Pediatric Spine Foundation

Title: Mortality in Early-Onset Scoliosis During the Growth-friendly Surgery Era

Authors: Ryan Guzek, Robert Murphy, Christina Hardesty, John Emans, Sumeet Garg, John T. Smith, Benjamin Roye, Michael Glotzbecker, Peter Sturm, Brian Snyder, Selina Poon, Connie Poe-Kochert, Pediatric Spine Study Group, Jason Anari

Journal: J Pediatr Orthop

Date: March 01, 2022

Excerpt: This study represents the largest collection of EOS mortality to date, providing surgeons with a modern-day examination of the effects of surgical intervention to better counsel patients and families.

Keywords: early-onset scoliosis, spine, mortality, growth-friendly surgery, complications

Summary:

Purpose

The purpose of this study is to provide current information on mortality in patients with EOS, including risk factors and data concerning growth-friendly treatment of early-onset scoliosis (EOS).

Results

  • There were 130/8009 patients in the Pediatric Spine Study Group registry identified as deceased with a registry mortality rate of 16 per 1000 patients. The mean age at death was 10.6 years and the most common EOS etiology was neuromuscular.
  • Children who underwent surgical treatment for their EOS had increased survival time. The mean age of death for patients treated operatively (12.3 y) was older than those treated nonoperatively (7.0 y) or observed (6.3 y) despite a larger curve and similar baseline body mass index and pulmonary requirements.
  • Most of the complications and causes of death were related to problems with the heart and lungs (cardiopulmonary system). These problems made up 47.6% of all complications and were the primary cause of death in 73.1% of all patients whose primary cause of death had been identified.

Discussion Points

  • Both fatal and nonfatal complications in children with EOS are most likely to involve the cardiopulmonary system. Limited lung development may occur due to spinal deformity, therefore cardiopulmonary complications are a serious concern in patients with EOS. Other complications with lower mortality rates include implant-related, wound-related, gastrointestinal, and neurological complications.
  • Children who undergo surgical intervention for their EOS can live 6-7 years longer than patients who are treated nonoperatively.
  • The information from this study can help surgeons to provide better care and support for children with EOS and their families.