1. 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

2. 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

3. 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

4. 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.

5. 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.

6. 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.

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

8. 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).

9. PSF Surgery 12/13, patients underwent multiple osteotomies:
average 5 SPO
one PVCR
3 costoplasties.
Surgical time was ± 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

10. 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.

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

12. 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