Brian Yang BA, Jill Larson MD, Michael Glotzbecker MD

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Presentation transcript:

Brian Yang BA, Jill Larson MD, Michael Glotzbecker MD Factors Affecting the Efficacy of Halo-Gravity Traction in Early Onset Scoliosis Brian Yang BA, Jill Larson MD, Michael Glotzbecker MD

Introduction Halo Gravity Traction (HGT) Adjunctive treatment for Early-Onset Scoliosis (EOS) Limited data exists describing which factors influence one’s response to HGT Source: D'Astous JL, Sanders JO. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 2007 Oct;38(4):477-84, v. Review

Classification of Early Onset Scoliosis (C-EOS) Introduction Classification of Early Onset Scoliosis (C-EOS) Classifies EOS patients based on: Etiology Major Curve Angle Kyphosis Annual Progression Ratio Source: Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, Flynn JM, Johnston CE, McCarthy RE, Roye DP Jr, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG. Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am. 2014 Aug 20;96(16):1359-67. doi: 10.2106/JBJS.M.00253.

Methods Retrospective cohort analysis Patients with scoliosis Received HGT between 2010 and 2016 Patients grouped by C-EOS classifications Etiology, major curve angle, kyphosis, annual progression ratio (APR) Groups within C-EOS classifications tested for association with: Major curve correction (MCC) due to HGT alone (degrees) Percent major curve correction due to HGT alone (% correction) Multivariable model of degrees of major curve correction created that considered etiology and major curve angle

Results – Demographics 28 Patients Median age at scoliosis dx requiring treatment – 4.75 years (range 1.28-10.91) Median age at halo application - 13.9 years (range 3.7-22.5 years) Indications for halo traction: 12 severe curves 6 rigid curves 4 severe and rigid curves 2 kyphoscoliotic curves 4 cases w/o explicit reasoning in medical charts

Results – MCC Association with C-EOS Groups Median major curve correction (MCC) – 34⁰ (range 5⁰ to 88⁰)

Results - MCC Association with C-EOS Groups Major curve correction was not associated with etiology, kyphosis, or APR classification individually. The median major curve correction due to HGT was 16.5⁰, 20.0⁰, and 42.5⁰ for major curve angle groups “2” (20⁰-50⁰), “3” (51⁰-90⁰), and “4” (>90⁰) respectively (p=0.014).

Results – Interaction Effect There is a significant difference in degrees of major curve correction due to HGT between major curve angle groups “3” and “4” in congenital scoliosis patients (75.8°, p<0.001) but not neuromuscular scoliosis patients (13.6°, p=0.054). Significant interaction effect remained when considering percent major curve correction between groups “3” and “4” in congenital patients (p=0.018) but not neuromuscular patients (p=0.615).

Conclusions Increasing major curve angle classification is significantly associated with increased curve correction due to HGT. This effect is particularly pronounced in congenital scoliosis patients between major curve angle groups “3” and “4”. These findings provide insight into which patients may best benefit from HGT.