Pediatric Spine Foundation

Title: The Association Between the Classification of Early-onset Scoliosis and Smith Complications After Initiation of Growth-friendly Spine Surgery: A Preliminary Study

Authors: Russo C, Trupia E, Campbell M, Matsumoto H, Smith JT, Samdani A, Emans J, Roye D, Vitale MG, Children’s Spine Study Group

Journal: JPO

Date: January 19, 2019

Excerpt: Growth-friendly, complications, early onset scoliosis

Keywords: Growth-friendly, complications, early onset scoliosis


What is the purpose of this study?

The Smith classification system of complications and the Classification of Early Onset Scoliosis (C-EOS) were created to organize complex and frequent complications and diagnoses. Separately they assist in understanding risk factors and surgical planning for this complex patient population. The purpose of this study was to determine if an association between the two systems exists to further improve the care and outcomes of children with complex spinal deformity. 


- 156 eligible study subjects were classified with the C-EOS and treated surgically. 153 treated with Vertical Expandable Prosthetic Titanium Rib (VEPTR) and 3 with general growing rods.

With an average of 7.7 years of postoperative follow-up, these patients experienced 245 total complications. 54 were disease related; 191 were device/implant related.

Major cobb angle of the populations were distributed as followed: 22 patients 22-50?; 105 patients 51-90?; 27 patients > 90?

Important Discussion Points

There are 48 distinct categories of C-EOS.  A major limitation of the study was insufficient number of patient cases (i.e. 156 patients wasn’t enough to show results in all 48 categories). 

Because of this limitation, it was unable to show that a more severe C-EOS patient correlates with more severe complications. For example: multiple unplanned trips to the operating room or catastrophic difficulties resulting in abandonment of growth friendly strategy.