Evidence map›Paper›PMID 38717696›Full record

ArticleSpine deformity2024

How do implants overlying the spine influence "The Law of Diminishing Returns" in early-onset scoliosis patients?

Stuart L Mitchell, Jessica H Heyer, Jason B Anari, Keith D Baldwin, Pranav Kodali, Brandon S Ramo, Jack M Flynn, Ryan Fitzgerald, Walter Truong, Ying Li and 3 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Spine deformity, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

13 authors.

Stuart L MitchellDepartment of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA.
Jessica H HeyerDepartment of Pediatric Orthopaedics, Hospital for Special Surgery, New York, NY, USA.
Jason B AnariDepartment of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Keith D BaldwinDepartment of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Pranav KodaliUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Brandon S RamoDepartment of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Scottish Rite for Children, Dallas, TX, USA.
Jack M FlynnDepartment of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Ryan FitzgeraldChildren's Orthopaedic and Scoliosis Surgery Associates, St. Petersburg, FL, USA.
Walter TruongDepartment of Orthopaedics, Gillette Children's, St. Paul, MN, USA.
Ying LiDepartment of Orthopaedics, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA.
Lindsay AndrasDepartment of Orthopaedics, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
Jaysson BrooksDepartment of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Scottish Rite for Children, Dallas, TX, USA.
Patrick J CahillDepartment of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. cahillp1@email.chop.edu.ORCID 0000-0002-7129-1007

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe "law of diminishing returns" (LODR) in early-onset scoliosis (EOS) is well-known. We hypothesized that previously observed variations between constructs may be related to the lateral distance that each construct lies from the spine. We therefore sought to determine whether the curve magnitude improvement and spinal length gains for distraction-based constructs in EOS are positively correlated with the collinearity of the spine and the convex-sided implant on posteroanterior radiographs.

methodsA prospectively-collected, multicenter EOS registry was queried for all patients who underwent non-fusion, distraction-based instrumentation surgery. Post-index radiographs were graded from 1 to 5 based on amount of overlap between the convex-sided rod and the apical vertebra. Grade 1: convex rod is lateral to convex-sided pedicle; Grade 2: overlaps the convex-sided pedicle; Grade 3: lies between pedicles; Grade 4: overlaps concave-sided pedicle; Grade 5: medial to concave-sided pedicle. ANOVA assessed the correlations between post-index overlap grade and change in (a) curve magnitude and (b) T1-T12 height. Multivariable regression modeling further assessed these associations.

results284 patients met all selection criteria and were included. On ANOVA, post-index grade was associated with curve magnitude (p <0.001) and T1-12 height (p = 0.028) change. Better curve correction and height change were associated with higher grade. On regression modeling, curve correction (R = 0.574) and T1-T12 height change (R = 0.339) remained significantly associated with grade when controlling for time, anchor locations, age, underlying diagnosis, and pre-index curve magnitude.

conclusionMore apical overlap by the convex rod was associated with better spinal deformity control and improved height gain. LEVEL OF EVIDENCE III: Therapeutic.

Indexed as

ScoliosisAge of OnsetChildChild, PreschoolFemaleHumansMaleProspective StudiesProstheses and ImplantsRadiographyRegistriesSpineThoracic VertebraeTreatment OutcomeDistraction-based spine implantsEarly-onset scoliosisGrowing rodsPediatric spinal deformity

Identifiers

PMID38717696
PMCPMC11343778

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