A Retrospective Cohort Study of Pulmonary Function, Radiographic Measures, and Quality of Life in Children With Congenital Scoliosis

Vitale, Michael G.; Matsumoto, Hiroko; Bye, Michael R.; Gómez, Jaime A.; Booker, Whitney A.; Hyman, Joshua E.; Roye, David P.

doi:10.1097/brs.0b013e3181714536

Cited by 178 publications

(108 citation statements)

References 34 publications

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“…The average age at the time of study was 10.5 years in the study by Bowen et al [4], 12.6 years in the study of Vitale et al [51], and in the TSRH study was only 14.6 years. Because many of the patients in these studies are not yet skeletally mature, their percent predicted pulmonary volumes will likely worsen because their spines do not grow and the space available for the lung does not elongate.…”

Section: To What Extent Does Early Definitive Spinal Fusion Influencementioning

confidence: 95%

“…Preoperative data are not available as a result of the fact that these children were operated on at an early age before pulmonary function data could be collected. Furthermore, the studies by Goldberg et al [19], Karol et al [23], Bowen et al [4], and Vitale et al [51] all report a single pulmonary function measurement rather than repeated testing over time. We can predict that pulmonary function will continue to decline as these children age, but their chests do not grow accordingly as a result of their fusions.…”

Section: Discussionmentioning

confidence: 99%

“…At the time of publication, five of 21 patients had undergone more than one spinal procedure to achieve fusion. The age at the time of followup averaged only 12.6 years ranging from 7 to 19 years [51]. Because this study includes young patients who have yet to complete their spinal growth (or even achieve peak growth velocity), additional patients may experience deformity progression and require revision surgery in the future.…”

Section: Does Early Definitive Fusion Arrest Progression Of Spinal Dementioning

confidence: 99%

“…Finally, Vitale et al published their results after definitive fusion in 21 patients with congenital scoliosis operated at an average age of 4.9 years and followed on average 7 years postoperatively [51]. They divided their patient population into two groups.…”

Section: To What Extent Does Early Definitive Spinal Fusion Influencementioning

confidence: 99%

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Early Definitive Spinal Fusion in Young Children: What We Have Learned

Karol¹

2011

Clinical Orthopaedics &Amp; Related Research

114

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Background Early-onset scoliosis, when left untreated, leads to severe deformity. Until the last decade, treatment of progressive curves in young children often consisted of definitive spinal fusion. The recognition of thoracic insufficiency syndrome associated with definitive early fusion has led to the development of new surgical techniques developed to preserve spinal and thoracic growth in young patients with progressive scoliosis. Questions/purposes We asked: (1) Does early definitive fusion arrest progression of spinal deformity? To what extent does early definitive spinal fusion influence (2) pulmonary function and (3) thoracic growth? Methods A Medline search of the published literature on early-onset scoliosis, congenital scoliosis, and infantile scoliosis between 2008 and 2010 was performed on spinal fusion for early-onset scoliosis, focusing on studies reporting pulmonary function at followup. Results Spinal deformity is apparently not well controlled by early fusion since revision surgery has been required in 24% to 39% of patients who underwent presumed definitive fusion in early childhood. Restrictive pulmonary disease, defined as forced vital capacity less than 50% of normal, occurs in 43% to 64% of patients who undergo early fusion surgery with those children who have extensive thoracic fusions and whose fusions involve the proximal thoracic spine at highest risk. Thoracic growth after early surgery is an average of 50% of that seen in children with scoliosis who do not have early surgery. Diminished thoracic spinal height correlates with decreased forced vital capacity. Conclusions The literature does not support routine definitive fusion of thoracic spinal deformity at an early age in children with scoliosis.

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Section: To What Extent Does Early Definitive Spinal Fusion Influencementioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Does Early Definitive Fusion Arrest Progression Of Spinal Dementioning

confidence: 99%

Section: To What Extent Does Early Definitive Spinal Fusion Influencementioning

confidence: 99%

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Early Definitive Spinal Fusion in Young Children: What We Have Learned

Karol¹

2011

Clinical Orthopaedics &Amp; Related Research

114

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“…Surgical treatment should be considered for patients with progressive deformities when cast or brace treatment have failed or is contraindicated. Surgical treatment options include early definitive surgery or temporary surgery [6,19,29,30]. Early definitive fusion [14,15] before the age 10 years may not prevent progression of deformity and may cause a crankshaft phenomenon [9,10] and/or thoracic insufficiency syndrome [8,22,30].…”

Section: Introductionmentioning

confidence: 99%

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Enercan¹,

Kahraman²,

Ertürer³

et al. 2014

Clin Orthop Relat Res

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Background The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach. Description of Technique In the initial procedure, polyaxial pedicle screws were placed with a muscle-sparing technique. Rods were placed in situ after achieving correction with intraoperative skull-femoral traction. The most proximal and most distal screws were fixed and the rest of the screws were left with nonlocked set screws to allow vertical growth. The lengthening reoperations were performed every 6 months. Methods Between 2007 and 2011, we treated 19 patients surgically for early-onset scoliosis. Of those, 16 (29%) were treated with the modified growing rod technique by the senior author (AH); an additional three patients were treated using another technique that was being studied at the time by one of the coauthors (CO); those three were not included in this study. The 16 children included nine girls and seven boys (median, 5.5 years of age; range, 4-9 years), and all had progressive scoliosis (median, 64°; range, 38°-92°). All were available for followup at a minimum of 2 years (median, 4.5 years; range, 2-6 years). Results The initial curve Cobb angle of 64°(range, 38°-92°) improved to 21°(range, 4°-36°) and was maintained at 22°(range, 4°-36°) throughout followup. Preoperative thoracic kyphosis of 22°(range, 18°-46°) was maintained at 23°(range, 20°-39°) throughout followup without showing any substantial change. There was a 47 mm (range, 38-72 mm) increase in T1-S1 height throughout followup. The mean number of lengthening operations was 5.5 (range, 4-10). The mean T1-S1 length gain from the first lengthening was 1.18 cm (range, 1.03-2.24 cm) and decreased to 0.46 cm (range, 0,33-1.1 cm) after the fifth lengthening procedure (p = 0.009). The overall complication rate was 25% (four of 16 patients) and the procedural complication rate was 7% (seven of 102 procedures). We did not experience any rod breakages or other complications apart from two superficial wound infections managed without surgery during the treatment period. The only implant-related complications were loosening of two pedicle screws at the uppermost foundation in one patient.

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Adolescent and Adult Spinal Deformity: Nonoperative Management

Thornley

Oitment

2021

Evidence‐Based Orthopedics

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A Retrospective Cohort Study of Pulmonary Function, Radiographic Measures, and Quality of Life in Children With Congenital Scoliosis

Cited by 178 publications

References 34 publications

Early Definitive Spinal Fusion in Young Children: What We Have Learned

Early Definitive Spinal Fusion in Young Children: What We Have Learned

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Adolescent and Adult Spinal Deformity: Nonoperative Management

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