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ICEOS 2016 Pelvic obliquity correction in distraction based growing spine constructs Mathew Schur BA1, Lindsay M Andras MD1, Nicholas R Gonsalves MD1,

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Presentation on theme: "ICEOS 2016 Pelvic obliquity correction in distraction based growing spine constructs Mathew Schur BA1, Lindsay M Andras MD1, Nicholas R Gonsalves MD1,"— Presentation transcript:

1 ICEOS 2016 Pelvic obliquity correction in distraction based growing spine constructs Mathew Schur BA1, Lindsay M Andras MD1, Nicholas R Gonsalves MD1, Paul D Sponseller MD MBA2, John B Emans MD3, Michael G Vitale MD MPH4, David L Skaggs MD MMM1, Growing Spine Study Group, Children’s Spine Study Group 1.Children's Orthopaedic Center, Children's Hospital Los Angeles; 2.Department of Orthopaedic Surgery, Johns Hopkins Children’s Hospital, Johns Hopkins University; 3.Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School; 4. Department of Orthopaedic Surgery , New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Medical Center

2 Disclosures Mathew Schur BA – None
Grants/Research Support Consultant Stock/Shareholder Speakers’ Bureau Other Financial Support Board/Committee member Mathew Schur BA – None Lindsay M. Andras MD – Eli Lilly (c); Biomet & Medtronic (d); SRS, POSNA, JPO (e); Orthobullets (f); Nicholas R. Gonsalves MD - None Paul D. Sponseller MD, MBA –DePuy (a, b, f); Globus Medical (f); Journal of Bone and Joint Surgery (e); Journal of Bone and Joint Surgery Oakstone Medical (f); SRS (e) John Emans MD – Journal of Children’s Orthopedics (e); Medtronic (b); Synthes (b, f) Michael G Vitale MD, MPH – Biomet (a, b & e); Children’s Spine Foundation (a & f); DePuy, A Johnson & Johnson Company (e); FOX, Children’s Spine Foundation (e); IPOS (f); Medtronic (e); OMEGA (e); OREF (a); POSNA (a & f); SRS (a); OSRF (a); Stryker (b); Synthes (e); Wellinks (b) David L. Skaggs MD MMM – Ellipse, POSNA (a), GSSG & GSF (e); SRS (a, e); ZimmerBiomet (b, d, e); Medtronic (b, d, e); Zipline Medical, Inc. (b, c); Orthobullets (b, c); Grand Rounds (b); Green Sun Medical (b, c); Johnson & Johnson (d); Wolters Kluwer Health - Lippincott Williams & Wilkins; Biomet Spine (e)

3 Background The use of pelvic fixation in growing spine constructs allows for improvement of the significant pelvic obliquity that can occur in patients with early-onset scoliosis (EOS) Multiple options exist to provide this fixation and little comparative data is available

4 (Iliac screws/Sacral Alar Iliac Screws)
Objective To determine if there is a difference in the correction of pelvic obliquity by different types of pelvic fixation Screw group (Iliac screws/Sacral Alar Iliac Screws) S Hooks

5 Methods Neuromuscular, syndromic, and congenital EOS patients treated with distraction based implants with pelvic fixation from 1990 to 2013 were reviewed from two EOS multicenter databases Patients were divided into groups by type of pelvic fixation: Screw group (SAI/Iliac screw) vs S hook group Patients with less than 2 year follow-up or index instrumentation at ≥ 10 years of age were excluded Statistical significance analyzed via t-test

6 154 patients met the inclusion criteria:
Results 154 patients met the inclusion criteria: Screw group=41 patients (Iliac screws=29;Sacral-alar-iliac (SAI) screws=12) S hook fixation=113 patients

7 Results Better Pelvic obliquity correction observed
in the screw group than the S hook group Type of pelvic fixation Mean preoperative pelvic obliquity (degrees) Mean postoperative pelvic obliquity (degrees) Mean pelvic obliquity correction (degrees) Percent correction (%) P-value Iliac/SAI screws 34.2 ± 11.9 8.2 ± 5.7 26.1 ± 11.9 74 0.039* S hooks 31.3 ± 9.2 14.0 ± 9.5 17.3 ± 9.2 57

8 No difference in change in T1-S1 or Cobb correction
Type of pelvic fixation Mean preoperative T1-S1 length (mm) Mean postoperative T1-S1 length (mm) Mean T1-S1 length change (mm) P-value Iliac/SAI screws 261.4 301.8 40.4 0.90 S hooks 238.3 277.8 39.5 Type of pelvic fixation Mean preoperative Cobb angle (degrees) Mean postoperative Cobb angle (degrees) Mean Cobb angle correction (degrees) Percent correction (%) P-value Iliac/SAI screws 80.9 49.6 31.2 33% 0.13 S hooks 72.7 48.6 24.1 31%

9 Results A trend toward more complications observed in S hook group than screw group but this did not reach statistical significance Type of pelvic fixation Complications P-value Iliac/SAI screws 14.6% (6/41) 0.21 S hooks 25.7% (29/113)

10 Discussion Screws (iliac/SAI screws) achieved better correction of pelvic obliquity than S hooks (p= 0.039) No difference was found in the increase in T1-S1 length (p=0.90) or Cobb angle correction (p=0.13) between the groups Rate of complications for the S hook group was greater than the screw group, although not statistically significant

11 Conclusion In distraction based growing spine constructs, pelvic fixation with screws achieved better correction of pelvic obliquity than S hooks

12 References Moe JH, Kharrat K, Winter RB, et al. Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res 1984;185:35–45. Akbarnia BA, Breakwell LM, Marks DS, et al. Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 2008;33:984–90. Muharrem Y, and Olgun ZD. Growing rod concepts: state of the art. Eur Spine J. March 2013; 22(Suppl 2): Sponseller P, Yang, JS, Thompson GH, McCarthy RE, Emans JB, Skaggs DL, Asher MA, Yazici M, Poe-Kochert C, Kostial P, Akbarnia BA. Pelvic fixation of growing rods: Comparison of constructs. Spine. July ; 34(16): Brooks JT, Jain A, Perez-Grueso FS, Skaggs D, Thompson GH, Akbarnia BA, Sponseller PD. Paper #35: Pelvic anchor outcomes in growing rod constructs: An analysis of patients with a minimum of 4 years of postoperative follow-up. Spine Deformity. November 2014; 2(6): 512. Protopsaltis T, Schwab F, Bronsard N, Smith JS, Klineberg E, Mundis G, Ryan DJ, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage V. The T1 Pelvic Angle, a Novel Radiographic Measure of Global Sagittal Deformity, Accounts for Both Spinal Inclination and Pelvic Tilt and Correlates with Health-Related Quality of Life. J Bone Joint Surg Am. October ; 96(19): Thompson GH, Akbarnia BA, Campbell Jr. RM. Growing rod techniques in early-onset scoliosis. Journal of Pediatric Orthopaedics. April/May 2007; 27(3):

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