Idiopathic Early-Onset Scoliosis: Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-Year Follow-up

Malick Bachabi, Anna McClung, Jeff B. Pawelek, Ron El Hawary, George H. Thompson, John T. Smith, Michael G. Vitale, Behrooz A. Akbarnia, Paul David Sponseller

Research output: Contribution to journalArticle

Abstract

Background: Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression. Methods: Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05. Results: In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18% (4 of 22) of VEPTR and 16% (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50%) than VEPTR patients (27%) (P<0.001) and achieved a greater percentage of thoracic height gain (24%) than VEPTR patients (12%) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15% greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14%) than VEPTR patients (41%) (P=0.011). Conclusions: In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR. Level of Evidence:: Level III.

Original languageEnglish (US)
JournalJournal of Pediatric Orthopaedics
DOIs
StateAccepted/In press - Jun 8 2018

Fingerprint

Scoliosis
Ribs
Titanium
Kyphosis
Thorax
Wounds and Injuries

Keywords

  • early-onset scoliosis
  • growing rod
  • vertical expandable prosthetic titanium rib

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Idiopathic Early-Onset Scoliosis : Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-Year Follow-up. / Bachabi, Malick; McClung, Anna; Pawelek, Jeff B.; El Hawary, Ron; Thompson, George H.; Smith, John T.; Vitale, Michael G.; Akbarnia, Behrooz A.; Sponseller, Paul David.

In: Journal of Pediatric Orthopaedics, 08.06.2018.

Research output: Contribution to journalArticle

Bachabi, Malick ; McClung, Anna ; Pawelek, Jeff B. ; El Hawary, Ron ; Thompson, George H. ; Smith, John T. ; Vitale, Michael G. ; Akbarnia, Behrooz A. ; Sponseller, Paul David. / Idiopathic Early-Onset Scoliosis : Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-Year Follow-up. In: Journal of Pediatric Orthopaedics. 2018.
@article{e333c725658a4a12ad4403a7fe0f76db,
title = "Idiopathic Early-Onset Scoliosis: Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-Year Follow-up",
abstract = "Background: Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression. Methods: Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05. Results: In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18{\%} (4 of 22) of VEPTR and 16{\%} (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50{\%}) than VEPTR patients (27{\%}) (P<0.001) and achieved a greater percentage of thoracic height gain (24{\%}) than VEPTR patients (12{\%}) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15{\%} greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14{\%}) than VEPTR patients (41{\%}) (P=0.011). Conclusions: In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR. Level of Evidence:: Level III.",
keywords = "early-onset scoliosis, growing rod, vertical expandable prosthetic titanium rib",
author = "Malick Bachabi and Anna McClung and Pawelek, {Jeff B.} and {El Hawary}, Ron and Thompson, {George H.} and Smith, {John T.} and Vitale, {Michael G.} and Akbarnia, {Behrooz A.} and Sponseller, {Paul David}",
year = "2018",
month = "6",
day = "8",
doi = "10.1097/BPO.0000000000001202",
language = "English (US)",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Idiopathic Early-Onset Scoliosis

T2 - Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-Year Follow-up

AU - Bachabi, Malick

AU - McClung, Anna

AU - Pawelek, Jeff B.

AU - El Hawary, Ron

AU - Thompson, George H.

AU - Smith, John T.

AU - Vitale, Michael G.

AU - Akbarnia, Behrooz A.

AU - Sponseller, Paul David

PY - 2018/6/8

Y1 - 2018/6/8

N2 - Background: Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression. Methods: Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05. Results: In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18% (4 of 22) of VEPTR and 16% (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50%) than VEPTR patients (27%) (P<0.001) and achieved a greater percentage of thoracic height gain (24%) than VEPTR patients (12%) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15% greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14%) than VEPTR patients (41%) (P=0.011). Conclusions: In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR. Level of Evidence:: Level III.

AB - Background: Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression. Methods: Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05. Results: In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18% (4 of 22) of VEPTR and 16% (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50%) than VEPTR patients (27%) (P<0.001) and achieved a greater percentage of thoracic height gain (24%) than VEPTR patients (12%) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15% greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14%) than VEPTR patients (41%) (P=0.011). Conclusions: In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR. Level of Evidence:: Level III.

KW - early-onset scoliosis

KW - growing rod

KW - vertical expandable prosthetic titanium rib

UR - http://www.scopus.com/inward/record.url?scp=85048371671&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048371671&partnerID=8YFLogxK

U2 - 10.1097/BPO.0000000000001202

DO - 10.1097/BPO.0000000000001202

M3 - Article

C2 - 29889772

AN - SCOPUS:85048371671

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

ER -