Spine (Phila Pa 1976). 2021 Oct 1.
doi:
10.1097/BRS.0000000000004245. Online
ahead of print.
Magnetically
Controlled Growing Rods (MCGR) Versus Single Posterior Spinal Fusion (PSF)
Versus Vertebral Body Tether (VBT) in Older Early Onset Scoliosis (EOS)
Patients: How Do Early Outcomes Compare?
Catherine Mackey 1, Regina Hanstein, Yungtai Lo, Majella Vaughan, Tricia St Hilaire, Scott J Luhmann, Michael G Vitale, Michael P Glotzbecker, Amer Samdani, Stefan Parent, Jaime A Gomez, Pediatric Spine Study Group
Affiliations expand
·
PMID: 34610613
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DOI: 10.1097/BRS.0000000000004245
Abstract
Study design: Retrospective review of prospective data from multicenter
registry.
Objective: Compare outcomes of posterior spinal fusion (PSF) versus
magnetically controlled growing rods (MCGR) versus vertebral body tethers (VBT)
in 8- to 11-year-old idiopathic early onset scoliosis (EOS) patients.
Summary of background data: In EOS, it is unclear at what age the benefit
of growth-sparing strategies outweighs increased risks of surgical
complications, compared with PSF.
Methods: One hundred thirty idiopathic EOS patients, 81% female, aged
8-11 at index surgery (mean 10.5 yrs), underwent PSF, MCGR, or VBT. Scoliosis
curve, kyphosis, thoracic and spinal height, complications, and Quality of Life
(QoL) were assessed preoperatively and at most recent follow-up (prior to final
fusion for VBT/MCGR).
Results: Of 130 patients, 28.5% received VBT, 39.2% MCGR, and 32.3% PSF.
The VBT cohort included more females (P < 0.0005), was older (P <
0.0005), more skeletally mature (P < 0.0005), and had smaller major curves
(P < 0.0005). At follow-up, scoliosis curve corrected 41.1 ± 22.4% in VBT,
52.2 ± 19.9% in PSF, and 27.4 ± 23.9% in MCGR (P < 0.0005), however, not all
VBT/MCGR patients finished treatment. Fifteen complications occurred in 10
VBTs, 6 requiring unplanned surgeries; 45 complications occurred in 31 MCGRs,
11 requiring unplanned surgeries, and 9 complications occurred in 6 PSFs, 3
requiring unplanned revisions. Cox proportional hazards regression adjusted for
age, gender, and preoperative scoliosis curve revealed that MCGR (hazard ratio
[HR] = 21.0, 95% C.I. 4.8-92.5; P < 0.001) and VBT (HR = 7.1, 95% C.I.
1.4-36.4; P = 0.019) patients were at increased hazard of requiring revision,
but only MCGR patients (HR = 5.6, 95% C.I. 1.1-28.4; P = 0.038) were at an
increased hazard for unplanned revisions compared with PSF. Thoracic and spinal
height increased in all groups. QoL improved in VBT and PSF patients, but not
in MCGR patients.
Conclusion: In older idiopathic EOS patients, MCGR, PSF, and VBT controlled
curves effectively and increased spinal height. However, VBT and PSF have a
lower hazard for an unplanned revision and improved QoL.Level of Evidence: 3.