Hospital Universitario La Paz, Madrid, Spain

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Hospital Universitario La Paz, Madrid, Spain Risk and Benefits of Definitive Fusion to Graduate Patients with Early Onset Scoliosis at the End of Distraction-based Programs Javier Pizones, Francisco Javier Sánchez Pérez-Grueso, José Miguel Sánchez Márquez, Nicomedes Fernández Baíllo, Mar Pérez Martín-Buitrago. Hospital Universitario La Paz, Madrid, Spain

Disclosures Javier Pizones (a) DePuy-Synthes Spine FJ Pérez Grueso (a) DePuy-Synthes Spine (b) K2M JM Sánchez-Márquez No Relationships N Fernández-Baíllo No Relationships M Pérez-Buitrago No Relationships Grants/Research Support Consultant Stock/Shareholder Speakers’ Bureau Other Financial Support

definitive fusion (PSF) Early onset scoliosis (EOS) is treated by growth-friendly techniques until skeletal maturity to improve trunk height while controlling the deformity. Afterwards, they can be “graduated,” either by: retaining the previous implants with no additional surgery (Observation) definitive fusion (PSF) Criteria for this decision-making and the risks and benefits of definitive fusion are still to be determined

Establish criteria for decision-making Objective Establish criteria for decision-making Determine the risks and benefits of definitive fusion Methods We analyzed a prospective cohort of “graduated” EOS patients after a distraction-based lengthening program. We gathered demographic, radiographic, and surgical data Results of the two final treatment options were compared after 2-years’ follow-up.

Sample description 28 patients were included (32-4) 9 boys and 19 girls 28% Neuromuscular, 25% syndromic, 18% congenital, 14% idiopathic,14% thoracogenic A total of 23 patients were treated with growing-rods, and 5 were treated with VEPTR.

Results 13 underwent PSF, and 15 OBSV. The mean age at initial treatment was 7.4 yrs, and the mean follow-up was 8.3 years.

Both groups had similar preoperative and final radiographic parameters (P>0.05)

Results The criteria for surgical decision-making were: 1. Implant-related complications 2. Main curve magnitude (PSF=63.2º±9 vs. OBS=47.9º±15; P=0.008) 3. Progression since last lengthening (PSF=12.5º ± 8.2 vs. OBS=1.9º ± 0.94; P=0.000 ) 4. Sagittal misalignment –SVA- (PSF=19.5mm±40 vs. OBS=-17.3mm±35; P=0.029) 5. Trend toward coronal misalignment (PSF=28.8mm±28 vs. OBS=13.3mm±11; P=0.08).

PSF Surgery 12/13, patients underwent multiple osteotomies: average 5 SPO one PVCR 3 costoplasties. Surgical time was 291.5 ± 58 min (5 hrs) Blood loss was 946 ± 375 ml The number of levels fused was 13.7 ± 1.6. PSF extended 1.3 ± 1.5 levels

Postop results Main Cobb was corrected by 19.7º ± 2.7 (31% correction) Compensatory curve was corrected by 13.3º ± 6.3 (34%) T1-S1 length gained was 31 ± 19.6 mm T1-T12 length gained was 9.3 ± 39 mm Kyphosis was reduced by 10º ± 10.4 (22%) SVA was reduced by 5.3 ± 30 mm. However, coronal balance worsened by 2.3 ± 30.8 mm. No major complications were encountered.

Conclusion The decision for graduation by observation was associated with: Neuromuscular curves Residual Cobb <50º Coronal misalignment <20 mm

Conclusion The decision for graduation by definitive fusion was related to congenital etiology And depended on: unacceptable major curve deformity (>50º) progressive major curve deformity (>10º) sagittal misalignment (SVA> 2 cm) complication with previous implants Coronal unbalance