Can distraction-based surgeries achieve minimum 18 cm thoracic height for patients with early onset scoliosis?

• Published in: Spine deformity 2021-03, Vol.9 (2), p.603-608
• Main Authors: ElBromboly, Yehia, Hurry, Jennifer, Johnston, Charles, McClung, Anna, Samdani, Amer, Glotzbecker, Michael, Hilaire, Tricia St, Flynn, Tara, El-Hawary, Ron
• Format: Article
• Language: English
• Subjects: Case Series; Medicine; Medicine & Public Health; Orthopedics
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1007/s43390-020-00230-1

Purpose Karol et al. introduced the concept that 18 cm thoracic height is the critical point where a patient with early onset scoliosis (EOS) can maintain adequate pulmonary function. Our purpose was to determine if distraction-based surgeries will increase thoracic spine height to at least 18 cm in patients with EOS. Methods Patients with EOS treated with distraction-based systems (minimum 5 years follow up, minimum five lengthenings). Radiographic analysis of thoracic spine height (T1–T12) at the last lengthening procedure. Results One hundred and fifty-three patients (67 congenital, 21 neuromuscular, 38 syndromic, 27 idiopathic) with pre-operative mean age 4.6 years, scoliosis 75°, kyphosis 47° were evaluated. Their mean age at final lengthening procedure was 11 years (6–16), average number of lengthening procedures was 10.5 (4–21), mean final scoliosis was 53°, and mean final kyphosis was 58°. Final thoracic height was > 18 cm in 65% and was > 22 cm in 31% of patients. Based on etiology, only 48% of the congenital patients reached 18 cm compared to 81% neuromuscular, 84% syndromic and 67% idiopathic. This height gain was closely related to the percentage of scoliosis correction achieved for each etiology. Comparing congenital etiology to other etiologies, there was a lower percentage of patients in the congenital group that passed the 18 cm threshold (48% vs. 78%) ( p