Comparison of deformity correction and complications with VEPTR and early primary posterior spinal fusion in young children with idiopathic scoliosis: A retrospective matched cohort analysis

• Micaela Cyr, BA• Patrick Cahill, MD• Suhong Tong, MS• Tricia St. Hilaire, MPH• Harms Study Group• Children’s Spine Study Group• Sumeet Garg, MD

Sumeet.garg@childrenscolorado.org

Study Question

• What is the optimal treatment of an idiopathic scoliosis patient between 8 and 10 with a curve >50 degrees?

Methods• Matched analysis: Age, gender, cobb angle (+/-

10°)

• Outcome variables:– Radiographic criteria– Number of operations– Unexpected re-operations– Complications

MethodsGrowth Friendly Construct

PSF

Number of patients 6 12

Age (years) 8-11 (Mean 9.8) 10-11 (Mean 10.6)

Average preoperative Cobb angle

66° 65°

Average follow up time (years) 3.2 2.2

Open triradiate

Each growing surgery patient matched with 1-4 fusion patients.

Results

PreOp Final PostOp0

50

100

150

200

250

300

350

245.6

295.03

185.52

214.82

Comparison of Thoracic Height

PSF Growing Surgery

Thora

cic

Heig

ht

(mm

)

Results• Growing surgery patients shorter by 52.65 mm

after controlling for preoperative thoracic height (p=0.032)

• There was a significant difference in Cobb angle at final follow up between the VEPTR cohort (65º) and PSF cohort (24º) (p<0.0001)

• Growing surgery patients on average had 6.3 more surgeries than PSF cohort (95% CI: 3.4-11.8)

Complications• PSF – 2 of 12 patients with complications– Pulmonary edema – treated medically– Anchor failure – required reoperation

• Rib based growing surgery – 2 of 6 patients with complications– Superficial infection – treated medically– Anchor failure – required reoperation

Limitations

• Preliminary study with small sample size

• Growing surgery patients have not had final fusion

• No PFT or quality of life data (EOSQ-24)

Conclusions• Rib based growing surgery patients undergo

more operations

• Complications and unexpected reoperations are frequent, but not significantly different in this small cohort

• PSF has reasonable results in immature patients between 10-11 years

• Rib based growing surgery can prevent progression in idiopathic scoliosis patients between 8-10 years

Significance• Both rib based growing surgery and PSF control

juvenile idiopathic scoliosis

• Further study is needed with a larger cohort and with growing surgery patients followed until their final fusion

References• 1. Samdani, A.F., et al., The usefulness of VEPTR in the older child with complex spine and chest

deformity. Clinical Orthopaedics and Related Research®, 2010. 468(3): p. 700-704.• 2. Gadepalli, S.K., et al., Vertical expandable prosthetic titanium rib device insertion: does it

improve pulmonary function? Journal of pediatric surgery, 2011. 46(1): p. 77-80.• 3. CampbellJr, R.M., et al., The effect of opening wedge thoracostomy on thoracic insufficiency

syndrome associated with fused ribs and congenital scoliosis. The Journal of Bone & Joint Surgery, 2004. 86(8): p. 1659-1674.

• 4. Emans, J.B., et al., 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, 2005. 30(17S): p. S58-S68.

• 5. Waldhausen, J.H., G.J. Redding, and K.M. Song, Vertical expandable prosthetic titanium rib for thoracic insufficiency syndrome: a new method to treat an old problem. Journal of pediatric surgery, 2007. 42(1): p. 76-80.

• 6. Campbell Jr, R.M., VEPTR: past experience and the future of VEPTR principles. European Spine Journal, 2013: p. 1-12.

• 7. Motoyama, E.K., C.I. Yang, and V.F. Deeney, Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatric respiratory reviews, 2009. 10(1): p. 12-17.