Pediatric Spine Foundation

Title: Distraction-based surgeries increase thoracic sagittal spine length after ten lengthening surgeries for patients with idiopathic early-onset scoliosis

Authors: Ron El-Hawary, Chukwudi K. Chukwunyerenwa, Luke E. Gauthier, Alan J. Spurway, Tricia St. Hilaire, Anna M. McClung, Yehia El-Bromboly, Charles E. Johnston, Children’s Spine Study Group

Journal: Spine Deformity

Date: February 01, 2020

Excerpt: Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic early-onset scoliosis (EOS).

Keywords: Spine growth, Early-onset scoliosis, Sagittal spine length (SSL), Three-dimensional true spine length (3D-TSL)

Summary:

Purpose

A main goal of growth-friendly surgery is correcting spinal deformity while preserving spinal growth. Sagittal Spine Length (SSL), the spine length as viewed from the side, can reliably assess spine height and growth. The purpose of this study is to determine if the choice of proximal (closest to the head) anchor (rib- or spine- based anchor) affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS).

Results

  • 34 patients were included in this study, 14 Rib-based (RB) and 20 spine-based (SB) patients.
  • Preoperative scoliosis was 60° for RB treatment and 77° for SB treatment. At final follow-up, SB treatment had a mean scoliosis of 46° versus 52° for RB. SB treatment had larger scoliosis correction than RB treatment (40% SB vs. 13% RB).
  • Thoracic sagittal spine length increased over treatment for both RB patients and for SB patients. Compared with Rib-Based patients, Spine-Based patients had higher sagittal spine length preoperatively and maintained this difference to the tenth lengthening. After ten lengthening surgeries, thoracic growth was greater for Rib-Based (27%) than for spine-based patients (19%).
  • 31/34 patients in this study experienced at least one complication for a complication risk per patient of 91%.

Discussion Points

  • As there is a high risk of complications with growth-friendly surgery, it is not surprising that this study documented a 91% risk of complication per patient and 57 reoperations.
  • Both treatment types were effective in maintaining gains in height and SSL over time. Spine-based treatment had greater scoliosis correction, but rib-based treatment had greater thoracic growth. Overall, in both rib-based and spine-based treatment types, thoracic length continued to increase during treatment.