Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs

Spine Deform. 2019 Jan;7(1):152-157. doi: 10.1016/j.jspd.2018.05.011.

Abstract

Study design: Retrospective review of prospectively collected data.

Objective: To compare the use of spine-based versus rib-based implants for the treatment of early-onset scoliosis (EOS) in the setting of rib fusions.

Summary of background data: Treatment for severe early-onset spinal deformity with rib fusions includes growing spine devices with proximal rib or spine anchors. The results of treatment, however, have not been compared between spine-based versus rib-based proximal anchors.

Methods: 169 patients with rib fusions treated with rib-based or spine-based constructs and minimum two-year follow-up were included. Sixteen patients were treated with proximal spine-based anchors and 153 with proximal rib-based devices (VEPTRs). Overall, 104 of the patients with rib-based fixation underwent thoracoplasty at the index surgery. We evaluated change in T1-T12 and T1-S1 height, coronal Cobb angle, kyphosis, and number of lengthening/revision surgeries.

Results: Kyphosis increased a mean of 7° in the rib-based group and decreased a mean of 20 degrees in the spine-based group (p = .002). Major Cobb angle decreased in both groups (p < .0001); however, the spine-based group had greater Cobb angle improvement (24 vs. 11 degrees, p = .04). From implant and lengthening of distraction devices, there was a mean 3.3-cm (22%) increase in T1-T12 height and a mean of 8.0 lengthenings in the rib-based group compared with a 5.7-cm increase and 6.3 lengthening surgeries in the spine-based group. Patients with rib-based constructs had a mean of 11 total procedures, whereas spine-based patients had a mean of 8.

Conclusions: Patients underwent a mean of eight lengthening surgeries before final fusion or cessation of lengthening with a modest 2.3-cm increase in T1-T12 height. Compared with proximal rib anchors, proximal spine anchors controlled kyphosis and improved Cobb angle correction for early-onset scoliosis with rib fusions.

Keywords: Chest wall; Deformity; Early-onset scoliosis; Growing spine; Rib; Spine; Thoracic; VEPTR.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Age of Onset
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Prospective Studies
  • Prosthesis Design
  • Retrospective Studies
  • Ribs / surgery*
  • Scoliosis / complications
  • Scoliosis / surgery*
  • Spinal Fusion / instrumentation*
  • Spinal Fusion / methods
  • Spine / abnormalities
  • Spine / surgery*
  • Suture Anchors*
  • Thoracic Diseases / complications
  • Thoracic Diseases / surgery*
  • Thoracic Vertebrae / surgery
  • Thoracoplasty / instrumentation
  • Thoracoplasty / methods
  • Treatment Outcome