Final Fusion in Patients Treated with Rib Based Distraction: A Review of Peri-operative Results

THE UNIVERSITYOF UTAHDepartment of Orthopaedic Surgery

John A Heflin, MD; John Smith, MD; Victoria Heagy, Jessica Morgan

Disclosures John A. Heflin – paid consultant for Globus

Spine, Medtronic John T. Smith – paid consultant for Globus

Spine, Depuy Synthes Spine, SpineGuard, Biomet, Ellipse; Board Member Children’s Spine Foundation; Royalties Synthes Spine

Victoria Heagy – none Jessica Morgan - none

Background Rib based distraction is

commonly used in children with EOS

At cessation of growth, definitive fusion is often performed– Gain additional correction– Prevent further progression

As patients mature, more definitive procedures are now being performed

Study Objective Review peri-operative outcomes for patients

undergoing definitive fusion following rib-based distraction treatment for early onset scoliosis:– Coronal curve correction– Correction of kyphosis– Technical difficulty

• EBL• Surgical time• Complications• Osteotomies

Review of IRB approved CSSG registry database, patient charts

Single surgeon Patients treated with rib based distraction Previous implantation of rib-based distraction

prior to definitive fusion Definitive fusion performed with segmental

instrumentation

Study Methods

27 Patients identified:– Age at initial surgery– Age at fusion– Number of lengthenings – Type of construct– Blood loss– Surgical time  – Pre/post-op Cobb angles– Pre/post-op kyphosis– Osteotomies required– Total complications

Data collection

Results27 patients Average Range

Age at initial implant (yrs.) 7.45 1.78 – 11.78 Age at fusion (yrs.) 13.51 9.21 – 18.51 Lengthenings 10.5 0 -18 Total surgical procedures 13.35 3 - 21 Fusion data:   EBL (cc) 534 180 - 1280 Surgical time (min.) 256 115 - 520 Osteotomies 11 total Complications 12 total Repeat procedures 9 total Pre-fusion Cobb 67.42 40 - 107 Pre-fusion Kyphosis 61.08 8 - 113 Post-fusion Cobb 50.17 32 - 82 Post-fusion Kyphosis 50.00 20 - 85

Results

Complications – 11 patients Required Surgery Neck pain No Crouched gait No Hardware Failure (broken rod) Yes Prominent hardware, wound dehiscence Yes Infection / wound dehiscence Yes Pseudarthrosis Yes Infection Yes Pseudarthrosis, hardware failure, wound dehiscence Yes Wound dehiscence Yes Wound dehiscence Yes Prominent hardware Yes

Conclusion Definitive fusion in patients treated with

rib-based distraction :– Technically challenging– Longer surgical times– Higher blood loss– Less correction– More surgical complications (44%)

Conclusion Despite technical challenges, definitive

fusion does improve pre-operative coronal Cobb angles and kyphosis

Longer follow-up will be needed to determine if correction maintained

Thank You