General Session: Pediatric Spine - Hall F

Presented by: J.F. Schulz

Author(s):

J.A. Gomez(1), J.F. Schulz(1), O. Kubat(2), J. Hurry(3), A. Soroceanu(4), T. Flynn(5), M. Tovar(1), R. Hanstein(1), V. Lafage(6), F. Schwab(6), J. Smith(7), D. Skaggs(8), R. El-Hawary(3), CSSG & GSSG

(1) Children's Hospital at Montefiore Medical Center, Orthopaedic Surgery, Bronx, NY, United States
(2) University of Zagreb, Zagreb, Croatia
(3) IWK Health Centre, Halifax, NS, Canada
(4) University of Calgary, Calgary, AB, Canada
(5) Children's Spine Study Group, Valley Forge, PA, United States
(6) Hospital for Special Surgery, New York City, NY, United States
(7) University of Utah, Salt Lake City, UT, United States
(8) Children's Hospital of Los Angeles, Los Angeles, CA, United States

Abstract

Introduction: The purpose of this study is to determine if spinopelvic parameters affect HRQoL in patients with EOS.

Methods: 75 children from 2 EOS registries, treated with rib (52) and spine (23)- based distraction implants at a mean age of 5.4 years were evaluated with EOS 24-Item Questionnaire (EOSQ-24) and radiographs at a mean follow-up of 4.5 years. Spinopelvic parameters were measured on AP and lateral radiographs. For HRQoL domains - General Health, Pain/Discomfort, Pulmonary Function, Transfer, Physical Function, Daily Living, Fatigue, Emotion, Parental Impact, Satisfaction - scores≥80 were considered good outcomes, scores< 80 poor. Scores were compared using unpaired t-test, risk ratios were calculated and analyzed using chi squared testing.

Results: Etiologies included 32 congenital, 20 idiopathic, 18 syndromic, 4 neuromuscular, and 1 unknown. Pre-operatively, the major curve was 69o, thoracic kyphosis (TK) 40o, lumbar lordosis (LL) 51o, pelvic incidence (PI) 48o, and pelvic tilt (PT) 11o. At final follow-up, the major curve corrected to 55o, TK was 42o, LL 53o, PI 53o and PT 15o. Etiology affected General Health (p=0.007) as outcomes were poor in 56% of syndromic and 50% of neuromuscular patients as compared to 25% of idiopathic and 9% of congenital patients. A post-operative PI-LL mismatch of > ±20o increased the risk for poor outcomes (scores < 80) in the following HRQoL domains: Fatigue (RR: 2.29, CI: 1.23-4.24, p=0.01), Pain (RR: 1.70, CI: 1.07-2.71, p=0.04), Daily Living (RR: 2.37, CI: 1.17-4.82, p=0.02), Parental Impact (RR: 1.94, CI: 1.14-3.31, p=0.002) and Emotion (RR: 1.82, CI: 1.03-3.22, p=0.05). Post-operative LL>70o increased the risk for high Family Burden (RR: 1.88, CI: 1.17-2.87, p=0.05) and post-operative PI>60o negatively impacted Transfer (RR: 1.76, CI: 1.24-13.25, p=0.008). In contrast, pre- and post-operative TK >40o decreased the risk for low Pulmonary Function (pre-op: RR: 0.202, CI: 0.05- 0.84, p=0.009; post-op RR: 0.313, CI: 0.10- 1.03, p=0.018). HRQoL was not affected by PT>30o, implant type or fusion to pelvis.

Conclusions: For children with early onset scoliosis, post-op PI-LL mismatch or more than ±20o poses the greatest risk for low HRQoL.