515Abstracts / Spine Deformity 2 (2014) 498e517

For each 1� increase in major curve size, the odds of complication

increased by 3% (OR, 1.03; p 5 .02). Classification and regression tree

analysis determined that the optimal cutoff for age was 8 years and for

preoperative major curve size was 82�. Based on these cutoffs, multivariate

regression determined that patients aged less than 8 years at implantation

had more than 4 times the odds of complication compared with older

subjects (OR, 4.4; p ! .001) and subjects who had a preoperative major

curve size greater than 82� had more than 6 times the odds of complication

(OR, 6.6; p 5 .02). The incidence of medical complications was signifi-

cantly correlated to ASA level (p 5 .02), whereas the incidence of implant

complications was not (p 5 .33).

Conclusions: These data provide objective cutoffs to help guide the

initiation of dual GR treatment and provide valuable information for pa-

tients and their families regarding the incidence of complications. The

ASA level may be used as a surrogate marker to preoperatively identify

patients at increased risk for medical complications.

Author disclosures: VVU (none); KCP (none); JP (none); PEM (none);

GHT (royalty/patent holder of Lippincott); DLS (consulting fees from

Medtronic, Biomet; Speakers’ bureau for Medtronic, Stryker, Biomet;

royalty/patent holder of Biomet, Wolters Kluwer HealtheLippincott Wil-

liams & Wilkins); JBE (consulting fees from Medtronic Sofamor Danek,

DePuy Synthes; royalty/patent holder of DePuy Synthes); MPG (grants/

research support from DePuy Synthes via the Children’s Spine Study

Group); Growing Spine Study Group (grants/research support from

Growing Spine Foundation)

Paper #41

Performing a Definitive Fusion in Juvenile CP Patients Is a Good

Surgical Option

Burt Yaszay, Paul D. Sponseller, Suken A. Shah, Jahangir Asghar,

Firoz Miyanji, Amer F. Samdani, Carrie E. Bartley, Peter O. Newton

Introduction: Management of juvenile cerebral palsy (CP) patients with

large scoliosis is a challenge. When observation with or without a brace is

no longer a viable option, surgeons frequently choose growing rod treatment

or early definitive fusion. The purpose of the study was to present a series of

juvenile CP scoliosis patients who underwent early definitive fusion.

Methods: A retrospective review of a multicenter database identified pa-

tients aged 10 years and younger who had a definitive fusion for the

scoliosis. Preoperative and postoperative demographic and radiographic

changes were evaluated with descriptive statistics. Repeated-measures

analysis of variance was used to compare outcome scores.

Results: Fifteen patients with an average age of 9.7 years (range, 8.2e10.7

years) and a minimum of 2 years’ follow-up were identified. The average

preoperative curve magnitude and pelvic obliquity was 87� and 28�,respectively. All patients were skeletally immature with open triradiate

cartilage. Fourteen patients underwent posterior-only surgery and 1 had an

anterior/posterior fusion. Three patients had unit rods with wires whereas

the rest incorporated pedicle screws. Immediately after surgery, the

average major Cobb was 22� (p < .001, 75% correction rate). At 2 years

after surgery, the average major Cobb increased to 29� (p < .001), for a

67% correction rate. Pelvic obliquity improved to 6� (79% correction; p <

.001) immediately after surgery and to 8� (p < .001) at 2 years after

surgery, for a 71% correction rate. No patients required revision surgery for

progression. From before to 2 years after surgery, CP child health outcome

scores improved from 45 to 58 (p 5 .004). One patient had a deep

infection requiring a return trip to the operating room and 1 had a broken

rod that did not require further treatment.

Conclusions: Progressive scoliosis refractory to conservative measures in

juvenile CP patients can be a challenge that requires the surgeon to balance

the need for further growth with the risks of progression or repeated sur-

gical procedures. This study demonstrated that definitive fusion results in

stable fusions in these skeletally immature patients. Further follow-up is

needed to determine whether the results are stable to skeletal maturity.

Author disclosures: BY (grants/research support from DePuy Synthes

Spine; consulting fees from DePuy Synthes Spine, K2M; speakers’ bureau

for DePuy Synthes Spine, K2M; royalty/patent holder of Orthopediatrics,

K2M); PDS (grants/research support from DePuy Synthes Spine; consul-

ting fees from DePuy Synthes Spine; royalty/patent holder of DePuy

Synthes Spine, Globus Medical); SAS (grants/research support from DePuy

Synthes Spine; consulting fees from DePuy Synthes Spine; ownership in-

terest/shareholder of Globus Medical; royalty/patent holder of Arthrex,

Inc., DePuy Synthes Spine); JA (consulting fees from DePuy Synthes

Spine); FM (grants/research support from DePuy Synthes Spine; consul-

ting fees from DePuy Synthes Spine); AFS (consulting fees from DePuy

Synthes Spine); CEB (none); PON (grants/research support from DePuy

Synthes Spine, EOS Imaging, Orthopediatrics institutional support;

consulting fees from Cubist, DePuy Synthes Spine, Ethicon Endosurgery;

speakers’ bureau for DePuy Synthes Spine; ownership interest/shareholder

of Electrocore; royalty/patent holder of DePuy Synthes Spine)

Paper #42

Can No Final Fusion Produce Results Equal to Final Fusion After

Growing Rod Treatment?

Amit Jain, MD, Paul D. Sponseller, MD, MBA, Urvij Modhia, MD,

Suken A. Shah, MD, George H. Thompson, MD, Jeff B. Pawelek,

Behrooz A. Akbarnia, MD, Growing Spine Study Group

Introduction: Definitive final fusion (FF) is the common end point to

growing rod treatment (GR) for early-onset scoliosis (EOS). However, FF

may not be necessary for a subset of EOS patients who have reached

skeletal maturity with good alignment, and these patients may end GR

treatment with no definitive fusion. The aim of this study was to charac-

terize patients who completed GR treatment but received no final spinal

fusion (NF) and to compare them with those who underwent fusion

Methods: A multicenter EOS database was queried to identify 160 pa-

tients who received GR treatment and reached skeletal maturity (Risser 3

or above). Radiographs and clinical records of these patients were

reviewed. Nineteen patients were identified as having received GR surgery

without an FF. Clinical and radiographic characteristics of NF patients

were compared against those who received FF at skeletal maturity. All

patients had a minimum of 2 years’ follow-up from the final procedure.

Results: There was no significant difference in the NF and FF groups in

age at which growing rod treatment was initiated, percentage of female

patients, or the distribution of C-EOS patient diagnoses. There was no

significant difference in the 2 groups in the mean lengthening procedures

(NF group 6.4 � 3.5 procedures vs. FF group 5.6 � 3.9 procedures; p 5

.36). All 19 patients in the NF group had the rods retained at final

distraction, and there were no rod fractures at 2-year follow-up. Mean

follow-up time in NF group after last distraction was 3.3 � 1.6 years.

Mean age at last follow-up in the NF group was 14.5 � 3.1 years, and in

the FF group was 15.2� 2.8 years. In the NF group, at the end of treatment

the average primary curve correction was 46%, from 76� � 23� to 41� �21�. In the FF group the average primary curve correction was 37%, from

74� � 19� to 46� � 18�. The difference in the final curve magnitude be-

tween the 2 groups was not significant (p 5 .23). In the NF group the

average increase in trunk height (as defined by T1eS1 length) was 30%,

from 270 � 54 mm to 385 � 30 mm. In the FF group the average increase

in T1eS1 trunk height was 25%, from 269 � 54 mm to 361 � 25 mm. The

final trunk height in the NF group was significantly higher (p ! .01).

Conclusions: Patients who did not receive an FF had excellent final cor-

onal correction and trunk height, and had no rod fractures. Because of

progressive ankylosis, NF at maturity is a viable option for patients being

treated with GR in all C-EOS diagnostic groups who have satisfactory final

alignment. Final fusion may thus be needed only in patients who have a

residual problem at maturity.

Author disclosures: AJ (none); PDS (grants/research support from DePuy

Synthes; consulting fees from DePuy Synthes; royalty/patent holder of

Globus Medical, DePuy Synthes, Journal of Bone and Joint Surgery,

Oakstone Medical); UM (none); SAS (grants/research support from DePuy

Synthes; consulting fees from DePuy Synthes; ownership interest/share-

holder of Globus Medical; royalty/patent holder of Arthrex, Inc., DePuy