Ying Li1, Jennylee Swallow2, Joel Gagnier3, John T Smith4, Robert F Murphy5, Paul D Sponseller6, Patrick J Cahill7. 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, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA. 5. Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA. 6. Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA. 7. Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Abstract
PURPOSE: A previous study showed that patients with neuromuscular scoliosis who underwent fusion to L5 had excellent coronal curve correction and improvement in pelvic obliquity (PO) when preoperative L5 tilt was < 15°. Our purpose was to identify indications to exclude the pelvis in children with cerebral palsy (CP) scoliosis treated with growing-friendly instrumentation. METHODS: In a retrospective cohort study, children with CP scoliosis treated with TGR, MCGR, or VEPTR with minimum 2-year follow-up were identified from a multicenter database. RESULTS: 27 patients with distal spine anchors (DSA) and 71 patients with distal pelvic anchors (DPA) placed at the index surgery were analyzed. The DSA group had a lower pre-index PO (9° vs 16°, P = 0.0001). Most recent radiographic data were similar except the DSA patients had a smaller major curve (47° vs 58°, P = 0.038). 6 (22%) DSA patients underwent extension of the instrumentation to the pelvis (DSA-EXT), most commonly at final fusion (5 patients). DSA-EXT patients had a higher pre-index L5 tilt than patients who did not require extension (DSA-NO EXT) (19° vs 10°, P = 0.009). Sub-analysis showed a lower major curve at most recent follow-up in the DSA-EXT group compared to the DPA group (33° vs 58°, P = 0.021). The DSA-EXT group had a higher number of complications per patient compared to the DSA-NO EXT group (2.3 vs 1.1, P = 0.029). CONCLUSION: Pre-index L5 tilt ≤ 10° and PO < 10° may be indications to exclude the pelvis in children with CP scoliosis treated with growth-friendly instrumentation. DSA may provide better long-term control of the major curve than DPA.
PURPOSE: A previous study showed that patients with neuromuscular scoliosis who underwent fusion to L5 had excellent coronal curve correction and improvement in pelvic obliquity (PO) when preoperative L5 tilt was < 15°. Our purpose was to identify indications to exclude the pelvis in children with cerebral palsy (CP) scoliosis treated with growing-friendly instrumentation. METHODS: In a retrospective cohort study, children with CP scoliosis treated with TGR, MCGR, or VEPTR with minimum 2-year follow-up were identified from a multicenter database. RESULTS: 27 patients with distal spine anchors (DSA) and 71 patients with distal pelvic anchors (DPA) placed at the index surgery were analyzed. The DSA group had a lower pre-index PO (9° vs 16°, P = 0.0001). Most recent radiographic data were similar except the DSA patients had a smaller major curve (47° vs 58°, P = 0.038). 6 (22%) DSA patients underwent extension of the instrumentation to the pelvis (DSA-EXT), most commonly at final fusion (5 patients). DSA-EXT patients had a higher pre-index L5 tilt than patients who did not require extension (DSA-NO EXT) (19° vs 10°, P = 0.009). Sub-analysis showed a lower major curve at most recent follow-up in the DSA-EXT group compared to the DPA group (33° vs 58°, P = 0.021). The DSA-EXT group had a higher number of complications per patient compared to the DSA-NO EXT group (2.3 vs 1.1, P = 0.029). CONCLUSION: Pre-index L5 tilt ≤ 10° and PO < 10° may be indications to exclude the pelvis in children with CP scoliosis treated with growth-friendly instrumentation. DSA may provide better long-term control of the major curve than DPA.
Authors: Lior Shabtai; Lindsay M Andras; Mark Portman; Liam R Harris; Paul D Choi; Vernon T Tolo; David L Skaggs Journal: J Pediatr Orthop Date: 2017-12 Impact factor: 2.324
Authors: Jaysson T Brooks; Amit Jain; Francisco Sanchez-Perez-Grueso; David L Skaggs; George H Thompson; Behrooz A Akbarnia; Paul D Sponseller Journal: Spine Deform Date: 2016-04-16
Authors: Jason B Anari; John M Flynn; Patrick J Cahill; Michael G Vitale; John T Smith; Jaime A Gomez; Sumeet Garg; Keith D Baldwin Journal: Spine Deform Date: 2020-02-06
Authors: Ying Li; Jennylee Swallow; Joel Gagnier; Patrick J Cahill; Paul D Sponseller; Sumeet Garg; George H Thompson; Brandon A Ramo Journal: Spine Deform Date: 2021-02-08
Authors: Hiroko Matsumoto; Brendan Williams; Howard Y Park; Julie Y Yoshimachi; Benjamin D Roye; David P Roye; Behrooz A Akbarnia; John Emans; David Skaggs; John T Smith; Michael G Vitale Journal: J Pediatr Orthop Date: 2018-03 Impact factor: 2.324
Authors: Anna K Hell; Lena Braunschweig; Jennifer Behrend; Heiko M Lorenz; Konstantinos Tsaknakis; Urs von Deimling; Kiril Mladenov Journal: BMC Musculoskelet Disord Date: 2019-12-07 Impact factor: 2.362