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

El-Hawary, Ron; Chukwunyerenwa, Chukwudi; Gauthier, Luke; Spurway, Alan J.; Hilaire, Tricia St.; McClung, Anna; ElBromboly, Yehia; Johnston, Charles E.

doi:10.1007/s43390-019-00025-z

Cited by 7 publications

(9 citation statements)

References 10 publications

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“…Considering that greater thoracic kyphosis can cause greater differences between sagittal and coronal heights, future studies should also investigate sagittal spinal length in these patients across repeated lengthening procedures to see if growth rate remains constant as in the coronal plane. 18…”

Section: Discussionmentioning

confidence: 99%

Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery

Marrache

Suresh

White

et al. 2021

Journal of Pediatric Orthopaedics

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Background: Recent studies have demonstrated diminishing returns in patients with early onset scoliosis (EOS) undergoing repeated lengthening of growing rods. Little is known about whether this same phenomenon occurs in patients with lax connective tissue disease (CTD). The primary purpose of this study is to investigate whether EOS patients with connective tissue laxity disorders have diminishing returns during growth friendly surgery. Methods: CTD EOS patients below 10 years old, underwent growth friendly spine surgery with distal anchors and at least 1 proximal spine anchor, and had minimum follow-up of 5 years were included in this study. Coronal T1-S1 height at preindex surgery, postindex, and every available lengthening was assessed. Mean coronal height change during early set distractions and late set distractions were calculated for the cohort. To account for varying distraction intervals, we normalized the distractions by the time interval. The outcome parameter was T1-S1 height gain, mm/year. Results: Twenty-one CTD patients were included in this study. Total coronal height (T1-S1) was 26.7MHCcm before index, 32.2 cm at D1-D3, 34.7 cm at D4-D6, and 36.7 cm at D7-L10. There were no significant differences in coronal height gains between early and late distractions (P = 0.70). Moreover, when normalized for time, there was no significant difference in net gain per year at different lengthening time points for the CTD group, P = 0.59. Conclusion: There is no evidence of diminishing returns in coronal T1-S1 height gain in patients with EOS in the setting of CTD. Level of Evidence: Level III.

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Section: Discussionmentioning

confidence: 99%

Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery

Marrache

Suresh

White

et al. 2021

Journal of Pediatric Orthopaedics

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“…Radiographs were obtained from the 2 registries and analyzed at initial implantation and before each subsequent lengthening procedure. The data was assembled at the following previously published lengthening intervals 6,8 : preimplantation surgery, L1 (obtained preoperative first lengthening surgery), L2-L5 (preoperative second lengthening surgery to preoperative fifth lengthening surgery), L6-L10 (preoperative sixth lengthening surgery to preoperative 10th lengthening surgery), and L11-L15 (preoperative 11th lengthening surgery to preoperative 15th lengthening surgery). The measurement at time point L1 reflects the length gained from the implantation surgery (biomechanical distraction) plus any growth from the time of implantation to just before the first lengthening surgery (likely negligible in comparison to the growth after a minimum of 5 y follow-up).…”

Section: Methodsmentioning

confidence: 99%

“…The Halifax method of measuring sagittal spine length (SSL), along the spine's sagittal arc of curvature, has been validated to reliably assess the spine length. 7,8 The SSL program instructs users to select measurement points on a lateral radiograph that represents the center of the superior endplate for each vertebra. Therefore, to measure from T1 to S1 (inclusive), a user would select each superior endplate from T1 through S1.…”

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confidence: 99%

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The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study

ElBromboly

Hurry

Padhye

et al. 2021

Journal of Pediatric Orthopaedics

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Background: It is unclear whether the type of proximal anchor affects the spine length achieved with distraction-based surgeries in patients with nonidiopathic early-onset scoliosis (EOS). Since distraction may produce kyphosis, spine length should be assessed in the sagittal plane using the sagittal spine length (SSLcurved arc length of the spine in the sagittal plane). Our purpose was to determine if the type of proximal anchor in distractionbased surgeries will affect final spine length. Methods: Patients with nonidiopathic EOS treated with distraction-based systems (minimum 5 y follow-up, 5 lengthenings) were identified from 2 EOS registries. Radiographic analysis preoperative, postimplant (L1), and after each lengthening (L2-L5, L6-L10, L11-L15) was performed with the primary outcome of T1-S1 SSL. Results: We identified 126 patients-70 had rib-based implants (52 congenital, 9 syndromic, 9 neuromuscular) and 56 had spine-based implants (15 congenital, 29 syndromic, 12 neuromuscular) with preoperative age 4.6 years, scoliosis 75 degrees, and kyphosis 48 degrees. After initial correction (P < 0.05), scoliosis remained constant [58 degrees (13 to 104 degrees) at L11-L15] and kyphosis increased over time [38 degrees (9 to 108 degrees) at L1 to 60 degrees (17 to 134 degrees) at L11-L15] (P < 0.05). Preoperative SSL was higher in the spine-based group (29.6 cm) when compared with the rib-based group (25.2 cm) (P < 0.05). This difference was maintained after initial implantation (spine-based: 32.2 cm vs. rib-based: 26.7 cm, P < 0.05) and at final follow-up (spine-based: 37.0 cm vs. rib-based: 34.4 cm, P < 0.05). As preoperative SSL differed between groups, maximum SSL gains per interval were also normalized to preoperative SSL. There was no statistically significant difference between groups at L1, L2-L5, and L6-L10. However, at L11-L15, the rib-based group achieved a more relative increase in spine length compared with the spine-based group (45% vs. 31%, P < 0.05). Conclusion: At minimum 5 year follow-up, distraction-based surgeries increased spine length for patients with nonidiopathic EOS; regardless of proximal anchor type.

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“…This could be due to increasing rigidity of growing spine with sustained implants in-situ or automatic fusion due to damaged posterior elements following large distractive force at sporadic interval. It may also be related to variability in radiographic measurements of spine height on coronal plane radiographs 7 Serial cast application provides near total correction of idiopathic curves which are lesser than 60 0 in magnitude if treatment is begun before age of 2 yrs 8,,9 (Figs. 1 and 2) For higher magnitude deformities in juvenile age group, literature shows successive plastercast delays index growth-rod intervention in non-congenital deformity; thereby reducing complication rate.…”

Section: Introductionmentioning

confidence: 99%

Evolution of casting techniques in early-onset and congenital scoliosis

Mahajan

Kishan

Mallepally

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Casting is being utilized as a therapeutic strategy in some mild to moderate cases obviating surgical intervention for management of early-onset scoliosis (EOS). Bracing, another conservative modality, applies comparable correcting forces on chest wall and axial skeleton. But cast application carries additional advantage of sustained restorative force which bypasses issue of compliance seen with brace wear. There is no specific blanket treatment, conservative or surgical, for the early-onset spinal deformities. Serial cast application provides near total correction of less severe curves (less than 50 0 to 60 0 ) if treatment is initiated before age of 2 yrs. In this review article, we will assess the evolution of plaster cast application in management of EOS and also describe technique of EDF (Elongation-Derotation-Flexion) casting.

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

Cited by 7 publications

References 10 publications

Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery

Connective Tissue Disease Patients Maintain Greater Distraction During Growth Friendly Surgery

The Effect of Proximal Anchor Choice During Distraction-based Surgeries for Patients With Nonidiopathic Early-onset Scoliosis: A Retrospective Multicenter Study

Evolution of casting techniques in early-onset and congenital scoliosis

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