr, Cleveland, OH, 44109, USA
| | - Ron El-Hawary
- Division of Orthopaedic Surgery, Department of Surgery, IWK Health Center, 5850 University Avenue, PO Box 9700, Halifax, NS, B3K-6R8, Canada.
| |
Collapse
|