Abstract
Purpose
The purpose of this study is to evaluate whether patients with high-tone neuromuscular early-onset scoliosis have different surgical outcome and complication rate, when compared to patients with low-tone neuromuscular early-onset scoliosis treated with a rib-to-pelvis rib-based dual growing system.
Methods
This is a retrospective cohort study of 67 neuromuscular early-onset scoliosis patients, collected from a multicenter database, treated with a rib-to-pelvis rib-based dual growing system. All patients were divided into two groups: high tone and low tone. Pre-, intra- and postoperative data were compared between both groups. Complications were reported by a standardized system.
Results
Twenty-six high-tone and 41 low-tone patients were found homogeneous regarding gender, age at surgery, weight, height, estimated blood loss and surgery time. High-tone group (19/26 = 73.1%) experiences more postoperative complications than low-tone group (22/41 = 53.7%). Most common complications were infection, device migration, death and hardware failure. Permanent abandonment of rib-based growing technique and device removal was required in 21% of high-tone patients (P < 0.001). None of the low-tone patients required abandonment.
Conclusion
High-tone patients had more complications than those with low tone in management of neuromuscular early-onset scoliosis treated with a rib-to-pelvis rib-based dual growing system. A different surgical approach may be required to treat the high-tone neuromuscular early-onset scoliosis.
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NR, GO, OR, PM, JS, SG, MV, TSt.H and RB substantial contributed to the conception or design of the work or involved in the acquisition, analysis or interpretation of data for the work. NR, GO, OR, PM, JS, SG, MV, TSt.H and RB drafted the work or revised it critically for important intellectual content. NR, GO, OR, PM, JS, SG, MV, TSt.H and RB are involved in the final approval of the version to be published.
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Dr. Ramirez, Dr. Olivella, Dr. Rodriguez and Dr. Marrero have nothing to disclose. Dr. Smith reports other from Globus, other from Nuvasive, personal fees from missonix, other from Wishbone medical, other from DepuySynthes, outside the submitted work. Dr. Garg reports personal fees from Nuvasive, personal fees from Medtronic, personal fees from Mighty Oak Medical, outside the submitted work. Dr. Vitale reports grants from Pediatric Orthopaedic Society of North America (POSNA), grants from Scoliosis Research Society (SRS), grants from Orthopedic Research and Education Foundation (OREF), grants from Children’s Spine Foundation (CSF), during the conduct of the study; personal fees from Zimmer Biomet, personal fees from STRYKER, personal fees from NUVASIVE, outside the submitted work. Ms. St. Hilaire reports grants received by her institution from DePuy Synthes Spine, during the conduct of the study. Dr. Betz reports other from Abyrx, personal fees and other from ApiFix, personal fees from DePuy Synthes Spine, other from Electrocore, personal fees from Globus Medical, other from Medovex, other from Orthobond, personal fees and other from SpineGuard, personal fees from Thieme Medical Publishers, personal fees and other from Wishbone Medical, outside the submitted work; and Son Randal Betz, Jr. is an employee of DePuy Synthes Spine.
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IRB approval: Protocol # 160719-NR by Ponce Research Institute.
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Ramirez, N., Olivella, G., Rodriguez, O. et al. Incidence of complications in the management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high- versus low-tone patients. Eur J Orthop Surg Traumatol 30, 621–627 (2020). https://doi.org/10.1007/s00590-019-02614-0
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DOI: https://doi.org/10.1007/s00590-019-02614-0