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Bigger is better: larger thoracic height is associated with increased health related quality of life at skeletal maturity

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Abstract

Study design

Cross sectional

Objectives

The purpose of this study is to evaluate the association between thoracic height and health-related quality of life (HRQoL) at skeletal maturity in patients with EOS.

Summary of background data

Current literature suggests a minimum thoracic height of 18 cm to 22 cm to avoid poor pulmonary function and related health outcomes.

Methods

Patients with EOS who reached skeletal maturity from 2005 to 2018 were identified in two registries including 32 centers. Thoracic height from T1 to T12 at skeletal maturity and Early Onset Scoliosis 24 Item Questionnaire (EOSQ-24) scores were collected. The EOSQ-24 domains included HRQoL of patients, parental impact, financial impact and patient and parental satisfaction.

Results

469 patients (mean age: 14.9, female: 77.4%) were identified. 29% patients were of congenital etiology, 20.3% neuromuscular, 13.6% syndromic, 34.8% idiopathic, and 2.3% other. When patients were grouped by thoracic height at skeletal maturity, all EOSQ-24 domains increased after a threshold of 18 cm. When stratified by etiology, the 18 cm cutoff held for patients with congenital, neuromuscular and syndromic EOS. The cutoff for idiopathic EOS was 20 cm. For all patients, after the threshold was met, HRQoL continued to improve with increases in thoracic height at skeletal maturity. A subset of 169 patients for which arm span measurements were available was also identified and their thoracic heights were normalized. When grouped by the percentage of expected thoracic height attained, EOSQ-24 domains increased after a threshold of 80%.

Conclusions

Once 18 cm of actual thoracic height or 80% of expected thoracic height is achieved, HRQoL continues to improve as thoracic height increases in skeletally mature patients with non-idiopathic EOS. Patients with idiopathic EOS had a higher threshold, possibly due to their larger average size and higher care giver expectations for HRQoL.

Level of evidence

Level III.

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Funding

This work was conducted without the support of additional funding.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA

    Benjamin D. Roye, Matthew E. Simhon, Hiroko Matsumoto & Michael G. Vitale

  2. Children’s Hospital Colorado Orthopedics Institute, University of Colorado, Aurora, CO, USA

    Sumeet Garg

  3. Pediatric Pulmonary Division, Seattle Children’s Hospital, Seattle, WA, USA

    Gregory Redding

  4. Shriner’s Hospital for Children, Philadelphia, PA, USA

    Amer Samdani

  5. Department of Orthopedics, University of Utah, Salt Lake City, UT, USA

    John T. Smith

  6. Division of Pediatric Orthopaedics, All Children’s Hospital at Johns Hopkins, Baltimore, MD, USA

    Paul Sponseller

  7. Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA

    Hiroko Matsumoto

Authors
  1. Benjamin D. Roye
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  2. Matthew E. Simhon
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  3. Hiroko Matsumoto
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  4. Sumeet Garg
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  5. Gregory Redding
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  6. Amer Samdani
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  7. John T. Smith
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  8. Paul Sponseller
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  9. Michael G. Vitale
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Consortia

Children’s Spine Study Group

Growing Spine Study Group

Contributions

BDR: Resources, Conception and design, data interpretation, revision, final approval. MES: Data analysis, data interpretation, drafting manuscript, revising manuscript, final approval. HM: Conception and design, Data analysis, data interpretation, final approval. SG: Resources, Manuscript revision, final approval. GR: Manuscript revision, final approval. AS: Resources, Manuscript revision, final approval. JTS: Resources, Manuscript revision, final approval. PS: Resources, Manuscript revision, final approval. MGV: Resources, Conception and design, supervision, final approval. Children’s Spine Study Group: Data acquisition, Final Approval. Growing Spine Study Group: Data acquisition, final approval.

Corresponding author

Correspondence to Hiroko Matsumoto.

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IRB approval/Research Ethics Committee

This work is approved by the Institutional Review Board at Columbia University (Protocol AAAS0358).

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Roye, B.D., Simhon, M.E., Matsumoto, H. et al. Bigger is better: larger thoracic height is associated with increased health related quality of life at skeletal maturity. Spine Deform 8, 771–779 (2020). https://doi.org/10.1007/s43390-020-00095-4

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  • DOI: https://doi.org/10.1007/s43390-020-00095-4

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