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

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusion

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.

This is a preview of subscription content, access via your institution.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

The software application and code used for the statistical analysis are available from the corresponding author on reasonable request.

References

  1. 1.

    Branthwaite MA (1986) Cardiorespiratory consequences of unfused idiopathic scoliosis. Br J Dis Chest 80(4):360–369

    CAS  Article  Google Scholar 

  2. 2.

    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

    Article  Google Scholar 

  3. 3.

    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

    CAS  Article  Google Scholar 

  4. 4.

    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

    CAS  Article  Google Scholar 

  5. 5.

    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

    Article  Google Scholar 

  6. 6.

    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

    Article  Google Scholar 

  7. 7.

    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

    Google Scholar 

  8. 8.

    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

    Article  Google Scholar 

  9. 9.

    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

    Article  Google Scholar 

  10. 10.

    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

    Article  Google Scholar 

  11. 11.

    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

    Article  Google Scholar 

  12. 12.

    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

    Article  Google Scholar 

  13. 13.

    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

    Article  Google Scholar 

  14. 14.

    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

    Article  Google Scholar 

  15. 15.

    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

    Article  Google Scholar 

  16. 16.

    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

    Article  Google Scholar 

  17. 17.

    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

    Article  Google Scholar 

  18. 18.

    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

    Article  Google Scholar 

  19. 19.

    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

    CAS  Article  Google Scholar 

  20. 20.

    Olafsson Y, Saraste H, Al-Dabbagh Z (1999) Brace treatment in neuromuscular spine deformity. J Pediatr Orthop 19(3):376–379

    CAS  PubMed  Google Scholar 

  21. 21.

    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

    CAS  Article  Google Scholar 

  22. 22.

    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

    Article  Google Scholar 

  23. 23.

    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

  24. 24.

    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

  25. 25.

    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

    Article  Google Scholar 

  26. 26.

    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

    Article  Google Scholar 

  27. 27.

    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

    Article  Google Scholar 

  28. 28.

    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

    Article  Google Scholar 

  29. 29.

    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

    Article  Google Scholar 

  30. 30.

    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

    Article  Google Scholar 

  31. 31.

    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

    Article  Google Scholar 

  32. 32.

    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

    Article  Google Scholar 

  33. 33.

    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

    Article  Google Scholar 

  34. 34.

    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

    Article  Google Scholar 

  35. 35.

    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

    Article  Google Scholar 

  36. 36.

    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

    Article  Google Scholar 

  37. 37.

    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

  38. 38.

    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

  39. 39.

    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

    Article  Google Scholar 

  40. 40.

    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

    Article  Google Scholar 

Download references

Funding

The study was funded by departmental resources.

Author information

Affiliations

Authors

Consortia

Contributions

YL: made substantial contributions to the conception or design of the work, and performed analysis and interpretation of data; drafted the work; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JS: performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JG: performed data analysis; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PJC: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PDS: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SG: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GHT: performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. BAR: made substantial contributions to the conception or design of the work and performed interpretation of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Pediatric Spine Study Group: performed acquisition of data; revised the work critically for important intellectual content; approved the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Ying Li.

Ethics declarations

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.

Ethics approval

IRB approval, University of Michigan, HUM 00082789, 1/7/14.

Consent to participate

Informed consent to participate in this study was obtained from the parent or legal guardian of all participants.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Keywords

  • Early onset scoliosis
  • Neuromuscular
  • Spinal fusion
  • Growth-friendly surgery
  • Complications