scholarly journals Analysis of serum levels of titanium and aluminium ions in patients with early onset scoliosis operated upon using the magnetic growing rod—a single centre study of 14 patients

2021 ◽  
Author(s):  
Mandar Deepak Borde ◽  
Sarang Sapare ◽  
Emile Schutgens ◽  
Chadi Ali ◽  
Hilali Noordeen
Keyword(s):  
Early Onset ◽  
Serum Levels ◽  
Early Onset Scoliosis ◽  
Ion Concentration ◽  
Long Term Effects ◽  
Blood Concentrations ◽  
Growing Rod ◽  
Rod System ◽  
Rod Breakage

Abstract Study design A cross-sectional retrospective Level 3 study. Objective To study the serum levels of Titanium and Aluminium ions in patients operated using the magnetically controlled growing rod (MCGR) system. Summary of background data 14 consecutive patients of early onset scoliosis with varying etiology managed with MCGR system with a minimum follow-up of 24 months were selected for the study. The group consisted of two boys (14.3%) and 12 girls (85.7%). The average age of the patients at the time of surgery was 10.4 years (5–15 years). The average period of follow-up was 43.7 months (28–79 months). After informed consent of the subjects and their caretakers, serum levels of titanium and aluminium were measured. These levels were then assessed with regards to the number of screws used, number of distractions and complications. Methods The concentration of titanium and aluminium ions in the serum was measured using high resolution inductively coupled plasma mass spectrometry. Results For the sake of ease of assessment, patients were divided into three etiology-based groups—idiopathic (n = 6), neuromuscular (n = 2) and syndromic (n = 6). The mean serum titanium level was 15.9 μg/L (5.1–28.2 μg/L) while that of aluminium was 0.1 μmol/L (0.1–0.2 μmol/L). Of the 14 patients, 2 (14.2%) patients had mechanical failure (actuator pin dysfunction), 3 (21.4%) had rod breakage requiring revision surgery and one patient (7.1%) had surgical site infection managed with appropriate antibiotics. Patients undergoing revision for rod breakage did not show any metallosis of the tissues during surgery. Conclusion Analysis of patients with scoliosis operated using the magnetic growing rod system concludes that it is accompanied by presence of titanium in the blood but whether clinically significant or not needs to be ascertained by comparison of preoperative and postoperative blood concentrations of the titanium ions in individual subjects. The aluminium ion concentration remains within normal limits. Though implant malfunction may raise the titanium levels in the blood, its clinical significance needs to be determined. The aluminium levels are not affected irrespective to the presence or absence of complications. The long-term effects of raised titanium levels in the blood also warrant further prospective studies designed for precise and deeper analyses.

A six-year observational study of 31 children with early-onset scoliosis treated using magnetically controlled growing rods with a minimum follow-up of two years

2018 ◽  
Vol 100-B (9) ◽  
pp. 1187-1200 ◽  
Author(s):  
T. Subramanian ◽  
A. Ahmad ◽  
D. M. Mardare ◽  
D. C. Kieser ◽  
D. Mayers ◽  
...  
Keyword(s):  
Observational Study ◽  
Cobb Angle ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Complication Rates ◽  
Growing Rod ◽  
Initial Surgery ◽  
Rod System ◽  
The Mean

Aims Magnetically controlled growing rod (MCGR) systems use non-invasive spinal lengthening for the surgical treatment of early-onset scoliosis (EOS). The primary aim of this study was to evaluate the performance of these devices in the prevention of progression of the deformity. A secondary aim was to record the rate of complications. Patients and Methods An observational study of 31 consecutive children with EOS, of whom 15 were male, who were treated between December 2011 and October 2017 was undertaken. Their mean age was 7.7 years (2 to 14). The mean follow-up was 47 months (24 to 69). Distractions were completed using the tailgating technique. The primary outcome measure was correction of the radiographic deformity. Secondary outcomes were growth, functional outcomes and complication rates. Results The mean Cobb angle was 54° (14° to 91°) preoperatively and 37° (11° to 69°) at the latest follow-up (p < 0.001). The mean thoracic kyphosis (TK) was 45° (10° to 89°) preoperatively and 42° (9° to 84°) at the latest follow-up. The mean T1–S1 height increased from 287 mm (209 to 378) to 338 mm (240 to 427) (p < 0.001) and the mean sagittal balance reduced from 68 mm (-76 to 1470) preoperatively to 18 mm (-32 to 166) at the latest follow-up. The mean coronal balance was 3 mm (-336 to 64) preoperatively and 8 mm (-144 to 64) at the latest follow-up. The mean increase in weight and sitting and standing height at the latest follow-up was 45%, 10% and 15%, respectively. The mean Activity Scale for Kids (ASKp) scores increased in all domains, with only personal care and standing skills being significant at the latest follow-up (p = 0.02, p = 0.03). The improvements in Cobb angle, TK and T1-S1 heights were not related to gender, the aetiology of the EOS, or whether the procedure was primary or conversion from a conventional growing rod system. A total of 21 children developed 23 complications at a rate of 0.23 per patient per year. Seven developed MCGR-specific complications. Complications developed at a mean of 38 months (3 to 67) after the initial surgery and required 22 further procedures. Children who developed a complication were more likely to be younger, have syndromic EOS, and have a single-rod construct (6.9 versus 9.3 years, p = 0.034). Conclusion The progression of EOS can be controlled using MCGRs allowing growth and improved function. Younger and syndromic children are more likely to develop complications following surgery. Cite this article: Bone Joint J 2018;100-B:1187–1200.

scholarly journals Evaluation of changes in shoulder balance and prediction of final shoulder imbalance during growing-rod treatment for early-onset scoliosis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ziyang Liu ◽  
Tie Liu ◽  
Yong Hai ◽  
Lingyun Wu ◽  
Junrui Jonathan Hai ◽  
...  
Keyword(s):  
Early Onset ◽  
Demographic Data ◽  
Potential Effect ◽  
Early Onset Scoliosis ◽  
Shoulder Balance ◽  
Related Factors ◽  
Growing Rod ◽  
Shoulder Imbalance ◽  
Entire Treatment

Abstract Background Obtaining and maintaining final shoulder balance after the entire treatment course is essential for early-onset scoliosis (EOS) patients. The relatively small number of growing-rod (GR) graduates who complete final fusion has resulted in an overall paucity of research on the GR treatment of EOS and a lack of research on the shoulder balance of EOS patients during GR treatment. Methods Twenty-four consecutive patients who underwent GR treatment until final fusion were included. Radiographic shoulder balance parameters, including the radiographic shoulder height (RSH), clavicle angle (CA), and T1 tilt angle (T1T), before and after each step of the entire treatment were measured. Shoulder balance changes from GR implantation to the last follow-up after final fusion were depicted and analysed. Demographic data, surgical-related factors, and radiographic parameters were analysed to identify risk factors for final shoulder imbalance. The shoulder balance of patients at different time points was further analysed to explore the potential effect of the series of GR treatment steps on shoulder balance. Results The RSH showed substantial improvement after GR implantation (P = 0.036), during the follow-up period after final fusion (P = 0.021) and throughout the entire treatment (P = 0.011). The trend of change in the CA was similar to that of the RSH, and the T1T improved immediately after GR implantation (P = 0.037). Further analysis indicated that patients with shoulder imbalance before final fusion showed significantly improved shoulder balance after fusion (P = 0.045), and their RSH values at early postfusion and the final follow-up did not show statistically significant differences from those in the prefusion shoulder balance group (P > 0.05). Early postfusion shoulder imbalance (odds ratio (OR): 19.500; 95% confidence interval (CI) = 1.777–213.949; P = 0.015) was identified as an independent risk factor for final shoulder imbalance. Conclusions Shoulder balance could be improved by GR implantation but often changes during the multistep lengthening process, and the final result is relatively unpredictable. Final fusion could further adjust the prefusion shoulder imbalance. Focusing on the prefusion shoulder balance of GR graduates and providing patients with early shoulder balance after fusion might be necessary.

Mid-term results of a modified self-growing rod technique for the treatment of early-onset scoliosis

2020 ◽  
Vol 102-B (11) ◽  
pp. 1560-1566
Author(s):  
Hossein Mehdian ◽  
Sleiman Haddad ◽  
Dritan Pasku ◽  
Luigi Aurelio Nasto
Keyword(s):  
Cerebral Palsy ◽  
Cobb Angle ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growth Spurt ◽  
Spinal Growth ◽  
Growing Rod ◽  
The Mean ◽  
Mid Term Results

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.

scholarly journals 3-Year follow-up of a single magnetically controlled growing rod with contralateral gliding system and apical control for early onset scoliosis

2020 ◽  
Vol 8 (4) ◽  
pp. 751-761 ◽  
Author(s):  
Sebastiaan P. J. Wijdicks ◽  
Simon Toftgaard Skov ◽  
Haisheng Li ◽  
René M. Castelein ◽  
Moyo C. Kruyt ◽  
...  
Keyword(s):  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod ◽  
Apical Control ◽  
Magnetically Controlled Growing Rod

Paper #38 Growing Rod and Vertical Expandable Prosthetic Titanium Rib Perform Differently for Idiopathic Early Onset Scoliosis at 5-year Follow-up

2015 ◽  
Vol 3 (6) ◽  
pp. 628
Author(s):  
Paul D. Sponseller ◽  
Anna McClung ◽  
Jeff Pawelek ◽  
Ron El Hawary ◽  
George H. Thompson ◽  
...  
Keyword(s):  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod

scholarly journals Risk Factors for Multiple Implant-Related Complications (MIRC) with Growing-Rod for Early-Onset Scoliosis

2021 ◽  
Author(s):  
Haijun Jiang ◽  
Junrui Jonathan Hai ◽  
Yong Hai ◽  
Peng Yin ◽  
Qingjun Su ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Onset ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Multivariate Logistic Regression Analysis ◽  
Early Onset Scoliosis ◽  
Multivariate Logistic Regression ◽  
Growing Rod ◽  
Independent Risk Factors

Abstract Study design: A retrospective single center study.Objective：To identify risk factors for multiple implant-related complications with growing-rod for early-onset scoliosis.Background: High incidence of implant-related complications in the treatment of early-onset scoliosis with traditional growing rod. The risk factors for multiple implant-related complications (MIRC) have not been adequately studied.Methods: Data of 59 early-onset scoliosis patients who had been underwent growing rod surgery at Beijing Chao-yang Hospital from September 2007 to December 2017 were reviewed. All patients had complete clinical and radiographic data. Patients were divided into groups with or without MIRC. The univariate and multivariate logistic regression analysis were performed to identify the risk factors associated MIRC.Results: The average age of insertion was 8.9 years and mean follow-up was 51.91 months. 234 implantation or expansion surgeries were performed and the average operation interval was 11.4 months. A total of 60 implant-related complications occurred. Ultimately, MIRC developed in 20 (33.9%) of 59 patients. Number of surgery procedure > 3 times , follow-up time ³50 months , preoperative thoracic kyphosis > 50°, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50°, postoperative sagittal vertical axial >40mm are potential risk factors for MIRC (P<0.1). Multivariate logistic regression analysis showed that Number of surgery procedure > 3 times, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50°are independent risk factors for MIFRC (P<0.05), Among them, patients with postoperative thoracic kyphosis >50°had an 18.647 times higher risk of MIFRC than postoperative thoracic kyphosis angle <50°.Conclusions: Traditional growing rod in the setting of EOS has excellent clinical and radiographic outcomes but a high multiple implant-related complications. Number of surgery procedure > 3 times, postoperative thoracic kyphosis >50°, postoperative lumbar lordosis >50° are independent risk factors for MIRC.

Coronal imbalance after growing rod treatment in early-onset scoliosis: a minimum of 5 years’ follow-up

2021 ◽  
pp. 1-8
Author(s):  
Liang Xu ◽  
Xu Sun ◽  
Muyi Wang ◽  
Bo Yang ◽  
Changzhi Du ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Consecutive Series ◽  
Growing Rod ◽  
Coronal Imbalance ◽  
Lowest Instrumented Vertebra ◽  
Independent Risk Factors ◽  
Type C

OBJECTIVE The objective of this study was to investigate the incidence and risk factors of coronal imbalance (CI) in patients with early-onset scoliosis (EOS) who underwent growing rod (GR) treatment. METHODS A consecutive series of 61 patients with EOS (25 boys and 36 girls, mean age 5.8 ± 1.7 years) who underwent GR treatment was retrospectively reviewed. Postoperative CI was defined as postoperative C7 translation on either side ≥ 20 mm. Patients were divided into an imbalanced and a balanced group. Coronal patterns were classified into three types: type A (C7 translation < 20 mm), type B (C7 translation ≥ 20 mm with C7 plumb line [C7PL] shifted to the concave side of the curve), and type C (C7 translation ≥ 20 mm and a C7PL shifted to the convex side of the curve). RESULTS Each patient had an average of 5.3 ± 1.0 lengthening procedures and was followed for an average of 6.2 ± 1.3 years. Eleven patients (18%) were diagnosed with CI at the latest distraction, 5 of whom graduated from GRs and underwent definitive fusion. However, these patients continued to present with CI at the last follow-up evaluation. The proportion of preoperative type C pattern (54.5% vs 16.0%, p = 0.018), immediate postoperative apical vertebral translation (30.4 ± 13.5 mm vs 21.2 ± 11.7 mm, p = 0.025), lowest instrumented vertebra tilt (11.4° ± 8.2° vs 7.3° ± 3.3°, p = 0.008), and spanned obliquity angle (SOA) (9.7° ± 10.5° vs 4.1° ± 4.5°, p = 0.006) values in the imbalanced group were significantly higher than in the balanced group. Multiple logistic regression demonstrated that a preoperative type C pattern and immediate postoperative SOA > 11° were independent risk factors for postoperative CI. CONCLUSIONS The incidence of CI in patients with EOS who underwent GR treatment was 18%. This complication could only be slightly improved after definitive spinal fusion because of the autofusion phenomenon. A preoperative type C pattern and immediate postoperative SOA > 11° were found to be the risk factors for CI occurrence at the latest follow-up.

scholarly journals The Fluoroscopic Technique for Monitoring Distraction of a Non-Invasive Lengthening Device in Early Onset Scoliosis

2014 ◽  
Vol 1 (1) ◽  
pp. 23-28 ◽  
Author(s):  
C. Thakar ◽  
S. Sonecha ◽  
D. Rolton ◽  
C. Nnadi
Keyword(s):  
Radiation Dose ◽  
Radiation Exposure ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
X Rays ◽  
Growing Rod ◽  
Non Invasive ◽  
Rod System ◽  
Effects Of Radiation

Study Design: Prospective non-randomised. Objective: To evaluate radiation exposure using fluoroscopy compared to x-rays in the monitoring of a growing rod system. Background: The integrity of implants in the treatment of early onset scoliosis (EOS) is usually monitored with repeated plain x-rays. The cumulative dosage of ionizing radiation may be high. Children are highly sensitive to the carcinogenic effects of radiation and have a longer life span in which to reflect this risk. Fluoroscopy is commonly used to obtain focused images in other areas of orthopaedics. It has the advantage of less radiation intensity due to flash exposure. We have used fluoroscopy to monitor the lengthening of a non-invasive growing rod system in the treatment of EOS. We report on the results. Methods: The technique was initially refined in vitro by performing an audit in which 10 radiographers screened a phantom spine (Plastic dummy) with an implanted non - invasive growing rod device. Pulse rate setting was 3. Average exposure time was 0.01 seconds. Average radiation dose was 0.04 μGym2. A plain x-ray of the same phantom spine yielded a radiation dose of 0.5 μGym2. Radiation exposure using fluoroscopy was compared to that received using plain radiographs in ten consecutive patients treated for EOS. There were 8 males and 2 females. Average age 5.2 years. Results: Mean radiation exposure using fluoroscopy was 0.0046 mSv compared to an average radiation exposure of 0.115 mSv using standard x-rays (p<0.003). Mean cancer induction risk was calculated to potentially reduce from 1:225,000 to 1:4.9 million. Conclusion: We would recommend fluoroscopy as a useful technique to monitor the lengthening of a non-invasive growing rod system due to the significantly smaller radiation exposure.

Thoracic Volume Follow-Up for Growing Rod Surgical Treatment in Early Onset Scoliosis Patients1

2016 ◽  
Vol 10 (3) ◽  
Author(s):  
Po-Chih Lee ◽  
Charles Ledonio ◽  
Arthur Erdman ◽  
David Polly
Keyword(s):  
Surgical Treatment ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod
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