Surgeon Experience Does Not Change Rate of Perioperative Surgical Complication in Rib-Based Distraction Surgery for Early-Onset Scoliosis.

OBJECTIVE: To report on the surgical learning curve in treating early-onset scoliosis with rib-based distraction. SUMMARY OF BACKGROUND DATA: The idea of a surgical learning curve proposes improved outcomes with experience. Early-onset scoliosis (EOS) is a challenging condition to treat and complication rates are high. METHODS: All patients from a single experienced spine surgeon's practice who had undergone placement of rib-based distraction constructs between 2002 and 2013 were identified. A retrospective chart review was performed to determine patient characteristics at implantation and follow-up surgeries and complications. The primary outcome was complication rate per surgical encounter. Experience was analyzed both by number of surgical procedures and year in study period. RESULTS: The surgeon began using rib-based distraction in 2002, and between 2002 and 2013, a total of 101 patients underwent 1,009 implantation or expansion surgeries involving rib-based distraction at a median age of 6 years at implantation (10 months-9.4 years). The median preoperative Cobb angle was 67° (8°-125°; IQR: 57°-76°) and follow-up was a median of 4.4 years (IQR 3.7-5.6 years). Overall, 65.3% of patients experienced complications, including 40 Grade I, 20 Grade II, 126 Grade IIA, and 3 Grade III. Univariate analysis identified a trend toward cumulative number of surgeries relating to a decreased complication rate, with every 50 surgeries decreasing the complication rate by 3% (p = .071). However, multivariate analysis found cumulative number of surgeries and complication rate to not be significantly related (p = .12). Surgeon experience as measured by study time (as both a continuous and categorical predictor) did not achieve statistical significance in either the univariate or multivariate models. CONCLUSION: This is the largest single-surgeon series of EOS patients treated with rib-based distraction. Surgeon experience defined either as number of procedures or years of experience within the study period did not impact the rate of complications.

Use of Rib-Based Distraction in the Treatment of Early-Onset Scoliosis Associated With Neurofibromatosis Type 1 in the Young Child.

STUDY DESIGN: This study was an institutional review board-approved retrospective review of a prospectively collected multicenter database for rib-based distraction systems used in the treatment of young children with early-onset scoliosis associated with neurofibromatosis type 1 (NF-1). OBJECTIVE: To evaluate the effectiveness of rib-based distraction and associated complications in managing scoliosis in the growing child with NF-1. SUMMARY OF BACKGROUND DATA: Patients with NF-1 commonly have scoliosis with curves that can be dysplastic and progressive and respond poorly to bracing. Rib-based distraction systems have recently been described in the management of these complex patients. The efficacy and complication rate using these systems have not previously been reported. METHODS: Twelve children with NF-1 and scoliosis who were treated with rib-based distraction systems were identified from a prospectively collected multicenter registry. Preoperative and postoperative Cobb angle and T1-S1 spine height were measured from posteroanterior radiographs. The number of lengthenings, age at implantation, years of follow-up, and complications were also acquired from the registry or patient charts. RESULTS: Mean age at implantation of the Vertical Expandable Prosthetic Titanium Rib device was 6.34 years. Mean preoperative Cobb angle was 66.3°. Average follow-up was 5.2 years. Mean postoperative Cobb angle was 60.8° after an average of 7.75 lengthening procedures (range, 2-16 procedures). T1-S1 height increased in all patients. There were 17 complications in 8 patients (device migration in 6, wound dehiscence in 3, rod breakage in 2, medical issues in 5, and 1 revision for progression of curve). Of the 17 complications, 10 were grade I, 1 was grade II, and 6 were grade IIA; there were no grade III complications. CONCLUSIONS: The use of rib-based distraction is an effective and relatively safe method of stabilizing curve progression through growth in severe dysplastic scoliosis associated with NF-1.