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Trends in the Utilization of Implants in Index Procedures for Early Onset Scoliosis From the Pediatric Spine Study
Robert F Murphy1, Garret B Neel1, William R Barfield1
1Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC.
Insights
Patient registries track growth-friendly implants for Early Onset Scoliosis (EOS). Magnetically controlled growing rods (MCGR) now dominate, replacing traditional growing rods (TGR) and vertical expandable prosthetic titanium rib devices (VEPTR).
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Biomedical Engineering
Background:
- Patient registries are crucial for studying rare conditions like Early Onset Scoliosis (EOS).
- Growth-friendly implants are vital for managing EOS, allowing spinal growth in young patients.
- This study analyzes trends in EOS surgical management using the Pediatric Spine Study Group database.
Purpose of the Study:
- To examine the historical trends and usage patterns of growth-friendly devices in index surgical procedures for EOS.
- To identify shifts in implant preferences over time within the Pediatric Spine Study Group registry.
- To compare the utilization of different types of growth-friendly implants in EOS treatment.
Main Methods:
- Data on index growth-friendly implants were extracted from the Pediatric Spine Study Group registry from inception to October 2020.
- Information collected included EOS etiology, device type, and geographic/institutional origin of each procedure.
- Statistical analysis was performed to identify trends and significant changes in implant usage.
Main Results:
- A total of 2786 EOS patients underwent index surgery between 1994 and 2020.
- Magnetically controlled growing rods (MCGR) became the predominant implant type by 2014, surpassing traditional growing rods (TGR) and vertical expandable prosthetic titanium rib devices (VEPTR).
- While overall index implant insertions increased annually until 2018, there was a significant decrease in TGR/VEPTR procedures after 2009 and a notable decline in all growth-friendly procedures in 2019 compared to 2018.
Conclusions:
- The use of growth-friendly implants for initial surgical management of EOS has significantly increased over the past two decades.
- MCGR has emerged as the leading device for index procedures in EOS patients within the study group.
- A recent decline in overall growth-friendly index procedures, particularly in 2019, warrants further investigation.
Introduction:
Because of the relative rarity of Early Onset Scoliosis (EOS) cases, patient registries were developed to combine clinical information from multiple institutions to maximize patient care and outcomes. This study examines the history and trends regarding the use of growth-friendly devices for index surgical procedures in EOS patients within the Pediatric Spine Study Group database.
Methods:
All index growth-friendly implants were queried from registry inception until October 2020. EOS etiology, device/implant type, and geographic area/institution for each procedure were recorded.
Results:
From 1994 to 2020, 2786 patients underwent index surgery at a mean age of 6.2±2.9 years. There were 908 traditional growing rods (TGR) (32.3%), 922 vertical expandable prosthetic titanium rib devices (VEPTR) (33.1%), 5 hybrid VEPTR/TGR (0.18%), and 951 magnetically controlled growing rods (MCGR) (34.2%) index implants. Fifty-six different institutions reported an index implant, and 5 accounted for 823 (30%) of the cases during the study period. Institutions in the Northeast accounted for more index implants than other regions of the United States. There was a 40% increase in index implant insertions annually when comparing 1994 (3 implants/1 center) to 2018 (234 implants/56 centers), ( P <0.001). Beginning in 2009, there was a 90.9% decrease in the number of TGR/VEPTR procedures (2009: 156 implants/32 centers; 2019: 22 implants/49 centers P =0.001), and a 479% increase in MCGR (2009: 1 implant/1 center; 2018: 197 implants/34 centers ( P =0.005). The overall number of growth-friendly index procedures performed in 2019 (150/49 centers) decreased 34.5% when compared to 2018 (234/48 centers).
Conclusion:
The number of growth-friendly implants reported in the Pediatric Spine Study Group registry as the initial surgical management of EOS increased markedly over the past 20 years. MCGR is currently the predominant type of device utilized for index surgical procedures by group members, surpassing the use of VEPTR and TGR in 2014. There was a significant decrease in index growth-friendly procedures in 2019 compared to 2018.
Level Of Evidence:
Level IV.
