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Scientific Articles   |    
Gain in Spinal Height from Surgical Correction of Idiopathic Scoliosis
Hillard T. Spencer, MD1; Meryl E. Gold, BA1; Lawrence I. Karlin, MD1; Daniel J. Hedequist, MD1; M. Timothy Hresko, MD1
1 Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Hunnewell 2, Boston, MA 02115. E-mail address for M.T. Hresko: Timothy.Hresko@childrens.harvard.edu
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Investigation performed at Boston Children’s Hospital, Boston, Massachusetts

Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article. Support for a data warehouse was provided by an educational grant from Medtronic.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 01;96(1):59-65. doi: 10.2106/JBJS.L.01333
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Abstract

Background: 

A relationship between spinal distraction and correction of the curvature of scoliosis has long been recognized. While attempts have been made to define the height that is lost with progression of scoliosis, much less information is available to define the height that is gained as a result of surgical correction of the curve and to quantify additional spinal growth after spine fusion.

Methods: 

The present study included 116 patients (mean age, 14.8 years) who underwent spinal instrumentation and fusion for the treatment of idiopathic scoliosis. The study group included ninety-one female patients and twenty-five male patients; all Lenke curve types were represented. The Cobb angle and the T1-L5 spinal height were evaluated on preoperative, postoperative, and two-year follow-up radiographs. Kyphosis, lordosis, and T1-L5 spinal length were measured on lateral radiographs. The Scoliosis Research Society (SRS) questionnaire was completed prior to surgery and at each visit. Multivariate linear regression defined the relationship between spinal height gain, Cobb angle correction, and other variables as well as final spinal height.

Results: 

The mean spinal height gain due to surgery was 27.1 mm (median, 25.1 mm; interquartile range, 14.5 to 37.9 mm; range, −3.8 to 66.1 mm). The magnitude of curve correction (mean, 38.2°; range, 6° to 67°), the number of vertebral levels fused (mean, 9.9; range, three to sixteen), and the preoperative stature (standing height) of the patient were all significant predictors (p < 0.01) of spinal height gain (R2 = 0.8508 for multivariate model). The mean changes in kyphosis and lordosis were small and were not significant predictors. An additional 4.6 mm of mean spinal height was gained at the time of the two-year follow-up; this increase was significantly related to young age, male sex, shorter fusions, and a Risser stage of ≤2 at the time of surgery (p < 0.01 for all in multivariate analysis). The SRS-30 scores improved significantly (p < 0.0001), independent of spinal height gain.

Conclusions: 

Patients undergoing surgical correction of idiopathic scoliosis gain substantial height related to the magnitude of surgical correction, the number of levels fused, and preoperative stature. Continued spine growth by two years after surgery is associated with shorter fusions, skeletal immaturity, young age, and male sex. Height gain is a quantifiable outcome of the surgical correction of scoliosis.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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