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Matsumoto H, Sinha R, Roye BD, Ball JR, Skaggs KF, Brooks JT, Welborn MC, Emans JB, Anari JB, Johnston CE, Akbarnia BA, Vitale MG, Murphy RF. Contraindications to magnetically controlled growing rods: consensus among experts in treating early onset scoliosis. Spine Deform 2022; 10:1289-1297. [PMID: 35780448 DOI: 10.1007/s43390-022-00543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The purpose of this study was to describe contraindications to the magnetically controlled growing rod (MCGR) in patients with early onset scoliosis (EOS) by establishing consensus amongst expert surgeons who treat these patients frequently. METHODS Nine pediatric spine surgeons from an international EOS study group participated in semi-structured interviews via email to identify factors that influence decision making in the use of MCGR. A 39-question survey was then developed to specify these factors as contraindications for MCGR-these included patient age and size, etiology, medical comorbidities, coronal and sagittal curve profiles, and skin and soft tissue characteristics. Pediatric spine surgeons from the EOS international study group were invited to complete the survey. A second 29-item survey was created to determine details and clarify results from the first survey. Responses were analyzed for consensus (> 70%), near consensus (60-69%), and no consensus/variability (< 60%) for MCGR contraindication. RESULTS 56 surgeons of 173 invited (32%) completed the first survey, and 64 (37%) completed the second survey. Responders had a mean of over 15 years in practice (range 1-45) with over 6 years of experience with using MCGR (range 2-12). 71.4% of respondents agreed that patient size characteristics should be considered as contraindications, including BMI (81.3%) and spinal height (84.4%), although a specific BMI range or a specific minimum spinal height were not agreed upon. Among surgeons who agreed that skin and soft tissue problems were contraindications (78.6%), insufficient soft tissue (98%) and skin (89%) to cover MCGR were specified. Among surgeons who reported curve stiffness as a contraindication (85.9%), there was agreement that this curve stiffness should be defined by clinical evaluation (78.2%) and by traction films (72.3%). Among surgeons who reported sagittal curve characteristics as contraindications, hyperkyphosis (95.3%) and sagittal curve apex above T3 (70%) were specified. Surgeons who indicated the need for repetitive MRI as a contraindication (79.7%) agreed that image quality (72.9%) and not patient safety (13.6%) was the concern. In the entire cohort, consensus was not achieved on the following factors: patient age (57.4%), medical comorbidities (46.4%), etiology (53.6%), and coronal curve characteristics (58.9%). CONCLUSION Surgeon consensus suggests that MCGR should be avoided in patients who have insufficient spinal height to accommodate the MCGR, have potential skin and soft tissue inadequacy, have too stiff a spinal curve, have too much kyphosis, and require repetitive MRI, particularly of the spine. Future data-driven studies using this framework are warranted to generate more specific criteria (e.g. specific degrees of kyphosis) to facilitate clinical decision making for EOS patients. LEVEL OF EVIDENCE Level V-expert opinion.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jacob R Ball
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Kira F Skaggs
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jaysson T Brooks
- Scottish Rite for Children/UT-Southwestern, Dallas, TX, 75219, USA
| | - Michelle C Welborn
- Department of Orthopaedic Surgery, Shriner's Hospital for Children Portland, Portland, OR, 97229, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Jason B Anari
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | | | - Behrooz A Akbarnia
- San Diego Spine Foundation, San Diego, CA, 92121, USA.,Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla, CA, 92093, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Robert F Murphy
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, 29492, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Lemans J, Wijdicks S, Castelein RM, Kruyt MC. Spring distraction system to correct early onset scoliosis: 2 year follow-up results from 24 patients. Stud Health Technol Inform 2021; 280:212-7. [PMID: 34190089 DOI: 10.3233/SHTI210470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Current surgical treatment options for Early Onset Scoliosis (EOS), with distraction- or growth-guidance systems, show limited growth and high complication rates. We developed the Spring Distraction System (SDS), which does not have to be periodically lengthened and which provides continuous corrective force to stimulate spinal growth. This study aimed to assess curve correction and maintenance, spinal growth, and complication rate following SDS treatment. All primary- and revision patients (conversion from failed other systems) with SDS and ≥2 years follow-up were included. Outcome measures were coronal Cobb angle, sagittal parameters, spinal length measurements and complications and re-operations. Radiographic parameters were compared pre-operatively, post-operatively and at latest follow-up. Spinal length increase was expressed as mm/year. Twenty-four skeletally immature EOS patients (18 primary and 6 revision cases) were included. There were 5 idiopathic, 7 congenital, 3 syndromic and 9 neuromuscular EOS patients. Mean age at implantation was 9.1 years (primary: 8.4; conversion: 11.2). Major curve improved from 60.3° to 35.3°, and was maintained at 40.6° at latest follow-up. Mean spring length increase during follow-up was 10.4mm/year. T1-S1 length increased 13.6mm/year and the instrumented segment length showed a mean increase of 0.8mm/segment/year. In total, 17 re-operations were performed. Ten re-operations were performed to treat 9 implant-related complications. In addition, 7 patients showed spinal growth that exceeded expected growth velocity; their springs were re-tensioned during a small re-operation. Spring distraction may be feasible as an alternative to current growing spine solutions. Curve correction and growth could be maintained satisfactory without the need for repetitive lengthening procedures. Complications and re-operations could not be prevented, which emphasizes the need for further improvement.
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Harris L, Andras LM, Mundis GM, Sponseller PD, Emans JB, Skaggs DL. Five or more proximal anchors and including upper end vertebra protects against reoperation in distraction-based growing rods. Spine Deform 2020; 8:781-786. [PMID: 32125653 DOI: 10.1007/s43390-020-00064-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Retrospective multi-center enrollment. OBJECTIVE To examine the impact of patient and surgical factors on proximal complication and revision rates of early onset scoliosis patients using a multicenter database. Proximal anchor pullout and junctional kyphosis are common causes necessitating revision surgery during growth friendly treatment of early onset scoliosis (EOS). Many options exist for proximal fixation and may impact the rate of these complications. METHODS Retrospective review of multicenter database of patients with growth friendly constructs for EOS. Inclusion criteria were patients with index instrumentation < 10 years of age and minimum of 2 year follow-up. RESULTS 353 patients met the inclusion criteria and had the following constructs: growing rods with spine anchors = 303; growing rods with rib anchors = 15 and VEPTR = 35. Mean age at index instrumentation was 6.0 years. Mean preoperative Cobb angle was 76° and mean kyphosis was 54°. Mean follow-up was 6.0 years. 21.8% of patients (77/353) experienced anchor pullout. Lower anchor pullout rates were associated with a higher numbers of proximal anchors (p = 0.003, r = - 0.157), and 5 or more anchors were associated with lower rates of anchor pullout (p = 0.014). Anchor type (rib hooks vs spine anchors vs rib cradle) did not impact rate of anchor pullout (p = 0.853). Kyphosis data was available for 198 patients. 23.2% (46/198) of these patients required proximal extension of their construct after index surgery. Initial instrumentation below the upper end vertebrae (UEV) of kyphosis was associated with higher rates of subsequent proximal revision; 28.9% (20/69) compared to 20.1% (26/129) for those instrumented at or above the UEV (p = 0.035). Preoperative kyphosis and change in thoracic kyphosis were not associated with anchor pullout (p = 0.436, p = 0.115) or proximal revision rates (p = 0.486, p = 0.401). CONCLUSION Five or more anchors are associated with lower rates of anchor pullout. Proximal anchor placement at or above the UEV resulted in a significant decrease in rates of proximal extension of the construct.
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Affiliation(s)
- Liam Harris
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Paul D Sponseller
- Department of Orthopaedic Surgery, Johns Hopkins Children's Hospital, Johns Hopkins University, Baltimore, MD, USA
| | - John B Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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Trupia E, Hsu AC, Mueller JD, Matsumoto H, Bodenstein L, Vitale M. Treatment of Idiopathic Scoliosis With Vertebral Body Stapling. Spine Deform 2019; 7:720-728. [PMID: 31495471 DOI: 10.1016/j.jspd.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/21/2019] [Accepted: 01/26/2019] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES Identify the effectiveness of vertebral body stapling (VBS) in children with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA VBS has been proposed as an alternative to bracing moderate curves in patients with adolescent idiopathic scoliosis (AIS) although a clear picture of comparative efficacy and safety remains to be established. METHODS Ten skeletally immature patients with AIS and curves between 25° and 35° underwent anterior VBS by a single surgeon from 2008 to 2018. Indications included strong family history, high ScoliScore, curve progression despite bracing, or as an alternative for patients/families refusing bracing. Patients with thoracic kyphosis greater than 40°, curvature with a level above T4 or below L4, and double major curves were contraindicated. Patients with hybrid surgical plans or those who failed to reach skeletal maturity were excluded. Age, gender, levels stapled, pre- and postoperative radiographs, and incidence of secondary surgical intervention were evaluated. Outcomes were also compared with untreated and braced subjects from the BrAIST study. RESULTS Ten patients met the inclusion criteria. Average age at VBS was 11.8 (9.7-13.5) with an average major Cobb angle of 30.9° (26°-35°). Average duration of follow-up was 6.4 years. All patients demonstrated curve correction at their first postoperative visit. At final follow-up, 50% of patients experienced curve progression greater than 5°, whereas the remaining 50% either remained stable or corrected over time. The five patients whose curves progressed underwent VBS at a significantly younger age (10.8 vs. 12.8; p value .003). Four of these patients required additional surgical intervention for worsening scoliosis. CONCLUSIONS Although early outcomes after VBS appear to parallel the results of bracing, stapling does not affect the percentage of patients ultimately requiring PSIF. Initial curve correction degraded over time in younger patients with significant growth remaining, and high rates of progression in this group, even with bracing, merits investigation into more efficacious treatment strategies. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Evan Trupia
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 370 Fort Washington Ave, Apt 306, 3959 Broadway, New York, NY 10032, USA.
| | - Anny C Hsu
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 370 Fort Washington Ave, Apt 306, 3959 Broadway, New York, NY 10032, USA
| | - John D Mueller
- Columbia University Medical Center, CH-8N, 3959 Broadway, New York, NY 10032, USA
| | - Hiroko Matsumoto
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 370 Fort Washington Ave, Apt 306, 3959 Broadway, New York, NY 10032, USA
| | - Lawrence Bodenstein
- Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Michael Vitale
- Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 370 Fort Washington Ave, Apt 306, 3959 Broadway, New York, NY 10032, USA
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ElBromboly Y, Hurry J, Padhye K, Johnston C, McClung A, Samdani A, Glotzbecker M, Attia A, St Hilaire T, El-Hawary R. Distraction-Based Surgeries Increase Spine Length for Patients With Nonidiopathic Early-Onset Scoliosis-5-Year Follow-up. Spine Deform 2019; 7:822-828. [PMID: 31495484 DOI: 10.1016/j.jspd.2019.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Retrospective, comparative. OBJECTIVES To determine if distraction-based surgeries will increase spine length in patients with nonidiopathic EOS and whether etiology affects final spine length. SUMMARY OF BACKGROUND DATA As early-onset scoliosis (EOS) has many etiologies, it is unclear whether etiology affects the spine length achieved with distraction-based surgeries. Since distraction may produce kyphosis, sagittal spine length (SSL; curved arc length of the spine in the sagittal plane) should be utilized. METHODS Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, 5 lengthenings) were identified from two EOS registries. Radiographic analysis preoperation, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with primary outcome of T1-S1 SSL. RESULTS We identified 126 patients (67 congenital, 38 syndromic, 21 neuromuscular) with a mean preoperative age of 4.6 years, scoliosis 75°, kyphosis 48°, and a mean of 12 lengthenings. After initial correction (p < .05), scoliosis remained constant (58° at L11-L15) and kyphosis increased (38° at L1 to 60° at L11-L15) (p < .05). SSL increased for the entire group from 27.1 cm preoperation to 35.3 cm at L11-L15 (p < .05) and during the distraction phase (29.2 cm at L1 to 35.3 cm at L11-L15) (p < .05). Preoperative SSL was higher in neuromuscular compared with congenital patients and maintained that difference until the 10th lengthening. Preoperative SSL did not differ between syndromic and congenital patients (28.0 cm vs. 25.6 cm); however, syndromic patients had greater SSL after implantation (L1: 30.5 cm vs. 26.8 cm) (p < .05) and maintained that difference until the 15th lengthening (37.1 cm vs. 34.3 cm) (p < .05). CONCLUSION At minimum 5-year follow-up, distraction-based surgeries increased spine length for all patients with nonidiopathic EOS; however, neuromusculars had higher preoperative spine length compared with congenital patients and maintained that difference until the 10th lengthening. Although congenital and syndromic patients had similar preoperative spine length, syndromic patients had greater SSL after implantation (L1) and maintained that difference until the 15th lengthening. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yehia ElBromboly
- Zagazig University, Shaibet an Nakareyah, Markaz El-Zakazik, Ash Sharqia Governorate 44519, Egypt
| | - Jennifer Hurry
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Kedar Padhye
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Charles Johnston
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX 75219, USA
| | - Anna McClung
- Growing Spine Study Group, 555 East Wells St, Suite 1100, Milwaukee, WI 53202, USA
| | - Amer Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA 19140, USA
| | | | - Abdallah Attia
- Zagazig University, Shaibet an Nakareyah, Markaz El-Zakazik, Ash Sharqia Governorate 44519, Egypt
| | - Tricia St Hilaire
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Ron El-Hawary
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada.
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Connell B, Oore JJ, Pahys JM, Thompson GH, St Hilaire T, Flynn T, El-Hawary R. Growth-Friendly Surgery Is Effective at Treating Early-Onset Scoliosis Associated With Goldenhar Syndrome. Spine Deform 2019; 6:327-333. [PMID: 29735145 DOI: 10.1016/j.jspd.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/12/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the radiographic results and complications of growth-friendly (GF) surgery in the treatment of early-onset scoliosis (EOS) associated with Goldenhar syndrome. BACKGROUND Goldenhar syndrome has been associated with spinal deformity, which may be progressive. Efficacy and complication rate of GF treatment has not been reported for this population of patients with EOS. METHODS Patients with Goldenhar syndrome and EOS with two years' follow-up were identified from two international multicenter EOS databases. Scoliosis, kyphosis, spine height, and hemithoracic height/width were determined preimplant, immediately postoperative, and at the two-year follow-up. Severity of complications (SV) was recorded (Smith et al. JPO 2015). RESULTS Ten patients met inclusion criteria and had a mean age of 4.6 ± 2.5 years at GF implantation (one spine and nine rib-based). Mean preoperative scoliosis was 64°, postimplant 52°, and at mean follow up of 2.4 ± 0.5 years was 50° (p = .09). Preoperative kyphosis was 36°, postimplant 38°, and final 42° (p = .08). Preoperative T1-S1 height was 23.5 cm, postimplant 23.6 cm, and final 27.3 cm (p = .06). Preoperative convex hemithoracic height was 10.4 cm, postimplant 7.9 cm, and final 12.8 cm (p < .05). Preoperative concave hemithoracic height was 8.4 cm, postimplant 8.8 cm, and final 9.9 cm (p = .30). Preoperative right hemithoracic width was 8.02 cm, postimplant 7.22 cm, and final 7.86 cm (p = .07). Preoperative left hemithoracic width was 7.18 cm, postimplant 7.86 cm, and final 8.60 cm (p = .43). Eight patients had ≥1 complication with SV I (n = 7), SV II (n = 2), and SV IIA (n = 7). These included infection (n = 4), migration (n = 3), pneumonia (n = 2), and instrumentation failure (n = 2). CONCLUSION At minimum two-year follow-up, GF surgical intervention for the treatment of EOS associated with Goldenhar syndrome trended toward improvements in scoliosis and spine height, but had a significant improvement in convex hemithoracic height; however, the majority of patients experienced severity grade I or II complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Braydon Connell
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada.
| | - Jonathan J Oore
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Joshua M Pahys
- Shriner's Hospital, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - George H Thompson
- Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Tricia St Hilaire
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Tara Flynn
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Ron El-Hawary
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
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