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Comparison of surgical interventions for the treatment of early-onset scoliosis: a systematic review and meta-analysis
Journal of Neurosurgery: Pediatrics ( IF 2.713 ) Pub Date : 2022-09-23 , DOI: 10.3171/2022.8.peds22156
Gloria Kim 1 , Sally El Sammak 2, 3 , Giorgos D Michalopoulos 2, 3 , William Mualem 2, 3 , Zachariah W Pinter 4 , Brett A Freedman 4 , Mohamad Bydon 2, 3
Affiliation  

OBJECTIVE

Several growth-preserving surgical techniques are employed in the management of early-onset scoliosis (EOS). The authors’ objective was to compare the use of traditional growing rods (TGRs), magnetically controlled growing rods (MCGRs), Shilla growth guidance techniques, and vertically expanding prosthetic titanium ribs (VEPTRs) for the management of EOS.

METHODS

A systematic review of electronic databases, including Ovid MEDLINE and Cochrane, was performed. Outcomes of interest included correction of Cobb angle, T1–S1 distance, and complication rate, including alignment, hardware failure and infection, and planned and unplanned reoperation rates. The percent changes and 95% CIs were pooled across studies using random-effects meta-analysis.

RESULTS

A total of 67 studies were identified, which included 2021 patients. Of these, 1169 (57.8%) patients underwent operations with TGR, 178 (8.8%) Shilla growth guidance system, 448 (22.2%) MCGR, and 226 (11.1%) VEPTR system. The mean ± SD age of the cohort was 6.9 ± 1.2 years. The authors found that the Shilla technique provided the most significant improvement in coronal Cobb angle immediately after surgery (mean [95% CI] 64.3% [61.4%–67.2%]), whereas VEPTR (27.6% [22.7%–33.6%]) performed significantly worse. VEPTR also performed significantly worse than the other techniques at final follow-up. The techniques also provided comparable gains in T1–S1 height immediately postoperatively (mean [95% CI] 10.7% [8.4%–13.0%]); however, TGR performed better at final follow-up (21.4% [18.7%–24.1%]). Complications were not significantly different among the patients who underwent the Shilla, TGR, MCGR, and VEPTR techniques, except for the rate of infections. The TGR technique had the lowest rate of unplanned reoperations (mean [95% CI] 15% [10%–23%] vs 24% [19%–29%]) but the highest number of planned reoperations per patient (5.31 [4.83–5.82]). The overall certainty was also low, with a high risk of bias across studies.

CONCLUSIONS

This analysis suggested that the Shilla technique was associated with a greater early coronal Cobb angle correction, whereas use of VEPTR was associated with a lower correction rate at any time point. TGR offered the most significant height gain at final follow-up. The complication rates were comparable across all surgical techniques. The optimal surgical approach should be tailored to individual patients, taking into consideration the strengths and limitations of each option.



中文翻译:

手术干预治疗早发性脊柱侧凸的比较:系统评价和荟萃分析

客观的

早发性脊柱侧弯 (EOS) 的管理采用了几种保生长手术技术。作者的目的是比较传统生长棒 (TGR)、磁控生长棒 (MCGR)、Shilla 生长引导技术和垂直扩张假体钛肋骨 (VEPTR) 在 EOS 管理中的应用。

方法

对包括 Ovid MEDLINE 和 Cochrane 在内的电子数据库进行了系统评价。感兴趣的结果包括矫正 Cobb 角、T1-S1 距离和并发症发生率,包括对齐、硬件故障和感染,以及计划和计划外的再手术率。百分比变化和 95% 置信区间是使用随机效应荟萃分析在各个研究中汇总的。

结果

总共确定了 67 项研究,其中包括 2021 名患者。其中,1169 例(57.8%)患者接受了 TGR 手术,178 例(8.8%)Shilla 生长指导系统,448 例(22.2%)MCGR 和 226 例(11.1%)VEPTR 系统。该队列的平均 ± SD 年龄为 6.9 ± 1.2 岁。作者发现 Shilla 技术在手术后立即提供了最显着的冠状 Cobb 角改善(平均 [95% CI] 64.3% [61.4%–67.2%]),而 VEPTR (27.6% [22.7%–33.6%])表现明显更差。在最后的随访中,VEPTR 的表现也明显差于其他技术。这些技术还在术后即刻提供了相当的 T1-S1 高度增益(平均 [95% CI] 10.7% [8.4%–13.0%]);然而,TGR 在最终随访时表现更好 (21.4% [18.7%–24.1%])。除感染率外,接受 Shilla、TGR、MCGR 和 VEPTR 技术的患者的并发症没有显着差异。TGR 技术的计划外再手术率最低(平均 [95% CI] 15% [10%–23%] vs 24% [19%–29%]),但每位患者的计划再手术次数最多(5.31 [4.83 –5.82])。总体确定性也很低,研究间存在很高的偏倚风险。

结论

该分析表明,Shilla 技术与更大的早期冠状 Cobb 角校正相关,而使用 VEPTR 与任何时间点的较低校正率相关。TGR 在最终随访中提供了最显着的身高增长。所有手术技术的并发症发生率都相当。最佳手术方法应针对个体患者量身定制,同时考虑到每种选择的优势和局限性。

更新日期:2022-09-23
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