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Multicenter Study
. 2022 Jul;10(4):933-941.
doi: 10.1007/s43390-022-00481-0. Epub 2022 Feb 11.

Scoliosis flexibility correlates with post-operative outcomes following growth friendly surgery

Riley Bowker  1 , Kevin Morash  1 , Amir Mishreky  1 , Burt Yaszay  2 , Lindsay Andras  3 , Peter Sturm  4 , Paul D Sponseller  5 , George H Thompson  6 ; Pediatric Spine Study Group; Ron El-Hawary  7
Affiliations
Multicenter Study

Scoliosis flexibility correlates with post-operative outcomes following growth friendly surgery

Riley Bowker et al. Spine Deform. 2022 Jul.

Abstract

Purpose: The purpose of this study was to determine the relationship between pre-operative scoliosis flexibility and post-operative outcomes, including curve correction and complications, for patients who have been treated with growth friendly surgery (GFS) for early onset scoliosis (EOS).

Methods: The study was conducted as a retrospective review of prospectively collected data from an international, multicenter, EOS database. EOS patients with pre-operative flexibility radiographs (traction or bending) were identified. Pre-operative flexibility and immediate post-operative correction were calculated for each patient. Post-operative complications were recorded at final follow-up. Pearson correlations were determined for flexibility vs correction for all patients and were compared between etiologies and between device types (MCGR, TGR, VEPTR).

Results: 107 patients (14 congenital, 43 neuromuscular, 31 syndromic, 19 idiopathic) with mean age 7.1 years at index surgery were identified. Mean pre-operative scoliosis was 77°. Mean flexibility of 36% was not significantly different between etiologies. Mean immediate post-operative scoliosis was 46° (p < 0.001 vs. pre-operative) with mean correction of 38%. Correction rate was not significantly different between etiologies; however, correction rate was different between device types (MCGR 45%, TGR 40%, VEPTR 14%; p = < 0.001). Pearson correlation for flexibility vs correction was fair (r = 0.37, p < 0.001). This correlation was observed for idiopathic (r = 0.53, p = 0.020) and neuromuscular (r = 0.46, p = 0.0020) scoliosis, but not for congenital or syndromic scoliosis. At a mean of 6.1 year follow-up (minimum 2 years to 15.5 years), 60 of 81patients (74%) experienced at least one complication. Odds ratio for developing a complication was 3.00 (1.03-8.76) for patients with pre-operative flexibility < 45% (p < 0.05).

Conclusions: As lower pre-operative flexibility was associated with less scoliosis correction and with a higher risk of post-operative complications, curve flexibility should be considered when deciding upon the timing of growth friendly surgery.

Level of evidence: Level III-retrospective comparative study.

Keywords: Early onset scoliosis; Flexibility; Growth friendly; MCGR; VEPTR.

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References

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