Final Fusion in Patients Treated with Rib Based Distraction: A Review of Peri- operative Results THE UNIVERSITY OF UTAH Department of Orthopaedic Surgery.

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Presentation transcript:

Final Fusion in Patients Treated with Rib Based Distraction: A Review of Peri- operative Results THE UNIVERSITY OF UTAH Department of Orthopaedic Surgery John A Heflin, MD; John Smith, MD; Victoria Heagy, Jessica Morgan

Disclosures  John A. Heflin – paid consultant for Globus Spine, Medtronic  John T. Smith – paid consultant for Globus Spine, Depuy Synthes Spine, SpineGuard, Biomet, Ellipse; Board Member Children’s Spine Foundation; Royalties Synthes Spine  Victoria Heagy – none  Jessica Morgan - none

Background  Rib based distraction is commonly used in children with EOS  At cessation of growth, definitive fusion is often performed – Gain additional correction – Prevent further progression  As patients mature, more definitive procedures are now being performed

Study Objective  Review peri-operative outcomes for patients undergoing definitive fusion following rib-based distraction treatment for early onset scoliosis: – Coronal curve correction – Correction of kyphosis – Technical difficulty EBL Surgical time Complications Osteotomies

 Review of IRB approved CSSG registry database, patient charts  Single surgeon  Patients treated with rib based distraction  Previous implantation of rib-based distraction prior to definitive fusion  Definitive fusion performed with segmental instrumentation Study Methods

 27 Patients identified: – Age at initial surgery – Age at fusion – Number of lengthenings – Type of construct – Blood loss – Surgical time – Pre/post-op Cobb angles – Pre/post-op kyphosis – Osteotomies required – Total complications Data collection

Results 27 patients Average Range Age at initial implant (yrs.) – Age at fusion (yrs.) – Lengthenings Total surgical procedures Fusion data: EBL (cc) Surgical time (min.) Osteotomies 11 total Complications 12 total Repeat procedures 9 total Pre-fusion Cobb Pre-fusion Kyphosis Post-fusion Cobb Post-fusion Kyphosis

Results Complications – 11 patientsRequired Surgery Neck pain No Crouched gait No Hardware Failure (broken rod) Yes Prominent hardware, wound dehiscence Yes Infection / wound dehiscence Yes Pseudarthrosis Yes Infection Yes Pseudarthrosis, hardware failure, wound dehiscence Yes Wound dehiscence Yes Wound dehiscence Yes Prominent hardware Yes

Conclusion  Definitive fusion in patients treated with rib-based distraction : – Technically challenging – Longer surgical times – Higher blood loss – Less correction – More surgical complications (44%)

Conclusion  Despite technical challenges, definitive fusion does improve pre-operative coronal Cobb angles and kyphosis  Longer follow-up will be needed to determine if correction maintained

Thank You