Final Fusion in Patients Treated with Rib Based

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

Disclosures John A. Heflin – paid consultant for Globus Spine, Medtronic § John T. Smith – paid consultant for Globus Spine, Depuy Synthes Spine, Spine. Guard, 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 •

Study Methods § § § 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

Data collection § 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

Results 27 patients Average Range Age at initial implant (yrs. ) Age at fusion (yrs. ) Lengthenings Total surgical procedures Fusion data: EBL (cc) 7. 45 13. 51 10. 5 13. 35 534 1. 78 – 11. 78 9. 21 – 18. 51 0 -18 3 - 21 Surgical time (min. ) Osteotomies Complications Repeat procedures Pre-fusion Cobb Pre-fusion Kyphosis Post-fusion Cobb Post-fusion Kyphosis 256 115 - 520 11 total 12 total 9 total 40 - 107 8 - 113 32 - 82 20 - 85 67. 42 61. 08 50. 17 50. 00 180 - 1280

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

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