Transcript Andrew Thome - School of Medicine

The Safety and Effectiveness of Convex Anterior and Posterior
Hemiepiphysiodesis for the Treatment of Congenital Scoliosis
Andrew Thome, Jr.1, Roshan Melvani1, Julia Leamon2, Nigel Price1,2
1UMKC School of Medicine; 2Children’s Mercy Hospital
Introduction
Results
Conclusion
Study Design.
• Retrospective Chart Review.
Objective.
• To assess the long-term outcomes and safety of
convex anterior and posterior (ant/post)
hemiepiphysiodesis for the treatment of congenital
scoliosis.
Summary of Background Data.
• Approximately one in 10,000 individuals is affected by
congenital scoliosis, with rates higher in females than
males1.
• The goal of the convex ant/post hemiepiphysiodesis
procedure is to arrest growth on the convex aspect of
the spine so that with continued growth on the concave
aspect of the spine, correction of the abnormal
curvature may occur1.
• Although studies have demonstrated the safety and
short-term effectiveness of ant/post
hemiepiphysiodesis for the treatment of congenital
scoliosis, there have been few studies based on long
term follow up data greater than ten years3.
• We hypothesize that convex ant/post
hemiepiphysiodesis remains an effective, safe
procedure in settings where more complex
hemivertebrectomies cannot be performed due to cost,
insufficient access to spinal cord monitoring equipment,
or lack of advanced surgical training.
• In our study, we had a mean follow up time of 12.1 years(time
from surgery to last follow up x-ray) (range of 10.5-13.1 years).
• The mean pre-operative Cobb angle measurement was 37.2
degrees (range 20-50 degrees) with a mean age at time of
surgery of 1.5 years old (range 0.9-2.4 years).
• Most recent follow-up Cobb angle measurements were noted
to have a mean of 27.7 degrees (range 9-51 degrees).
• Cobb angle improved in 6 out of 7 patients with an average
improvement of 7.4 degrees (range -19-28 degrees).
• Mean estimated blood loss was 107mL (range 10-215mL) and
mean length of surgery was 5.4 hours (range 3.8-6.9 hours).
• No patients required a second operation. One complication of
a pneumothorax was noted in one patient. However, no other
patients suffered any post-surgical complications.
• Our study suggests that convex anterior and
posterior hemiepiphysiodesis is a safe, effective
procedure with promising long-term results.
• Though there are newer alternative procedures
available for the treatment of congenital
scoliosis, convex ant/post hemiepiphysiodesis
remains a safe and effective alternative in
settings where access to newer technologies
and expertise to perform a more complex
hemivertebrectomy with instrumentation may
not be available.
References
Figure 2. Subject 4 pre-op
X-ray at 10 months of age
with a 50 degree curve
Figure 3. Subject 4 post-op X-ray at
13 years of age with a 22 degree
curve
1.
2.
3.
4.
Methods
• Seven patients(5 females, 2 males aged 0.9-2.4 years
old) who underwent convex ant/post
hemiepiphysiodesis for the treatment of congenital
scoliosis were selected for review. Patient charts and
relevant imaging studies were reviewed.
• Main outcome measures were Cobb angles(degrees)
from pre-operative x-ray and most recent follow up xray as of 01/01/14. These angles constituted the
segmental main curves. Cobb angles were measured
by NP.
• All surgical interventions were performed by a single
orthopaedic spine surgeon, NP.
Study Limitations.
• Small number of patients in the study and a lack
of a control group for comparison with other
procedures.
Figure 1. Pre-op Cobb angle comparison with most
recent follow up Cobb angle measurement
http://orthoinfo.aaos.org/topic.cfm?topic=A00576. Last accessed 2/20/14
Ginsbury G et al. Transpedicular hemeipiphysiodesis and posterior
instrumentation as a treatment for congenital scoliosis. J Pediatric
Orthopaedics.2007;27:387-91.
Thompson AG et al. Long-term results of combined anterior and posterior
convex hemiepiphysiodesis for congenital scoliosis due to hemivertebrae.
Spine. 1995;20:1380-5.
Winter RB et al. Convex growth arrest for progressive congenital scoliosis
due to hemivertebrae. J Pediatric Orthopaedics. 1998;8:633-8.
Subject
No.
Case
Description
Pre-Op Cobb
Angle (degrees)
Post-Op Cobb
Angle (degrees)
Age at Surgery
(Years, months)
Follow Up
Time (years)
1
L L2 hemivertebrae
30
23
1,11
12.1
2
L T8 hemivertebrae
20
9
1,6
12.0
3
L T5, T11 hemivertebrae
48
40
1,7
12.6
4
R T7, T9-10 hemivertebrae
50
22
1,3
13.1
5
T8-10 Bar, T9, T11 hemivertebrae
47.5
37
0,11
12.3
6
R L2 hemivertebrae
35
27
2,5
10.6
7
R T5, L T9-10 hemivertebrae
32
51
1,3
11.7