TY - JOUR
T1 - Characterizing Use of Growth-friendly Implants for Early-onset Scoliosis
T2 - A 10-Year Update
AU - Klyce, Walter
AU - Mitchell, Stuart L.
AU - Pawelek, Jeff
AU - Skaggs, David L.
AU - Sanders, James O.
AU - Shah, Suken A.
AU - McCarthy, Richard E.
AU - Luhmann, Scott J.
AU - Sturm, Peter F.
AU - Flynn, John M.
AU - Smith, John T.
AU - Akbarnia, Behrooz A.
AU - Sponseller, Paul D.
N1 - Funding Information:
Supported in part by a T32 grant (AR067708) from the National Institutes of Health.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background:Growth-friendly treatment of early-onset scoliosis (EOS) has changed with the development and evolution of multiple devices. This study was designed to characterize changes in the use of growth-friendly implants for EOS from 2007 to 2017.Methods:We queried the Pediatric Spine Study Group database for patients who underwent index surgery with growth-friendly implants from July 2007 to June 2017. In 1298 patients, we assessed causes of EOS; preoperative curve magnitude; age at first surgery; patient sex; construct type; lengthening interval; incidence of "final" fusion for definitive treatment; and age at definitive treatment. a=0.05.Results:From 2007 to 2017, the annual proportion of patients with idiopathic EOS increased from 12% to 33% (R2=0.58, P=0.006). Neuromuscular EOS was the most common type at all time points (range, 33% to 44%). By year, mean preoperative curve magnitude ranged from 67 to 77 degrees, with no significant temporal changes. Mean (±SD) age at first surgery increased from 6.1±2.9 years in 2007 to 7.8±2.5 years in 2017 (R2=0.78, P<0.001). As a proportion of new implants, magnetically controlled growing rods increased from <5% during the first 2 years to 83% in the last 2 years of the study. Vertically expandable prosthetic titanium ribs decreased from a peak of 48% to 6%; growth-guidance devices decreased from 10% to 3%. No change was seen in mean surgical lengthening intervals (range, 6 to 9 mo) for the 614 patients with recorded lengthenings. Final fusion was performed in 88% of patients who had undergone definitive treatment, occurring at a mean age of 13.4±2.4 years.Conclusions:From 2007 to 2017, neuromuscular EOS was the most common diagnosis for patients treated with growth-friendly implants. Patient age at first surgery and the use of magnetically controlled growing rods increased during this time. Preoperative curve magnitude, traditional growing rod lengthening intervals, and rates of final fusion did not change.Level of Evidence:Level II.
AB - Background:Growth-friendly treatment of early-onset scoliosis (EOS) has changed with the development and evolution of multiple devices. This study was designed to characterize changes in the use of growth-friendly implants for EOS from 2007 to 2017.Methods:We queried the Pediatric Spine Study Group database for patients who underwent index surgery with growth-friendly implants from July 2007 to June 2017. In 1298 patients, we assessed causes of EOS; preoperative curve magnitude; age at first surgery; patient sex; construct type; lengthening interval; incidence of "final" fusion for definitive treatment; and age at definitive treatment. a=0.05.Results:From 2007 to 2017, the annual proportion of patients with idiopathic EOS increased from 12% to 33% (R2=0.58, P=0.006). Neuromuscular EOS was the most common type at all time points (range, 33% to 44%). By year, mean preoperative curve magnitude ranged from 67 to 77 degrees, with no significant temporal changes. Mean (±SD) age at first surgery increased from 6.1±2.9 years in 2007 to 7.8±2.5 years in 2017 (R2=0.78, P<0.001). As a proportion of new implants, magnetically controlled growing rods increased from <5% during the first 2 years to 83% in the last 2 years of the study. Vertically expandable prosthetic titanium ribs decreased from a peak of 48% to 6%; growth-guidance devices decreased from 10% to 3%. No change was seen in mean surgical lengthening intervals (range, 6 to 9 mo) for the 614 patients with recorded lengthenings. Final fusion was performed in 88% of patients who had undergone definitive treatment, occurring at a mean age of 13.4±2.4 years.Conclusions:From 2007 to 2017, neuromuscular EOS was the most common diagnosis for patients treated with growth-friendly implants. Patient age at first surgery and the use of magnetically controlled growing rods increased during this time. Preoperative curve magnitude, traditional growing rod lengthening intervals, and rates of final fusion did not change.Level of Evidence:Level II.
KW - cerebral palsy
KW - early-onset scoliosis
KW - lengthening interval
KW - magnetically controlled growing rods
KW - myelodysplasia
UR - http://www.scopus.com/inward/record.url?scp=85085874939&partnerID=8YFLogxK
U2 - 10.1097/BPO.0000000000001594
DO - 10.1097/BPO.0000000000001594
M3 - Article
C2 - 32467421
AN - SCOPUS:85085874939
SN - 0271-6798
VL - 40
SP - e740-e746
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 8
ER -