The Classification for Early-onset Scoliosis (C-EOS) Correlates With the Speed of Vertical Expandable Prosthetic Titanium Rib (VEPTR) Proximal Anchor Failure

Abstract

Background The Classification for Early-onset Scoliosis (C-EOS) was developed by a consortium of early-onset scoliosis (EOS) surgeons. This study aims to examine if the C-EOS classification correlates with the speed (failure/unit time) of proximal anchor failure in EOS surgery patients. Methods A total of 106 EOS patients were retrospectively queried from an EOS database. All patients were treated with vertical expandable prosthetic titanium rib and experienced proximal anchor failure. Patients were classified by the C-EOS, which includes a term for etiology [C: Congenital (54.2%), M: Neuromuscular (32.3%), S: Syndromic (8.3%), I: Idiopathic (5.2%)], major curve angle [1: ≤20 degrees (0%), 2: 21 to 50 degrees (15.6%), 3: 51 to 90 degrees (66.7%), 4: >90 degrees (17.7%)], and kyphosis [“−”: ≤20 (13.5%), “N”: 21 to 50 (42.7%), “+”: >50 (43.8%)]. Outcome was measured by time and number of lengthenings to failure. Results Analyzing C-EOS classes with >3 subjects, survival analysis demonstrates that the C-EOS discriminates low, medium, and high speed of failure. The low speed of failure group consisted of congenital/51-90/hypokyphosis (C3−) class. The medium-speed group consisted of congenital/51-90/normal and hyperkyphosis (C3N, C3+), and neuromuscular/51-90/hyperkyphosis (M3+) classes. The high-speed group consisted of neuromuscular/51-90/normal kyphosis (M3N), and neuromuscular/>90/normal and hyperkyphosis (M4N, M4+) classes. Significant differences were found in time (P < 0.05) and number of expansions (P < 0.05) before failure between congenital and neuromuscular classes. As isolated variables, neuromuscular etiology experienced a significantly faster time to failure compared with patients with idiopathic (P < 0.001) and congenital (P = 0.026) etiology. Patients with a major curve angle >90 degrees demonstrated significantly faster speed of failure compared with patients with major curve angle 21 to 50 degrees (P = 0.011). Conclusions The ability of the C-EOS to discriminate the speeds of failure of the various classification subgroups supports its validity and demonstrates its potential use in guiding decision making. Further experience with the C-EOS may allow more tailored treatment, and perhaps better outcomes of patients with EOS. Level of Evidence Level III.

Magnetically Controlled Growing Rod in Early-Onset Scoliosis: A Minimum of 2-Year Follow-Up

“…Syndromic scoliosis is seen concomitant with syndromes (Marfan syndrome, Ehler-Danlos syndrome, neurofibromatosis, etc.). In cases with no clear cause, the scoliosis is classified as idiopathic [1,11,12]. There were 5 patients with idiopathic and 3 patients with neuromuscular scoliosis in the presented series.…”

“…There are diverse kinds of etiologies for EOS: congenital/structural, neuromuscular, syndromic, and idiopathic [1]. Congenital/structural scoliosis develops due to structural abnormality or asymmetry of the spine.…”

“…Early-onset scoliosis (EOS) which appears before age of 5 years can be classified as congenital/structural, neuromuscular, syndromic, or idiopathic scoliosis [1,2]. Even though nonsurgical treatment is the first-line treatment for patients with EOS, scoliosis can be surgically corrected using single rod assembly, dual rod assembly, vertical expandable prosthetic titanium rib, and magnetically controlled growing rod (MCGR) techniques when the nonsurgical treatment fails [2].…”

From the Wild West to the Moon: The Future of Early Onset Scoliosis

“…The reality is that we have a complex diverse population with regard to underlying cause and curve characteristics. 15 Patients are spread across a wide age range, and we are treating them during a rapid period of trunk and lung growth. 16 Even at different life stages, patients have different individual growth rates that also vary by underlying diagnosis.…”

Clinical Issues for Pediatric Pulmonologists Managing Children With Thoracic Insufficiency Syndrome

“…A classification system to address this heterogeneity has been devised for spine surgeons which includes age of onset, etiology of scoliosis, degree of coronal curve magnitude, degree of kyphosis, and rate of progression of the coronal curve deformity over time (14). Use of this classification system has enabled surgeons to estimate risk of post-operative complications (15). However, there are no functional elements in this system, such as pain, nutritional status, or lung function measures.…”