Ramirez Norman, Acosta Julbe José I, Smith John, Emans John, Samdani Amer, Erickson Mark, Flynn John, Torres Lugo Norberto J, Claudio-Marcano Alexandra M, Olivella Gerardo
Department of Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez.
The Orthopaedic Partners, Park City, UT.
J Pediatr Orthop. 2025 Aug 1;45(7):370-375. doi: 10.1097/BPO.0000000000002971. Epub 2025 Apr 28.
Untreated early-onset scoliosis (EOS) is often complicated by decreased thoracic expansion growth and pulmonary complications. Various fusion-less techniques have been developed to address these complications, including growing rods and vertical expandable prosthetic titanium rib (VEPTR) devices. To achieve adequate spinal growth, optimal lengthening timing is required. Yet, there are no evidence-based guidelines for these intervals. We aimed to evaluate the clinical outcomes concerning the distraction intervals of surgically untreated EOS patients who underwent VEPTR treatment with a minimum 5-year follow-up.
We conducted a multicentered retrospective review of EOS patients managed with VEPTR and grouped them as those patients who underwent lengthening procedures in intervals of ≤8 months throughout 5 years (ie, group 1) and those who were lengthened in intervals >8 months during the same time frame (ie, group 2). The 8-month average interval cutoff was chosen following the findings of Yang and colleagues. We compared demographic variables, radiographic parameters, pulmonary function tests, 24-item Early Onset Scoliosis Questionnaire (EOSQ) findings, and complication rates between both groups.
Our study included 447 patients (158 in group 1 and 289 in group 2) with similar preoperative baseline characteristics. Postoperatively, no statistically significant differences were observed between groups regarding the coronal and sagittal major curve magnitudes, spine height gains (ie, T1-T12, L1-S1, and T1-S1), and the 24-EOSQ results. However, group 1 had a higher postoperative complication rate ( P =0.034) than group 2.
More frequent lengthening intervals were associated with a higher rate of postoperative complications. Further studies are needed to clarify the optimal timing of these intervals among patients with EOS and their association with the outcomes.
Level III-therapeutic retrospective study.
未经治疗的早发性脊柱侧凸（EOS）常伴有胸廓扩张生长受限和肺部并发症。已开发出多种非融合技术来解决这些并发症，包括生长棒和垂直可扩展人工钛肋骨（VEPTR）装置。为实现足够的脊柱生长，需要最佳的延长时机。然而，目前尚无基于证据的这些间隔时间指南。我们旨在评估接受VEPTR治疗且至少随访5年的未经手术治疗的EOS患者延长间隔时间的临床结果。
我们对接受VEPTR治疗的EOS患者进行了多中心回顾性研究，并将他们分为两组，一组是在5年期间延长间隔时间≤8个月的患者（即第1组），另一组是在同一时间段内延长间隔时间>8个月的患者（即第2组）。根据Yang及其同事的研究结果选择了8个月的平均间隔时间截断值。我们比较了两组之间的人口统计学变量、影像学参数、肺功能测试、24项早发性脊柱侧凸问卷（EOSQ）结果和并发症发生率。
我们的研究纳入了447例患者（第1组158例，第2组289例），术前基线特征相似。术后，两组在冠状面和矢状面主弯大小、脊柱高度增加（即T1-T12、L1-S1和T1-S1）以及24-EOSQ结果方面均未观察到统计学上的显著差异。然而，第1组的术后并发症发生率高于第2组（P = 0.034）。
更频繁的延长间隔时间与更高的术后并发症发生率相关。需要进一步研究来阐明EOS患者这些间隔时间的最佳时机及其与结果的关联。
III级治疗性回顾性研究。
