Abstract
Abstract
Purpose
To compare objective outcomes for EOS patients age 6–10 years treated by growth-sparing (GS) surgery or definitive one-stage correction and fusion (DF).
Methods
We reviewed surgical, radiographic, PFT’s, and EOSQ-24 outcomes for EOS patients > age 6 at index surgery treated at a single institution, minimum 2-year follow-up. Neuromuscular diagnoses were excluded.
Results
47 patients underwent index surgery between age 6 and 10.9 years. Twenty-one had DF, 26 had GS surgery (13 MCGR, 13 TGR). Diagnoses included 15 congenital, 15 idiopathic, 17 syndromic. Age at index was 9.1 years DF, 7.8 GS (p < .001). Follow-up was 63–78 months. 18/26 GS cases converted to DF, 13 due to complications, which occurred in 8/21 DF cases vs 19/26 GS (p = .016). DF patients had fewer post-index surgeries (0.6 vs 3.7, p < .001). At follow-up there were no differences in curve magnitudes, %correction, T1–12/T1-S1 segment lengths, EOSQ-24 scores or PFTs. 18 patients converting to DF after initial GS had equal outcomes as DF initially. 31 patients > age 8 at index (“tweeners”) were studied separately. 13 had GS surgery (7 MCGR), 18 had DF. At > 60 months follow-up, curve magnitudes, spine lengths, PFT’s, or EOSQ scores were equivalent. DF patients had fewer procedures and complications.
Conclusion
For patients age 6–10.9 years, outcomes were no different at > 5 year follow-up between DF and GS groups. DF patients had fewer total surgeries and complications. Equal outcomes also occurred for tweeners. As a result, GS treatment does not appear to benefit patients > age 8.
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine
Reference20 articles.
1. El-Hawary R, Akbarnia BA (2015) Latter to the editor: early onset scoliosis – time for consensus. Spine Deformity 3:105
2. Karol LA, Johnston C, Mladenov K et al (2008) Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am 90:1272
3. Goldberg CJ, Gillic I, Connaughton O et al (2003) Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine 28:2397
4. Emans JB, Kassab F, Caubert JF et al (2004) Earlier and more extensive thoracic fusion is associated with diminished pulmonary function. Presented at the 39th annual meeting of the Scoliosis research Society, Buenos Aires, Argentina
5. Vitale MG, Matsumoto H, Bye MR et al (2008) A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion. Spine 33(11):1242