Michael Vitale (Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, Morgan Stanley Children’s Hospital of New York-Presbyterian, New York, USA) told IMAST delegates that the results of a retrospective review showed that patients with a non-idiopathic form of early onset scoliosis have more frequent and more severe complications than patients with idiopathic scoliosis.
Vitale reported that the classification of early onset scoliosis system was developed, alongside other initiatives, to improve the evidence base for early onset scoliosis. He explained that the purpose of the system was to: “Predict the disease course of individual patients, prognosticate and determine beneficiaries of differing treatment modalities, and improve communication among early onset scoliosis providers and facilitate research”.
The system categorises patients into four different aetiologies: congenital/structural, neuromuscular, syndromic, and idiopathic. According to Vitale, it has already been shown to predict the timing of vertical expandable prosthetic titanium rib anchor failure. The aim of the present study was to further validate the prognostic value of the classification of early onset scoliosis by “examining the rate and severity of complications in surgical early onset scoliosis patients.”
Vitale et al conducted a retrospective review of two databases; patients were included in the review if they had early onset scoliosis and had been followed-up for a minimum of five years after their index surgery. The outcome measures were the rate and severity of standardised complications. Vitale explained that complications were divided into grades: 1—resolved; 2a—one unplanned trip to the operating room; 2b—multiple unplanned trips to the operating room; and 3—change in outcome.
Overall, 67% of patients (52 of 78) had some form of complication during the first five years after their index procedure (18% had grade 1, 24% had grade 2a, 4% had grade 2b, and 18% had grade 3). Vitale said: “The most frequent complication was hardware failure that was corrected at the next planned surgery (21.4%), followed by surgical site infection requiring surgery (19.1%).” He added: “Aetiology alone did not predict the rate of complications, nor did kyphosis alone. However, when we grouped these classifications together, there were some interesting findings—severe complications occur in patients with a large Cobb angle and in hyperkyphotic patients.” Furthermore, Vitale et al found that non-idiopathic patients “experience more and more significant complications” than idiopathic patients.
The presenter concluded: “Classification of early onset scoliosis can predict frequency and severity of complications.”
Vitale told Spinal News International: “Once we are able to better predict which patients are at specific risk of complications, we will be better able to specifically target appropriate care. For example, if we understand that certain patients are at much higher risk of hardware failure, as the classification of early onset scoliosis system seems to predict, we would treat that patient group with alternate spinal fixation systems—perhaps a higher density of proximal implants— to better customise care to the patient”.