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Influence of Paraspinal Growth-Friendly Spinal Implants in Children with Spinal Muscular Atrophy on Parasol
Julia Austein1, Friederike Austein2, Katja A Lüders1
1Pediatric Orthopaedics; Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Göttingen, Göttingen, Germany.
Insights
Growth-friendly spinal implants (GFSI) with rib-to-pelvis fixation did not improve spinal deformity, rib-vertebral angles, or lung volumes in children with spinal muscular atrophy (SMA). Parasol deformity continued to progress despite GFSI treatment.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Diseases
- Spinal Surgery
Background:
- Children with spinal muscular atrophy (SMA) and progressive neuromuscular scoliosis often require spinal implant treatment.
- Growth-friendly spinal implants (GFSI) with rib-to-pelvis fixation are used for deformity correction.
- This fixation method was hypothesized to improve parasol deformity and thoracic/lung volumes.
Purpose of the Study:
- To analyze the effect of GFSI with bilateral rib-to-pelvis fixation on parasol deformity, rib-vertebral angle (RVA), thoracic, and lung volumes in SMA children.
Main Methods:
- Retrospective analysis of SMA children with (n=19) and without (n=18) GFSI treatment.
- Radiographs measured scoliosis, kyphosis, parasol deformity, and RVA.
- CT scans reconstructed thoracic and lung volumes.
Main Results:
- Convex RVA was consistently smaller than concave RVA in all SMA children.
- GFSI did not significantly influence RVA, thoracic, or lung volumes over a 4.6-year follow-up.
- Parasol deformity progressed over time, irrespective of GFSI treatment.
Conclusions:
- GFSI with rib-to-pelvis fixation did not positively impact parasol deformity, RVA, or thoracic/lung volumes in SMA children.
- The study did not support the hypothesis that this GFSI approach benefits these parameters.
- Further research may be needed to explore alternative treatments for spinal deformity in SMA.
Introduction:
Children with spinal muscular atrophy (SMA) and progressive neuromuscular scoliosis often require early growth-friendly spinal implant (GFSI) treatment for deformity correction with implant fixation either through pedicle screws or bilateral to the spine using ribto pelvis fixation. It has been proposed that the latter fixation may change the collapsing parasol deformity via changes in the rib-vertebral angle (RVA) with a positive effect on thoracic and lung volume. The purpose of this study was to analyze the effect of paraspinal GFSI with bilateral rib-to-pelvis fixation on the parasol deformity, RVA, thoracic, and lung volumes.
Methods:
SMA children with (n = 19) and without (n = 18) GFSI treatment were included. Last follow-up was before definite spinal fusion at puberty. Scoliosis and kyphosis angles, parasol deformity, and index, as well as convex and concave RVA, were measured on radiographs, whereas computed tomography images were used to reconstruct thoracic and lung volumes.
Results:
In all SMA children (n = 37; with or without GFSI), convex RVA was smaller than concave values at all times. GFSI did not crucially influence the RVA over the 4.6-year follow-up period. Comparing age- and disease-matched adolescents with and without prior GFSI, no effect of GFSI treatment could be detected on either RVA, thoracic, or lung volumes. Parasol deformity progressed over time despite GFSI.
Conclusion:
Despite different expectations, implantation of GFSI with bilateral rib-to-pelvis fixation did not positively influence parasol deformity, RVA and/or thoracic, and lung volumes in SMA children with spinal deformity directly and over time.
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