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Title: Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs.

Authors: Larson AN, Baky FJ, St Hilaire T, Pawelek J, Skaggs DL, Emans JB, Pahys JM, Children's Spine Study Group, Growing Spine Study Group.

Journal: Spine Deformity

Date: January 01, 2019

Excerpt: Patients with early-onset scoliosis and fused ribs treated with devices connected superiorly (top of the device) to the spine had better correction of kyphosis and scoliosis than those treated with rib-based devices. Patients with rib-based devices underwent more total surgeries than those treated with spine-based devices. Further studies are necessary to evaluate whether rib-based devices and expansion thoracoplasty provide better health-related quality of life, pulmonary function outcomes, or life expectancy for patients with severe chest wall deformities.

Keywords: VEPTR, Early onset scoliosis (EOS), Chest wall deformity, fused ribs

Summary:

 What is the purpose of this study?

Patients with chest wall deformities requiring surgery are often selected to undergo rib-based implantation to improve deformity and pulmonary function. This study compares the outcomes of constructs connected superiorly to ribs or to the spine. Outcomes were measured by cobb and kyphosis angle correction, and spine growth during the course of treatment.

Results

·   169 patients with early onset scoliosis and fused ribs were identified. 16 were treated with spine based and 153 were treated with rib-based growth friendly constructs.

·   Patients had an average age of 4.7 years at initial surgery, and an average of 5.9 years of follow-up.

·   Spine based constructs underwent an average of 8.0 surgeries versus 11.3 for rib-based constructs.  Revision surgery and total number of expansion surgeries averages were not of significant statistical difference.

·   The only statistically significant difference between the groups was device migrations, with rib-based constructs at 26.8% and spine based at 6.3%. implant failures infections, and unplanned returns to the OR were not of significant statistical difference.

·   Cobb angles decreased in both groups, while kyphosis increased in rib-based patients and decreased in spine-based patients. Spine based constructs experienced greater growth in the thoracic spine following implantation, before fusion and throughout the course of treatment.

·   At the conclusion of treatment, spine-based constructs achieved better scoliosis correction, and improved kyphosis.

Important Discussion Points

·   Patients with rib-based devices underwent more total surgeries than those treated with spine-based devices.

·   The results of this study demonstrate that spine-based constructs offer better correction of spinal deformity, as measured by correction of Cobb angle and kyphosis, while demonstrating equivalent correction of thoracic and spinal height; however, pulmonary function, quality of life data, thoracic volume, or more complete lung analysis data is not available from this patient population.

·   Major limitations of this study are that a much smaller proportion of patients were treated with spine-based constructs, and there may be surgeon selection bias of constructs to treat larger chest wall deformities.