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Preoperative Thoracic Kyphosis Can Predict Complications in Growing Rod Surgery for Early Onset Scoliosis: Paper #82

Schroerlucke, Samuel MD; Salari, Pooria MD; BS, JeffPawelek; Mundis, Gregory M. MD; Akbarnia, Behrooz A. MD; Growing Spine Study Group

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United States

Summary: Ninety‐four early onset scoliosis patients were categorized into three groups based on the degree of pre‐op thoracic kyphosis. Patients with (>40 deg) had significantly more complications than patients with normal kyphosis (10‐40 deg) with implant complications being most common.

Introduction: Sagittal plane alignment is one of many important factors in assessing patient outcomes after spinal deformity surgery. However, the restoration of sagittal alignment has not been well documented in EOS. The purpose of this study was to examine the relationship between pre‐op thoracic kyphosis and incidence of complications with growing rods.

Methods: Out of 387 patients from a multi‐center EOS database, 94 patients had complete data with two year follow up after initial surgery. The patients were categorized into three groups based on degree of pre‐op thoracic kyphosis (T5‐T12): <10 degrees (K‐ group), 10‐40 degrees (N group) and >40 degrees (K+ group). Diagnosis, demographics, radiographic parameters and complications were analyzed. A multivariate analysis was performed to identify possible confounding effects on complication rates.

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Results: Mean age was 5+8 years, mean pre‐op Cobb angle was 74 degrees, and mean T5‐T12 thoracic kyphosis was 26 degrees. Diagnoses included 20 congenital, 28 idiopathic, 22 neuromuscular, and 24 syndromic patients. 24 had a single rod (SR) and 70 had dual rods (DR). 26 complications occurred in the K‐ group, 13 occurred in the N group and 49 complications occurred in the K+ group (Table 1).The K+ group had significantly more complications than the N group (p<0.01). The most common complication was implant failure. Multivariate analysis identified diagnosis and proximal kyphosis (T2‐T5) as confounding variables. Accounting for these variables the K+ and K‐ groups were 4.9 and 2.9 times more likely to experience a complication compared to the N group, respectively (p<0.05 for K+ group only). Syndromic children had the highest rate of complications in all groups. No correlation existed between the degree of kyphosis correction and the incidence of complications.

Conclusion: GR patients with thoracic kyphosis out of normal range are more likely to experience complications compared to those with normal kyphosis. The likelihood of complications, particularly implant failure, is highest in patients with kyphosis >40 deg irrespective of diagnosis.

Significance: Thoracic kyphosis in EOS should be closely monitored for complications, particularly implant failure.

The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an ‘off label’ use).

© 2010 Lippincott Williams & Wilkins, Inc.

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