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Incidence of complications in the management of non-ambulatory neuromuscular early-onset scoliosis with a rib-based growing system: high- versus low-tone patients

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

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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References

  1. Skaggs D, Guillaume T, El-Hawary R, Emans J, Mendelow M, Smith J (2015) Early onset scoliosis consensus statement, SRS growing spine committee. Spine Deform 3:A1–A8. https://doi.org/10.1016/j.jspd.2015.01.002

    Article  Google Scholar 

  2. Yang S, Andras LM, Redding GJ, Skaggs DL (2016) Early-onset scoliosis: a review of history, current treatment, and future directions. Pediatrics. https://doi.org/10.1542/peds.2015-0709

    Article  PubMed  Google Scholar 

  3. Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, Flynn JM, Johnston CE, McCarthy RE, Roye DP Jr, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG (2014) Development and initial validation of the classification of early-onset scoliosis (C-EOS). J Bone Jt Surg Am 96(16):1359–1367. https://doi.org/10.2106/JBJS.M.00253

    Article  Google Scholar 

  4. Abol Oyoun N, Stuecker R (2014) Bilateral rib-to-pelvis Eiffel Tower VEPTR construct for children with neuromuscular scoliosis: a preliminary report. Spine J 14(7):1183–1191. https://doi.org/10.1016/j.spinee.2013.07.484

    Article  PubMed  Google Scholar 

  5. Murphy RF, Mooney JF 3rd (2019) Current concepts in neuromuscular scoliosis. Curr Rev Musculoskelet Med 12(2):220–227

    Article  Google Scholar 

  6. Rosenfeld S, Schlechter J, Smith B (2018) Achievement of guided growth in children with low-tone neuromuscular early-onset scoliosis using a segmental sublaminar instrumentation technique. Spine Deform 6(5):607–613. https://doi.org/10.1016/j.jspd.2018.02.012

    Article  PubMed  Google Scholar 

  7. Bar-On L, Molenaers G, Aertbeliën E, Campenhout AV, Feys H, Nuttin B, Desloovere K (2015) Spasticity and its contribution to hypertonia in cerebral palsy. Biomed Res Int 2015:317047. https://doi.org/10.1155/2015/317047

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vialle R, Thévenin-Lemoine C, Mary P (2013) Neuromuscular scoliosis. Orthop Traumatol Surg Res 99(1 Suppl):S124–S139. https://doi.org/10.1016/j.otsr.2012.11.002

    Article  PubMed  CAS  Google Scholar 

  9. Chandran S, McCarthy J, Noonan K, Mann D, Nemeth B, Guiliani T (2011) Early treatment of scoliosis with growing rods in children with severe spinal muscular atrophy: a preliminary report. J Pediatr Orthop 31(4):450–454. https://doi.org/10.1097/BPO.0b013e31821722b1

    Article  PubMed  Google Scholar 

  10. Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H, Boachie-Adjei O, Karlin LI, Canale S, Poe-Kochert C, Skaggs DL (2010) Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Jt Surg Am 92(15):2533–2543. https://doi.org/10.2106/JBJS.I.01471

    Article  Google Scholar 

  11. Brooks JT, Sponseller PD (2016) What’s new in the management of neuromuscular scoliosis. J Pediatr Orthop 36(6):627–633. https://doi.org/10.1097/BPO.0000000000000497

    Article  PubMed  Google Scholar 

  12. Park HY, Matsumoto H, Feinberg N, Roye DP, Kanj WW, Betz RR, Cahill PJ, Glotzbecker MP, Luhmann SJ, Garg S, Sawyer JR, Smith JT, Flynn JM, Vitale MG (2017) The classification for early-onset scoliosis (C-EOS) correlates with the speed of vertical expandable prosthetic titanium rib (VEPTR) proximal anchor failure. J Pediatr Orthop 37(6):381–386. https://doi.org/10.1097/BPO.0000000000000682

    Article  PubMed  PubMed Central  Google Scholar 

  13. McElroy MJ, Sponseller PD, Dattilo JR, Thompson GH, Akbarnia BA, Shah SA, Snyder BD, Growing Spine Study Group (2012) Growing rods for the treatment of scoliosis in children with cerebral palsy: a critical assessment. Spine (Phila Pa 1976) 37(24):E1504–E1510. https://doi.org/10.1097/BRS.0b013e31826fabd3

    Article  Google Scholar 

  14. Smith JT (2011) Bilateral rib-to-pelvis technique for managing early-onset scoliosis. Clin Orthop Relat Res 469(5):1349–1355. https://doi.org/10.1007/s11999-010-1700-2

    Article  PubMed  Google Scholar 

  15. Smith JT, Johnston C, Skaggs D, Flynn J, Vitale M (2015) A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 35(8):798–803. https://doi.org/10.1097/BPO.0000000000000386

    Article  PubMed  Google Scholar 

  16. Thometz J, Simon S (1988) Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Jt Surg Am 70:1290

    Article  CAS  Google Scholar 

  17. Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351(9117):1687–1692

    Article  CAS  Google Scholar 

  18. Children’s Hospital (2014) Early-onset scoliosis. https://www.chop.edu/conditions-diseases/early-onset-scoliosis. Accessed 21 Mar 2019

  19. Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK, Kostial PN, Tambe A, Asher MA, Growing Spine Study Group (2008) Dual growing rod technique followed for 3 to 11 years until final fusion: the effect of frequency of lengthening. Spine (Phila Pa 1976) 33(9):984–990. https://doi.org/10.1097/BRS.0b013e31816c8b4e

    Article  Google Scholar 

  20. Hell AK, Campbell RM, Hefti F (2005) The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children. J Pediatr Orthop B 4:287–293

    Article  Google Scholar 

  21. Livingston K, Zurakowski D, Snyder B, Growing Spine Study Group, Childrenʼs Spine Study Group (2015) Parasol rib deformity in hypotonic neuromuscular scoliosis: a new radiographical definition and a comparison of short-term treatment outcomes with VEPTR and growing rods. Spine (Phila Pa 1976) 40(13):E780–E786. https://doi.org/10.1097/BRS.0000000000000911

    Article  Google Scholar 

  22. Haaker G, Fujak A (2013) Proximal spinal muscular atrophy: current orthopedic perspective. Appl Clin Genet 6(11):113–120. https://doi.org/10.2147/TACG.S53615

    Article  PubMed  PubMed Central  Google Scholar 

  23. McElroy MJ, Shaner AC, Crawford TO, Thompson GH, Kadakia RV, Akbarnia BA, Skaggs DL, Emans JB, Sponseller PD (2011) Growing rods for scoliosis in spinal muscular atrophy: structural effects, complications, and hospital stays. Spine (Phila Pa 1976) 36(16):1305–1311. https://doi.org/10.1097/BRS.0b013e3182194937

    Article  Google Scholar 

  24. Fujak A, Ingenhorst A, Heuser K, Forst R, Forst J (2005) Treatment of scoliosis in intermediate spinal muscular atrophy (SMA type II) in childhood. Ortop Traumatol Rehabil 7(2):175–179

    PubMed  Google Scholar 

  25. Emans JB, Caubet JF, Ordonez CL, Lee EY, Ciarlo M (2005) The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes. Spine (Phila Pa 1976) 30(17 Suppl):S58–S68

    Article  Google Scholar 

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Funding

This study did not receive any type of funding sources.

Author information

Authors and Affiliations

  1. Pediatric Orthopedic Department, Hospital de la Concepción - San German, P Box 6847, Mayagüez, 00681, Puerto Rico

    Norman Ramirez

  2. Surgery Department, Ponce Health Sciences University, Ponce, Puerto Rico

    Gerardo Olivella

  3. Medicine Department, Universidad Central del Caribe, Bayamón, Puerto Rico

    Omar Rodriguez

  4. Orthopedic Department, UPR Medical Sciences Campus, San Juan, Puerto Rico

    Pablo Marrero

  5. Children’s Center, Salt Lake City, UT, USA

    John Smith

  6. Pediatric Orthopedic Department, Children’s Hospital, Aurora, CO, USA

    Sumeet Garg

  7. Pediatric Orthopedic Department, New York-Presbyterian University Hospital of Columbia, New York, NY, USA

    Michael Vitale

  8. Children’s Spine Foundation, Valley Forge, PA, USA

    Tricia St. Hilaire

  9. Orthopedic Department, Institute for Spine and Scoliosis, Lawrenceville, NJ, USA

    Randal Betz

Authors
  1. Norman Ramirez
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  2. Gerardo Olivella
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  3. Omar Rodriguez
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  4. Pablo Marrero
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  5. John Smith
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  6. Sumeet Garg
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  7. Michael Vitale
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  8. Tricia St. Hilaire
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Contributions

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.

Corresponding author

Correspondence to Norman Ramirez.

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Conflict of interest

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.

Ethical approval

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

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