Ying Li1, Jennylee Swallow2, Joel Gagnier3, Patrick J Cahill4, Paul D Sponseller5, Sumeet Garg6, George H Thompson7, Brandon A Ramo8. 1. Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, Michigan Medicine, 1540 E. Hospital Dr., SPC 4241, Ann Arbor, MI, 48109-4241, USA. yingyuli@med.umich.edu. 2. Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, Michigan Medicine, 1540 E. Hospital Dr., SPC 4241, Ann Arbor, MI, 48109-4241, USA. 3. Department of Orthopaedic Surgery and Department of Epidemiology, School of Public Health, Michigan Medicine, Ann Arbor, MI, USA. 4. Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 5. Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA. 6. Department of Orthopaedic Surgery, Children's Hospital Colorado, Aurora, CO, USA. 7. Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH, USA. 8. Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children and University of Texas Southwestern, Dallas, TX, USA.
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.
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 GFDFpatients 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 GFDFpatients (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 GFDFpatients had smaller preoperative T1-T12 and T1-S1 lengths, these were similar to the PSF patients at final follow-up, indicating that the GFDFpatients 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. GFDFpatients achieved more spinal growth but eight times more complications and nine times more UPRORs.
Entities:
Keywords:
Complications; Early onset scoliosis; Growth-friendly surgery; Neuromuscular; Spinal fusion
Authors: Arun R Hariharan; Suken A Shah; Paul D Sponseller; Burt Yaszay; Michael P Glotzbecker; George H Thompson; Patrick J Cahill; Tracey P Bastrom Journal: Spine Deform Date: 2022-09-26
Authors: Ying Li; Jennylee Swallow; Joel Gagnier; John T Smith; Robert F Murphy; Paul D Sponseller; Patrick J Cahill Journal: Spine Deform Date: 2022-01-23