Long-Term Radiographic and Pulmonary Function Outcomes After Dual Growing-Rod Treatment for Severe Early-Onset Scoliosis

"Cured" patients with early-onset idiopathic scoliosis after serial casting are at risk of recurrence at intermediate follow-up

PURPOSE

Serial casting limits curve progression while preserving spinal growth, delaying or even eliminating the need for surgery. Some patients with EOIS can be "cured" with curve reduction under 15°. However, no long-term studies have defined whether "cured" patients maintain small curves or if they are at risk of progression. We examined if casting patients remained "cured" following treatment.

METHODS

We identified 40 EOIS patients who were treated with serial casting, achieved curves under 15° and had minimum 2 years of follow-up after completing the treatment. Failure was defined as an increase > 6° resulting in a curve magnitude > 15° at any point during follow-up, requiring cast/brace treatment after cessation of initial cast/brace, or undergoing surgery. Average curve magnitude at the time of cure was 11.1°. Kaplan-Meier survival analysis was used to identify failure rates over time.

RESULTS

10 patients (25.0%) met criteria for failure. Mean time from cure to last follow-up was 4.3 years. 3 patients (7.5%) completed bracing and were later re-braced while 2 (5.0%) required surgery. Mean curve magnitude of "failed" patients was 27.4° with an average increase of 15.6°. At 5.1 years, probability of successful treatment is 64.2%. For "failed" patients, median time to failure was 2.4 years. Successful patients were braced for median 1.4 years, while "failed" patients had a median of 1 year.

CONCLUSION

While EOIS patients may be "cured" with serial casting, this may not be sustained. The percentage of "failures" likely will increase with longer follow-up through skeletal maturity, and patients must be closely monitored after concluding casting/bracing.

The Effect of Comprehensive Spinal Correction Rehabilitation in Children With Early-Onset Idiopathic Scoliosis: A Clinical Controlled Trial

Study DesignSingle-blind, prospective controlled trial.ObjectiveWhile physiotherapy scoliosis-specific exercise improves spinal deformities in mild adolescent idiopathic scoliosis, evidence for early-onset idiopathic scoliosis (EOIS) is limited. This study proposed comprehensive spinal correction rehabilitation (CSCR) and evaluated its efficacy in EOIS.Methods44 EOIS patients aged 7-10 years were divided into 2 groups matching for age and gender. The interventional group (n = 22) underwent CSCR, and the control group (n = 22) was followed up for observation. Bracing was added if the patients' Cobb angle reached 25° and above. All enrolled patients were evaluated at the initial visit and after the 6-month intervention, including baseline condition, the major curve Cobb angle, lung function, balance function, and quality of life, respectively.ResultsAfter the intervention, the amount of change in the main curve Cobb angle, forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) (△Cobb angle, △FVC, △FEV1) in the intervention group increased significantly compared with the control group (P = .001, P = .001, P = .002); in the intervention group, the main curve Cobb angle decreased, and FVC and FEV1 increased significantly after the intervention (P = .001 P = .007, P = .003), but there was no significant difference compared with the control group; and the difference in balance function and quality of life between the 2 groups after the intervention was also not significant (all P > .01).ConclusionCSCR could effectively improve the spinal deformity of patients with EOIS and simultaneously increase their lung function.

Validation of the Korean Version of the 24-Item Early-Onset Scoliosis Questionnaire: A Multicenter Study from the Korean Research Society of Spinal Deformity

Background

A 24-item early-onset scoliosis questionnaire (EOSQ-24) has been developed as a valid tool for assessing the physical and emotional function of patients with early-onset scoliosis (EOS). Previous studies that conducted transcultural adaptation of the original EOSQ-24 into other languages have demonstrated the high reliability of the questionnaire. However, a Korean version of the EOSQ-24 is not available, limiting optimal patient assessment in this nation. Therefore, this study was conducted to develop and validate a Korean version of EOSQ-24.

Methods

The original English version of the EOSQ-24 was cross-culturally adapted following standard guidelines. The final version of the Korean EOSQ-24 was prospectively applied to a group of patients who were native Korean speakers. Internal consistency was evaluated using the Cronbach α coefficient and item-total correlations. The mean, standard deviation, floor effect, and ceiling effect of each item were also assessed.

Results

A total of 102 caregivers of patients with EOS (45 males and 57 females) completed the Korean EOSQ-24. The patients' average age was 6.39 ± 2.16 years. The Cronbach α coefficient for the 24-item scale was 0.942, indicating excellent reliability. The corrected item-total correlation coefficients ranged between 0.449 and 0.788. The mean value of the EOSQ-24 questionnaire was 3.19. Floor and ceiling effects for all questionnaires were below 30%, which could be considered acceptable.

Conclusions

Our study successfully developed and validated the Korean version of the EOSQ-24, providing a reliable instrument for assessing the physical and emotional well-being of patients with EOS and their caregivers in the Korean context. The widespread adoption of the Korean EOSQ-24 in clinical practice and research settings can enhance the quality of care and improve outcomes for individuals affected by EOS in Korea.

Comprehensive spinal correction rehabilitation (CSCR) study: a randomised controlled trial to investigate the effectiveness of CSCR in children with early-onset idiopathic scoliosis on spinal deformity, somatic appearance, functional status and quality of life in Shanghai, China

INTRODUCTION

Presently, the physiotherapy scoliosis-specific exercise recommended by the International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment guidelines is primarily advised for adolescents with scoliosis, and there is a lack of individualised and precise exercise therapy for children with early-onset idiopathic scoliosis (EOIS), whose bodies are in the nascent stages of development. Therefore, this study aims to investigate the efficacy of comprehensive spinal correction rehabilitation in treating EOIS.

METHODS AND ANALYSIS

This study will be designed as a randomised controlled trial, and the subjects participating in the study will consist of 122 EOIS patients between the ages of 7-10 years. Subjects will be randomly assigned to an experimental group (n=61) and a control group (n=61). Both groups will be treated for 6 months, with the experimental group receiving comprehensive spinal correction rehabilitation (including specific exercise therapy, balance and stability training, breathing training, strength training, home-based exercise and bracing) and the control group receiving core stability training. Enrolled subjects will be evaluated at the initial visit and after 6 months of treatment, and data will be processed and analysed after collecting data from both evaluations. The primary outcome index is the major curvature Cobb angle, and the secondary outcome indices are the angle of trunk rotation, plumb line distance, the Trunk Aesthetic Clinical Evaluation index, forced vital capacity and the Scoliosis Research Society-22 questionnaire.

ETHICS AND DISSEMINATION

The current study received ethical approval from the Xinhua Hospital Ethics Committee Affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2023-108-3). Written informed consent will be obtained from all participants and their guardians. Any interim analyses and full results will be published in an international peer-reviewed journal.

TRIAL REGISTRATION NUMBER

The study protocol was registered at www.

CLINICAL TRIALS

gov (number identifier: ChiCTR2300078359).

A multicenter evaluation of the time and travel burden on families with children treated for early-onset scoliosis

PURPOSE

Patients who undergo growth-friendly (GF) treatment for early-onset scoliosis (EOS) undergo multiple clinical and surgical encounters. We sought to quantify the associated temporal and travel burden and estimate subsequent cost.

METHODS

Four centers in an international study group combined data on EOS patients who underwent surgical GF treatment from 2006 to 2021. Data collected included demographics, scoliosis etiology, GF implant, encounter type, and driving distance. We applied 2022 IRS and BLS data or $0.625/mile and $208.2/day off work to calculate a relative financial burden.

RESULTS

A total of 300 patients were analyzed (55% female). Etiologies were: congenital (33.3%), idiopathic (18.7%), neuromuscular (30.7%), and syndromic (17.3%). The average age at the index procedure was 5.5 years. For the 300 patients, 5899 encounters were recorded (average 18 encounters/patient). Aggregate encounter types were 2521 clinical office encounters (43%), 2045 surgical lengthening encounters (35%), 1157 magnetic lengthening encounters (20%), 149 spinal fusions (3%), and 27 spinal fusion revisions (0.5%). When comparing patients by scoliosis etiology or by GF implant type, no significant differences were noted in the total number of encounters or average travel distance. Patients traveled a median round trip distance of 158 miles/encounter between their homes and treating institutions (range 2.4-5654 miles), with a cumulative median distance of 2651 miles for the entirety of their treatment (range 29-90,552 miles), at an estimated median cost of $1656.63. The mean number of days off work was 18 (range 3-75), with an associated loss of $3643.50 in income.

CONCLUSION

Patients with EOS averaged 18 encounters for GF surgical treatment. These patients and their families traveled a median distance of 158 miles/encounter, with an estimated combined mileage and loss of income of $5300.

Optimal timing of starting growing rod treatment for early-onset scoliosis

BACKGROUND CONTEXT

Growing rod (GR) systems require periodical surgical intervention and may cause associated complications, as well as worsened sagittal plane deformity. Generally, the risk of complications decreases with an increment in age at the time of the index surgery with GR construct placement. However, the optimal timing to begin GR treatment has not reached a consensus yet.

PURPOSE

This study was performed to investigate the effect of age at the index GR surgery on the complication rates and formulate clinical guidelines for the optimal timing to begin GR treatment for EOS patients.

STUDY DESIGN

Kaplan-Meier analysis was used to determine complication occurrence as a function of the age at the index surgery and to determine the survival rates for the procedures. The receiver operator characteristic (ROC) curve was used to determine optimal cut-off values for the optimal timing of index surgery based on whether complications occurred or not.

PATIENT SAMPLE

54 patients who met the criteria were enrolled in this study.

OUTCOME MEASURES

The following spinal parameters were measured: major coronal Cobb angle, global kyphosis (GK), and coronal balance (CB). CB was defined as the horizontal distance from the C7 plumb line to the center sacral vertical line.

METHODS

All patients had completed GR treatment and had a minimum 1-year follow-up duration after the final surgical intervention. Patient data were collected as follows: age at the index surgery, gender, diagnosis, type of GR construct, and the number of lengthening procedures. The standing full-spine radiographs were obtained before and after the index surgery, before and after each lengthening procedure, before and after the final surgical intervention, and at the latest follow-up. Complications were categorized as implant, alignment, and general.

RESULTS

Kaplan-Meier analysis of complications demonstrated a declining trend in complication rates with increasing age at the index surgery. The absence of perioperative complications was targeted, we constructed the ROC curve and the cut-off value was 71.0 months. Age at the index surgery was therefore categorized into two groups: younger-age group (≤ 71.0 months) and advanced-age group (> 71.0 months). There was a higher complication rate for the younger-age group than versus the advanced-age group (61.5% vs 22.0%, p=.011). PJK as a major alignment-related complication, was more frequent in the younger-age group than in the advanced-age group (30.8% vs 4.9%, p=.025). But the advanced-age group exhibited significantly more severe deformities before GR surgery compared to the younger-age group.

CONCLUSIONS

This study shows that the elevated risk of complications observed in the younger-age group, which can be attributed to the younger age at the index surgery and the increased number of lengthening procedures during treatment. We suggest deferring the initiation of GR treatment until after the age of six years for EOS patients. We hope it will serve as a basis for GR technique in the treatment of EOS, with the ultimate goal of enhancing treatment outcomes for this challenging disorder.

Dual Growing Rods and the Apical Control Technique for Treating Congenital Early-Onset Scoliosis: Lessons Learned

BACKGROUND

Congenital early-onset scoliosis (CEOS) is characterized by a spectrum of vertebral anomalies, including formation failures and segmentation failures at the apex segment, which makes CEOS different from other etiologies of early-onset scoliosis. To date, studies on patients who have graduated from CEOS treatment using traditional dual growing rods (TDGR) have been scarce, and the preliminary results of TDGR with or without the apical control technique (ACT) have varied. We therefore compared the final outcomes of patients with CEOS who graduated from TDGR with or without the ACT.

METHODS

A retrospective study of patients with CEOS who had graduated from TDGR treatment performed from 2007 to 2020 was conducted. Graduation included final fusion or observation after reaching skeletal maturity. Patients were divided into the ACT-TDGR group (apical vertebrectomy and/or hemivertebrectomy with short fusion and TDGR) and the TDGR-only group. Demographic characteristics, radiographic data, patient-reported clinical outcomes, pulmonary function, and complications were analyzed.

RESULTS

A total of 41 patients with CEOS were enrolled: 13 in the ACT-TDGR group and 28 in the TDGR-only group. The lengthening intervals were longer in the ACT-TDGR group (mean [and standard deviation], 1.26 ± 0.66 years) than in the TDGR-only group (0.80 ± 0.27 years). The preoperative main curve was larger in the ACT-TDGR group (80.53° ± 19.50°) than in the TDGR-only group (64.11° ± 17.50°). The residual curve was comparable between groups (26.31° ± 12.82° in the ACT-TDGR group compared with 27.76° ± 15.0° in the TDGR group) at the latest follow-up. The changes in apical vertebral rotation and thoracic rotation were significantly larger in the ACT-TDGR group. Patients had comparable T1-12 and T1-S1 heights, pulmonary function, and 22-item Scoliosis Research Society (SRS-22) scores at the latest follow-up. The mean number of mechanical-related complications per patient was lower in the ACT-TDGR group (0.77 ± 0.73) than in the TDGR-only group (1.54 ± 1.43). Seventeen patients underwent final fusion.

CONCLUSIONS

In this small-scale study, we observed that both ACT-TDGR and TDGR-only could correct the deformity while allowing for spinal growth in patients with CEOS. ACT-TDGR yielded better correction in severe cases and did not have a deleterious effect on spinal height. A large number of cases will be needed to validate the clinical value of the ACT.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Early-onset scoliosis

PURPOSE OF REVIEW

The aim of this review is to provide the reader with the most updated available information so that it can be helpful in the approach of patients with early-onset scoliosis (EOS).

RECENT FINDINGS

While confirming the efficacy and safety of classic techniques for the treatment of EOS such as traditional growing rods or Mehta casting, recent research suggests that there is room for improvement with less invasive techniques.

SUMMARY

The most important goal when treating patients with EOS should be to promote rib cage expansion and lung development. Different techniques have been described and may be used depending on the specific patient's characteristics.