Top Eleven Podium Presentations at the 2017 ICEOS Meeting
Which Will Impact the Care of EOS Patients in My Practice
1.
Paper #1
a.
Bouton D, Karol L, Poppino K, Johnson C. Continued deterioration in pulmonary function
at a minimum 18-year follow-up from early thoracic fusion in non-neuromuscular
patients.
b.
Conclusion: Patients with thoracic spinal fusion
at a very young age (mean 2.7 years) have a continued decline in pulmonary
function (38% of normal) as they enter adulthood, which can be
life-threatening. Additionally, their
functional capacity (6-minute walk test) is severely limited to 62% vs.
age-matched controls.
c. Take-away message: Avoid
thoracic spine fusions in children less than 5 years of age.
2.
Paper #3
a.
Celebiolglu E, Yataganbaba A, Asli O, Degirmenci
C, Kocyigit IA, Tekin R, Demirkiran HG, Yalcin EE, Demir AU, Yazici M. Can TGR change the natural history of
pulmonary function in EOS? Is
radiological straightness correlated with normal lung development?
b.
Conclusion: Traditional Growing Rods can help Early
Onset Scoliosis patients who would otherwise have serious pulmonary
insufficiency and help achieve pulmonary capacities compatible with a healthy
life. Despite significant decreases in Traditional
Growing Rod graduates in oxygen consumption capacity and pulmonary test
compared to healthy controls, results were not statistically different than Adolescent
Idiopathic Scoliosis.
c. Take-away message: Traditional Growing
Rods are effective and successful in achieving good results in pulmonary
functions as well as radiological parameters.
3.
Paper #5
a.
Kawakami N, Matsumoto H, Saito T, Tauchi R,
Ohara T, Redding G. Pre-operative Six
Minute Walk Performance in Children with Congenital Scoliosis.
b.
Conclusion: The 6 minute walk test is a feasible
measure of function and is substantially reduced prior to surgery in most
children with congenital scoliosis. The
6 minute walk test correlates with age
and inversely with Cobb angle, but not FVC%.
c. Take-away message: The 6 minute
walk test measured serially in meters and not as a % of normal is a useful
measure of functional status in children with congenital scoliosis.
4.
Paper #25
a.
Ahmad A, Subramanian T, Panteliadis P,
Wilson-Macdonald J, Rothenfluh D, Nnadi C.
Quantifying the “Law of Diminishing Returns” in Magnetically Controlled
Growing Rods.
b.
Conclusion: The “Law of Diminishing Returns” can
also be observed following serial distraction in Magnetically Controlled Growing
Rods. In comparison to previously
published data for Traditional Growing Rods, there is a gradual linear decline
as opposed to a rapid initial decline in lengthening.
c. Take-away message: Magnetically
Controlled Growing Rods gradually appear to stiffen the spine in a similar way
as Traditional Growing Rods.
5.
Paper #26
a.
Poon S, Spencer HT, Sever R, Cho R. Maximal Force Generated by Magnetically
Controlled Growing Rods Decreases with Rod Lengthening.
b.
Conclusion:
There is a small (3.6 lb.) statistically significant decrease in the
maximal force generated by MCGR as the rods are lengthened. This decrease may contribute to diminished
spine length gained with each subsequent MCGR lengthening.
c. Take-away message: Magnetically
Controlled Growing Rods are able to maintain >92% of distraction force near
the end (83%) of the actuator length.
6.
Paper #29
a.
ElBromboly Y, Johnston C, McClung A, Samdani A,
Glotzbecker M, St. Hilaire T, Hurry J, Kedar P, Flynn T, El-Hawary R. Does the Type of Proximal Anchor Used During
Distraction-Based Surgeries for Patients with Non-Idiopathic EOS Affect Spine
Length?
b.
Conclusion:
At a minimum 5 year follow-up, distraction-based surgeries increased
spine length for patients for non-idiopathic EOS; regardless of proximal anchor
choice. Rib-based anchors may protect
against potential law of diminishing returns.
c. Take-away message: Rib-based proximal
anchors in growing rods appear to achieve equivalent correction as spine-based
anchors in non-idiopathic patients.
7.
Paper #38
a.
Luhmann SJ, McAughey E, Ackerman S, Bumpass D,
McCarthy R. Cost analysis of growth
guidance system compared with magnetically controlled and traditional growing
rods for early-onset scoliosis in the US: an integrated health care delivery
system perspective.
b.
Conclusion: Growth Guidance Systems resulted in
fewer invasive surgeries (3.4 vs. 14.4) and deep Surgical Site Infections than
Traditional Growing Rods with lower cumulative costs per patient than both Magnetically
Controlled Growing Rods ($29,916 less) and Traditional Growing Rods ($25,226
less) over a 6-year episode of care.
c. Take-away message: Growth
Guidance Systems result in fewer infections, less surgery and are 16-18%
cheaper than Magnetically Controlled Growing Rods or Traditional Growing Rods
of the entire episode of care.
8.
Paper #40
a.
Bauer J, Yogova P, Neiss G, Rogers KJ, Sturm PF,
Sponseller P, Luhmann SJ, Pawelek J, Shah SA.
Is There an Improvement in Quality of Life with Early Onset Scoliosis
Managed with Traditional Growing Rods Converted to Magnetically Controlled
Growing Rods.
b.
Conclusion: Although patient families and their
surgeons may subjectively report improved Quality of Life after conversion from
frequent surgical Traditional Growing Rods lengthenings to in-office Magnetically
Controlled Growing Rod lengthenings, these improvement were not evident in
Quality of Life surveys.
c. Take-away message: In patients
converted to Magnetically Controlled Growing Rods the benefits are obvious to
caregivers and surgeons, but the outcome measures are not sensitive enough to
pick up a difference.
9.
Paper #41
a.
Skaggs D, Akbarnia B, Pawelek J, Matsumoto H,
St. Hilaire T, Sturm PF, Perez-Grueso FJS, Luhmann SJ, Sponseller P, Smith J,
White K, Vitale M. Two Year HRQOL
Measures are Similar Between Magnetically-Controlled Growing Rod (MCGR)
Patients and Traditional Growing Rod Patients.
b.
Conclusion: Prior to surgery MCGR patients has
lower HRQOL in 3 out of 10 domains (Daily Living, Physical Function,
Transfers), however at 24 months both groups were similar across all
domains. Subgrouping of neuromuscular
patients revealed differences in financial and parental impact domains which
suggest etiology plays a role in the Health-Related Quality of Life in these
patients.
c. Take-away message: There may be
a benefit to Magnetically Controlled Growing Rods in Daily Living and Physical
Function when compared to Traditional Growing Rods. More study is needed.
10.
Paper #42
a.
Gomez JA, Kubat O, Hurry J, Soroceanu A, Flynn
T, Tovar M, Hanstein R, Lafage V, Schwab F, Smith J, Skaggs, El-Hawary R. Spinopelvic alignment affect Health-related
Quality of Life (HRQoL) for Patients with Early Onset Scoliosis.
b.
Conclusion: For children with early onset
scoliosis, preop Pelvic Incidence >60 degrees (poor Pain outcomes), pre and
post-op Lumbar Lordosis>60 degrees (poor Satisfaction outcomes), postop Pelvic
Incidence-Lumbar Lordosis mismatch >20 degrees (poor Fatigue outcomes) and
post-op Proximal Junctional Kyphosis (poor Fatigue outcomes) all decrease Health-Related
Quality of Life.
c. Take-away message: Achieving
good spinopelvic alignment is important in Early-Onset Scoliosis treated
surgically.
11.
Paper #45
a.
Matsumoto H, Campbell M, Minkara A, Roye DP,
Garg S, Johnston C, Samdani A, Smith J, Sponseller P, Sturm PF, Vitale M. Development of a Risk Severity Score (RSS)
Predicting Surgica Site Infection in Early Onset Scoliosis: Identifying
High-Risk Patients.
b.
Conclusion: The Risk Severity Score
(neuromuscular diagnosis and endocrine, gastrointestinal, pulmonary
comorbidities, etc…) provides empirically-derived patient-specific Surgical Site
Infection risks. It can be used to
prepare for high-risk patients for surgery, as a factor in clinical
decision-making, and to facilitate comparison between hospital outcomes.
c. Take-away message: The risk of a
postoperative surgical wound infection can be tabulated for preoperative
optimization and in discussions with caregivers preoperatively.
The Growing Spine Study Group
