New growth rod concept provides three dimensional correction, spinal growth, and preserved pulmonary function in early-onset scoliosis

Aims To report the mid-term results of a modified self-growing rod (SGR) technique for the treatment of idiopathic and neuromuscular early-onset scoliosis (EOS). Methods We carried out a retrospective analysis of 16 consecutive patients with EOS treated with an SGR construct at a single hospital between September 2008 and December 2014. General demographics and deformity variables (i.e. major Cobb angle, T1 to T12 length, T1 to S1 length, pelvic obliquity, shoulder obliquity, and C7 plumb line) were recorded preoperatively, and postoperatively at yearly follow-up. Complications and revision procedures were also recorded. Only patients with a minimum follow-up of five years after surgery were included. Results A total of 16 patients were included. Six patients had an idiopathic EOS while ten patients had a neuromuscular or syndromic EOS (seven spinal muscular atrophy (SMA) and three with cerebral palsy or a syndrome). Their mean ages at surgery were 7.1 years (SD 2.2) and 13.3 years (SD 2.6) respectively at final follow-up. The mean preoperative Cobb angle of the major curve was 66.1° (SD 8.5°) and had improved to 25.5° (SD 9.9°) at final follow-up. The T1 to S1 length increased from 289.7 mm (SD 24.9) before surgery to 330.6 mm (SD 30.4) immediately after surgery. The mean T1 to S1 and T1 to T12 growth after surgery were 64.1 mm (SD 19.9) and 47.4 mm (SD 18.8), respectively, thus accounting for a mean T1 to S1 and T1 to T12 spinal growth after surgery of 10.5 mm/year (SD 3.7) and 7.8 mm/year (SD 3.3), respectively. A total of six patients (five idiopathic EOS, one cerebral palsy EOS) had broken rods during their growth spurt but were uneventfully revised with a fusion procedure. No other complications were noted. Conclusion Our data show that SGR is a safe and effective technique for the treatment of EOS in nonambulatory hypotonic patients with a neuromuscular condition. Significant spinal growth can be expected after surgery and is comparable to other published techniques for EOS. While satisfactory correction of the deformity can be achieved and maintained with this technique, a high rate of rod breakage was seen in patients with an idiopathic or cerebral palsy EOS. Cite this article: Bone Joint J 2020;102-B(11):1560–1566.

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The challenge of accurate spinal growth assessment inthetreatment of early onset scoliosis with growth-friendly systems

The Spine Journal ◽

10.1016/j.spinee.2019.02.009 ◽

2019 ◽

Vol 19 (5) ◽

pp. 800-802

Author(s):

John T. Braun

Keyword(s):

Early Onset ◽

Early Onset Scoliosis ◽

Spinal Growth ◽

Growth Assessment

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Is There a Relationship Between Thoracic Dimensions and Pulmonary Function in Early-Onset Scoliosis?

Spine ◽

10.1097/brs.0000000000000449 ◽

2014 ◽

Vol 39 (19) ◽

pp. 1590-1595 ◽

Cited By ~ 15

Author(s):

Michael Glotzbecker ◽

Charles Johnston ◽

Patricia Miller ◽

John Smith ◽

Francisco Sanchez Perez-Grueso ◽

...

Keyword(s):

Pulmonary Function ◽

Early Onset ◽

Early Onset Scoliosis

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Traditional Dual Growing Rod Technique in the Management of Early Onset Scoliosis and Its Effects on Spinal Growth and Lung Development: The Mid-Term Prospective Results

Cureus ◽

10.7759/cureus.14422 ◽

2021 ◽

Author(s):

Bertan Cengiz ◽

Haci Mustafa Ozdemir ◽

Abdurrahman Sakaogullari ◽

Metin Isik ◽

Nevres Hürriyet Aydoğan

Keyword(s):

Early Onset ◽

Lung Development ◽

Early Onset Scoliosis ◽

Spinal Growth ◽

Growing Rod ◽

Growing Rod Technique

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Pulmonary Function Changes After Spine Fusion in Children with Early Onset Scoliosis (EOS)

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a4669 ◽

2020 ◽

Author(s):

G.J. Redding ◽

K. White ◽

H. Matsumoto ◽

V. Bompadre ◽

W. Krengel III ◽

...

Keyword(s):

Pulmonary Function ◽

Early Onset ◽

Spine Fusion ◽

Early Onset Scoliosis

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Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.7.peds17233 ◽

2017 ◽

Vol 20 (6) ◽

pp. 561-566 ◽

Cited By ~ 1

Author(s):

Zhonghui Chen ◽

Song Li ◽

Yong Qiu ◽

Zezhang Zhu ◽

Xi Chen ◽

...

Keyword(s):

Early Onset ◽

Thoracic Kyphosis ◽

Sagittal Plane ◽

Early Onset Scoliosis ◽

Sagittal Profile ◽

Neutral Position ◽

Sagittal Vertical Axis ◽

Spinal Growth ◽

Radiographic Measurements

OBJECTIVEAlthough the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI.METHODSThe data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years’ follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded.RESULTSPatients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1–S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%).CONCLUSIONSThe VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.

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