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Title: Prospectively collected surgeon indications for discontinuation of a lengthening program for early onset scoliosis

Authors: Murphy RF, Barfeld WR, St Hilaire T, Smith JT, Emans JB, Samdani A, Garg S, Sawyer JR, Pahys JM, CSSG.

Journal: Spine Deformity

Date: January 24, 2020

Excerpt: At some point during the growth-friendly treatment of a child, a decision is made to stop lengthening or expanding the device. However, ascertaining timing and indications for stopping the lengthening of a growth-friendly construct remains unclear, as the heterogeneity of the scoliosis etiology and curve history vary widely from patient to patient.

Keywords: EOS, surgical treatment, growth, final fusion, observation

Summary:

 What is the purpose of this study?

The purpose of this study was to determine why a surgeon would stop using a growth friendly treatment (i.e. VEPTR, MCGR, etc.) for children with early onset scoliosis. Secondarily, the study follows the patient after they’ve stopped growth-friendly treatment and continued on to spine fusion or observation.   

Results:

- The most common reasons for ending surgical lengthening included: end of growth, patient age, devices that stop lengthening and health of the patient.

- At the end of treatment, 92/121 (76%) patients were treated with a definitive spinal final fusion, whereas 29 (24%) were treated with only observation (no additional surgery).

- There were no major differences in reasons for selection of observation or final fusion.

Important Discussion Points

- We found that the most common surgeon-listed indications to stop lengthening centered around end of growth (46 responses) and the patient’s age (33 responses).

- Most of these patients had a final fusion. This is a complicated decision. Many surgeons choose final fusion for further correction of a spine’s deformity, but there are many risks involved with this surgery.

- Further study on this subject is needed to determine how definitive treatments affect patients’ lives long-term.