Pediatric Spine Foundation

Title: Incidence of Complications in the Management of Non-Ambulatory Neuromuscular EOS with a Rib Based Growing System: High- vs Low-Tone Patients

Authors: Norman Ramirez, Gerardo Olivella, Omar Rodriguez, Pablo Marrero, John Smith, Sumeet Garg, Michael Vitale, Tricia St. Hilaire, Randal Betz, Pediatric Spine Study Group

Journal: European Journal of Orthopaedic Surgery & Traumatology

Date: December 18, 2019

Excerpt: The purpose of this study is to evaluate whether patients with high-tone neuromuscular early onset scoliosis have different surgical outcomes and complication rate, when compared to patients with low-tone neuromuscular early-onset scoliosis treated with a rib-to-pelvis dual growing system. High-tone patients had more complications than those with low tone in management of neuromuscular early- onset scoliosis treated with a rib-to-pelvis rib-based dual growing system.

Keywords: Neuromuscular, Early Onset Scoliosis, muscle tone, rib-based growing system

Summary:

Purpose

This study aims to compare outcomes and complication rates in neuromuscular EOS patients with high- and low-tone when treated with a rib-based dual growing system.

Results

  • The study was comprised of 26 high-tone neuromuscular EOS patients and 41 low-tone neuromuscular EOS patients. The high-tone group had spasticity, or stiff or rigid muscles. Diagnoses included spastic cerebral palsy, arthrogryposis, and acquired brain injury. The low-tone group included patients with SMA, congenital muscular dystrophy, and undiagnosed hypotonia.
  • High-tone patients had a complication rate of 73.1%, which was significantly higher than low tone patients, which had a rate of 53.7%. High-tone patients are 2x more likely to develop a severe (grade 3) complication.

Discussion Points

  • Currently, growth friendly treatments are the most common technique for treating EOS in high-tone patients. High-tone patients face significant complication risks during treatment with a rib-based dual growing system. A different treatment plan may be recommended for high-tone patients to prevent serious complications. However high complication rate in high-tone patients could be related to the natural history in these patients.
  • Further studies may be necessary to examine high-tone Neuromuscular EOS patients who present with lower coronal Cobb angle degree at initial time of surgical evaluation.