Compare radiographic outcomes, complications, and QoL in neuromuscular early-onset scoliosis (EOS) patients treated with single posterior spinal fusion (PSF) versus growth-friendly surgery and definitive fusion (GFDF).
In a retrospective cohort study, children with neuromuscular EOS, age 8–11 years at index surgery with PSF or GF devices, with minimum 2-year follow-up after final fusion were identified from a multicenter database.
16 PSF and 43 GFDF patients were analyzed. Demographics were similar except PSF patients were older at index surgery and had shorter follow-up. PSF patients had greater percentage major curve correction (62% vs 38%, p = 0.001) and smaller major curve at final follow-up (23° vs 40°, p = 0.005). The GFDF group underwent over five times more surgeries (8.7 vs 1.6, p = 0.0001). Four PSF patients (25%) experienced ten complications, resulting in five unplanned returns to the operating room (UPROR) in three patients (19%). 36 GFDF patients (84%) experienced 83 complications, resulting in 45 UPRORs in 24 patients (56%). Poisson regression adjusted for age showed that the GFDF group had more complications (p = 0.001) and UPRORs (p = 0.01). Although the GFDF patients had smaller preoperative T1–T12 and T1–S1 lengths, these were similar to the PSF patients at final follow-up, indicating that the GFDF patients had greater spinal growth. PSF patients had better postoperative EOSQ-24 Financial Impact and Family Burden scores.
While there was a difference in age at index surgery, PSF may be more effective than GFDF at controlling neuromuscular EOS. GFDF patients achieved more spinal growth but eight times more complications and nine times more UPRORs.
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The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
The software application and code used for the statistical analysis are available from the corresponding author on reasonable request.
Branthwaite MA (1986) Cardiorespiratory consequences of unfused idiopathic scoliosis. Br J Dis Chest 80(4):360–369
Campbell RM Jr, Smith MD, Mayes TC et al (2003) The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 85(3):399–408
Pehrsson K, Larsson S, Oden A, Nachemson A (1992) Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976) 17(9):1091–1096
Goldberg CJ, Gillic I, Connaughton O et al (2003) Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine (Phila Pa 1976) 28(20):2397–2406
Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH (2008) Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am 90(6):1272–1281
Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA (2005) Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine (Phila Pa 1976) 30(17 Suppl):S46–S57
Moe JH, Kharrat K, Winter RB, Cummine JL (1984) Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res 185:35–45
Campbell RM Jr, Smith MD, Mayes TC et al (2004) The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 86(8):1659–1674
Bess S, Akbarnia BA, Thompson GH et al (2010) Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am 92(15):2533–2543
Lucas G, Bollini G, Jouve JL et al (2013) Complications in pediatric spine surgery using the Vertical Expandable Prosthetic Titanium Rib: the French experience. Spine(Phila Pa 1976) 38(25):E1589–E1599
Murphy RF, Moisan A, Kelly DM, Warner WC Jr, Jones TL, Sawyer JR (2016) Use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in the treatment of congenital scoliosis without fused ribs. J Pediatr Orthop 36(4):329–335
Anari JB, Flynn JM, Cahill PJ et al (2020) Unplanned return to OR (UPROR) for children with early onset scoliosis (EOS): a comprehensive evaluation of all diagnoses and instrumentation strategies. Spine Deform 8(2):295–302
Choi E, Yaszay B, Mundis G et al (2017) Implant complications after magnetically controlled growing rods for early onset scoliosis: a multicenter retrospective review. J Pediatr Orthop 37(8):e588–e592
Kwan KYH, Alanay A, Yazici M et al (2017) Unplanned reoperations in magnetically controlled growing rod surgery for early onset scoliosis with a minimum of two-year follow-up. Spine (Phila Pa 1976) 42(24):E1410–E1414
Teoh KH, Winson DM, James SH et al (2016) Do magnetic growing rods have lower complication rates compared with conventional growing rods? Spine J 16(4 Suppl):S40-44
Thakar C, Kieser DC, Mardare M, Haleem S, Fairbank J, Nnadi C (2018) Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis. Eur Spine J 27(9):2062–2071
Fletcher ND, McClung A, Rathjen KE, Denning JR, Browne R, Johnston CE 3rd (2012) Serial casting as a delay tactic in the treatment of moderate-to-severe early-onset scoliosis. J Pediatr Orthop 32(7):664–671
Gussous YM, Tarima S, Zhao S et al (2015) Serial derotational casting in idiopathic and non-idiopathic progressive early-onset scoliosis. Spine Deform 3(3):233–238
Miller A, Temple T, Miller F (1996) Impact of orthoses on the rate of scoliosis progression in children with cerebral palsy. J Pediatr Orthop 16(3):332–335
Olafsson Y, Saraste H, Al-Dabbagh Z (1999) Brace treatment in neuromuscular spine deformity. J Pediatr Orthop 19(3):376–379
Emery JL, Mithal A (1960) The number of alveoli in the terminal respiratory unit of man during late intrauterine life and childhood. Arch Dis Child 35:544–547
Russo C, Trupia E, Campbell M et al (2019) The association between the classification of early-onset scoliosis and smith complications after initiation of growth-friendly spine surgery: a preliminary study. J Pediatr Orthop 39(10):e737–e741
Gomez JA, Xin R, Hanstein R et al (2018) Single fusion vs growth friendly instrumentation in older EOS patients. How do outcomes compare? 12th International Congress on Early Onset Scoliosis. Lisbon, Portugal
Howard R, Bastrom TP, Cross M et al (2019) Is performing a definitive fusion for scoliosis in juvenile cerebral palsy (CP) patients a good long-term surgical option? 54th Scoliosis Research Society Annual Meeting and Half-Day Course. Montreal, Canada
Matsumoto H, Williams B, Park HY et al (2018) The final 24-item early onset scoliosis questionnaires (EOSQ-24): validity, reliability and responsiveness. J Pediatr Orthop 38(3):144–151
Sankar WN, Skaggs DL, Yazici M et al (2011) Lengthening of dual growing rods and the law of diminishing returns. Spine (Phila Pa 1976) 36(10):806–809
Dede O, Motoyama EK, Yang CI et al (2014) Pulmonary and radiographic outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) treatment in early-onset scoliosis. J Bone Joint Surg Am 96(15):1295–1302
Flynn JM, Tomlinson LA, Pawelek J et al (2013) Growing-rod graduates: lessons learned from ninety-nine patients who completed lengthening. J Bone Joint Surg Am 95(19):1745–1750
Sawyer JR, de Mendonca RG, Flynn TS et al (2016) Complications and radiographic outcomes of posterior spinal fusion and observation in patients who have undergone distraction-based treatment for early onset scoliosis. Spine Deform 4(6):407–412
Ramo BA, Roberts DW, Tuason D et al (2014) Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: a thirty-year experience at a single institution. J Bone Joint Surg Am 96(24):2038–2048
Samdani AF, Belin EJ, Bennett JT et al (2016) Major perioperative complications after spine surgery in patients with cerebral palsy: assessment of risk factors. Eur Spine J 25(3):795–800
Sharma S, Wu C, Andersen T, Wang Y, Hansen ES, Bunger CE (2013) Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 22(6):1230–1249
Toovey R, Harvey A, Johnson M, Baker L, Williams K (2017) Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review. Dev Med Child Neurol 59(7):690–698
Bohtz C, Meyer-Heim A, Min K (2011) Changes in health-related quality of life after spinal fusion and scoliosis correction in patients with cerebral palsy. J Pediatr Orthop 31(6):668–673
Miyanji F, Nasto LA, Sponseller PD et al (2018) Assessing the risk-benefit ratio of scoliosis surgery in cerebral palsy: surgery is worth it. J Bone Joint Surg Am 100(7):556–563
Vitale MG, Matsumoto H, Roye DP Jr et al (2008) Health-related quality of life in children with thoracic insufficiency syndrome. J Pediatr Orthop 28(2):239–243
Ramo BA, McClung A, Jo CH et al (2019) Validation of the early onset scoliosis questionnaire (EOSQ) as applied to the classification of early onset scoliosis (C-EOS) etiology designation before scoliosis treatment. 13th International Congress on Early Onset Scoliosis. Atlanta, GA
Buckler N, Sun M, Al Nouri M et al (2019) Analysis of health-related quality of life in cerebral palsy patients treated with growth-friendly surgery for early-onset scoliosis. 13th International Congress on Early Onset Scoliosis. Atlanta, GA
Doany ME, Olgun ZD, Kinikli GI et al (2018) Health-related quality of life in early-onset scoliosis patients treated surgically: EOSQ scores in traditional growing rod versus magnetically controlled growing rods. Spine (Phila Pa 1976) 43(2):148–153
Hollenbeck SM, Yaszay B, Sponseller PD et al (2019) The pros and cons of operating early versus late in the progression of cerebral palsy scoliosis. Spine Deform 7(3):489–493
The study was funded by departmental resources.
Conflict of interest
Dr. Li has received a research grant and non-financial support from the Scoliosis Research Society. Dr. Cahill has received a research grant from the Pediatric Spine Study Group and has received personal fees from NuVasive. Dr. Sponseller has received a grant from Depuy Synthes/Johnson and Johnson, and has received personal fees from Depuy Synthes/Johnson and Johnson, Globus, and OrthoPediatrics. Dr. Garg has received grants from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America, and has received personal fees from Medtronic, NuVasive, and ACI Clinical. Dr. Thompson has received personal fees from Shriners Hospitals for Children and Wolters Kluwer, personal fees and non-financial support from Broadwater, personal fees and royalties from OrthoPediatrics, and non-financial support from NuVasive and the Scoliosis Research Society. The Pediatric Spine Study Group has received research grants from the Pediatric Orthopaedic Society of North America, Food and Drug Administration, Depuy Synthes/Johnson and Johnson, NuVasive, Children’s Spine Foundation, and Growing Spine Foundation. The remaining authors declare that they have no conflicts of interest.
IRB approval, University of Michigan, HUM 00082789, 1/7/14.
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Li, Y., Swallow, J., Gagnier, J. et al. Growth-friendly surgery results in more growth but a higher complication rate and unplanned returns to the operating room compared to single fusion in neuromuscular early-onset scoliosis: a multicenter retrospective cohort study. Spine Deform (2021). https://doi.org/10.1007/s43390-020-00270-7
- Early onset scoliosis
- Spinal fusion
- Growth-friendly surgery