EOS Patients from A Retrospective database

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Presentation transcript:

EOS Patients from A Retrospective database Billy Lavelle, Aaron Buckland, Greg Redding, John Schmidt

EOS Patients Early Onset Scoliosis (EOS) Treatment is based on future spine and thoracic growth Growth-friendly constructs require implantation, expansion, revisions and eventually fusion Question: Has lung function increased after expansion and maintained after fusion?

Retrospective database Retrospective database (DB) DB was independently set up 2009 Independently monitored (Watermark) Shut down in July 2015 2397 patients were examined 48 sites including 5 OUS ALL Demographics, Operative, Diagnostic, Radiographic, Follow-up … etc

Research Question How frequently is lung function assessed pre- and post-operatively in children with EOS? Intent – to assess lung function (PFTs) in EOS patients before and after growth friendly implantation and after fusion Query limited to confirmed diagnosis of scoliosis prior to age 10

Growing Rod Constructs Dual rod 24 Mo post-op Single rod 48 Mo post-op

Results 18 children from 6 spine centers found 11 of the 18 underwent growing rod surgeries Implant ages ranged from 1.8 to 9.9 YO Spine fusion involving >8 VBs performed in 6 cases

Results Pre-operative spirometry was performed in one child prior to fusion. No PFTs were documented for ANY child in the study.

Discussion PFTs are NOT used in EOS patients AIS fusion patients with vital capacity <40% have 3X more complications Lung functions are almost never used to assess timing of fusion So why bother with a growing rod construct?

PFT Testing Because Scoliosis distorts the thoracic cavity: Cobb Angle: 50-60° abnormal lung function >90° cardiorespiratory failure Results in fewer and smaller alveoli and stiffer chest wall

PFT Pre- and Post-op “Some patients with adolescent idiopathic scoliosis may have clinically relevant pulmonary impairment that is out of proportion with the severity of the scoliosis, and this may alter the decision-making process regarding which fusion technique will produce an acceptable clinical result with the least additional effect on pulmonary function.” PO Newton et al., JBJS (US) Vol 87A, pg 1937, 2005

All Deformity pts & PFTs Pre-Op PFT Yes No Pre-op PFT are rarely done No evidence of Post-op PFTs in over 1150 deformity patients