Distraction-Based Surgeries Increase Spine Length for Patients with Non-Idiopathic EOS - 5 Year Follow up Yehia ElBromboly, Jennifer Hurry, Kedar Padhye,

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Distraction-Based Surgeries Increase Spine Length for Patients with Non-Idiopathic EOS - 5 Year Follow up Yehia ElBromboly, Jennifer Hurry, Kedar Padhye, Charles Johnston, Anna McClung, Amer Samdani, Michael Glotzbecker, Tricia St. Hilaire, Tara Flynn, Ron El-Hawary, Children’s Spine and Growing Spine Study Groups

Author’s financial disclosure Yehia ElBromboly None Jennifer Hurry None Kedar Padhye None Charles Johnston Medtronic Sofamor Danek: IP royalties OrthopedicsJournal of Childrens Orthopedics: Editorial or governing board Pediatric Orthopaedic Society of North America: Board or committee member Saunders/Mosby-Elsevier: Publishing royalties, financial or material support Scoliosis Research Society: Board or committee member Anna McClung None Amer Samdani Children's Spine Study Group: Board or committee member DePuy, A Johnson & Johnson Company: Paid consultant Ethicon: Paid consultant Globus Medical: Paid consultant Misonix: Paid consultant Scoliosis Research Society: Board or committee member Setting Scoliosis Straight Foundation: Board or committee member Stryker: Paid consultant Zimmer Biomet: Paid consultant Michael Glotzbecker Biomet: Paid presenter or speaker DePuy, A Johnson & Johnson Company: Paid presenter or speaker Member of CSSG: Research support Member of GSSG: Research support Member of HSG: Research support Orthobullets: Publishing royalties, financial or material support Tricia St. Hilaire None Tara Flynn None Ron El-Hawary Apifix Ltd.: Paid consultant Children's Spine Study Group: Board or committee member DePuy, A Johnson & Johnson Company: Paid consultant; Research support Medtronic: Paid consultant; Research support Pediatric Orthopaedic Society of North America: Board or committee member

Background Auto fusion? Supports delay tactic with casting

Introduction It has been shown that Spine length continued to increase during distraction phase of treatment for idiopathic EOS. As EOS has many etiologies, it is unclear whether underlying etiology affects the spine length achieved with distraction- based surgeries.

Purpose To determine if distraction-based surgeries will increase spine length in patients with non-idiopathic EOS and whether etiology affects final spine length. Hypothesis Distraction-based surgeries will increase spine length in patients with non-idiopathic EOS; although there may be differences between etiologies

Design & Methods Retrospective, comparative multi-center, review of patients with non-idiopathic EOS treated with distraction-based systems Minimum 5 yr f/u and 5 lengthenings Primary outcome was T1-S1 SSL Pre-op Post-implant (L1) Lengthening Intervals (L2-5, L6-10, L11-15).

Patients 126 patients Average pre-op age 4.6 yrs 67 congenital 38 syndromic 21 neuromuscular Average pre-op age 4.6 yrs Average pre-op Scoliosis 75o Average pre-op Kyphosis 48o.

Results *p<0.05 Scoliosis Kyphosis After initial correction*, Scoliosis remained constant and Kyphosis increased over time*

Results

Results

Conclusion At minimum 5 year follow up, distraction-based surgeries increased spine length for patients with non-idiopathic EOS. The etiology of non-idiopathic scoliosis affects final spine length achieved during distraction-based surgeries: Pre-op SSL was higher in neuromuscular patients compared to congenital patients and maintained that difference until the 10th lengthening* Congenital & syndromic patients had similar pre-op spine length, however; syndromic patients achieved higher final spine length*

References Sankar WN, Skaggs DL, Yazici M, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine (Phila Pa 1976). 2011 May 1;36(10):806-9 Spurway AJ, Chukwunyerenwa CK, Kishta WE, Hurry JK, El-Hawary R. Sagittal Spine Length Measurement: A Novel Technique to Assess Growth of the Spine. Spine Deformity. 2016 Sep;4(5):331-337 El-Hawary R, Vitale M, Samdani A, Wade J, Heflin J, Smith M, Klatt J, Smith J. Rib-Based Distraction Surgery Maintains Total Spine Growth. J Pediatr Orthop. 2016 Dec;36(8):841-846