Serial casting in early onset scoliosis: syndromic scoliosis is no contraindication

Abstract Background Serial casting is a treatment for early onset scoliosis (EOS) in young children to achieve curve correction before bracing or to postpone initial surgical treatment until the patient is older. Good results have been reported for patients with idiopathic early onset scoliosis (IS). However, there are few reports of results in non-idiopathic cases, and the benefits of non-surgical methods in the syndromic-associated early onset scoliosis subgroup are unknown. Methods Retrospective single-institution study of patient charts and X-rays of all cases of sustained serial casting for EOS. Staged correction was obtained by applying three consecutive casts under general anaesthesia. These were changed every 4 weeks, followed by the implementation of a custom-made full-time Chêneau brace. Correction was measured by Cobb angle (CA) and rib-vertebra angle difference (RVAD) on whole spine anterior-posterior radiographs. Statistical analysis was performed via ANOVA. Results The study group consisted of 6 patiens with IS and 10 with non-idiopathic scoliosis (NIS) – exclusively syndromic-associated. The mean age at onset of treatment was 35 months (±15). The mean follow up was 21 months (±15). In IS patients average CA/RVAD before treatment was 46°(±8)/20°(±12). In NIS patients average CA/RVAD before treatment was 55°(±15)/24°(±14). After application of the third cast, the CA/RVAD was reduced to 20°(±11)/11°(±10) in IS patients. Whereas in NIS patients average CA/RVAD after the thrid cast was 28°(±12)/18°(±13). At latest follow-up the CA/RVAD was 16°(±7)/9°(±8) in IS patients and 31°(±11)/17° (±15) in NIS patients. Conclusion Syndromic etiology is not a contraindication for serial casting in EOS. Our results show a curve correction, measured in CA, of 65% in IS patients and 44% in NIS patients. Significant reduction in the morphologic deformity, measured in RVAD, was achieved in the IS cohort, but not in the NIS cohort. In all cases surgical treatment could be delayed.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.102b11.bjj-2020-0412.r3 ◽

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.

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Outcomes of growing rods in a series of early-onset scoliosis patients with neurofibromatosis type 1

Journal of Neurosurgery Spine ◽

10.3171/2020.2.spine191308 ◽

2020 ◽

Vol 33 (3) ◽

pp. 373-380

Author(s):

Charlie Bouthors ◽

Ruben Dukan ◽

Christophe Glorion ◽

Lotfi Miladi

Keyword(s):

Neurofibromatosis Type 1 ◽

Early Onset ◽

Neurofibromatosis Type ◽

Posterior Spinal Fusion ◽

Early Onset Scoliosis ◽

Mechanical Complication ◽

Growing Rods ◽

The Mean

OBJECTIVEEarly-onset scoliosis (EOS) is not uncommon in patients with neurofibromatosis type 1 (NF1). Despite conservative treatment, spinal deformities progress and require early surgical intervention. To avoid potential interference with chest and trunk growth, growing rods (GRs) have been used effectively in EOS of various etiologies. In this study the authors sought to analyze the outcomes of GRs in EOS patients with NF1.METHODSThis was a retrospective single-center cohort study that included consecutive EOS patients with NF1 who were treated with GRs and were followed up for a minimum of 2 years. Clinical and radiological analyses were performed preoperatively and until the last follow-up.RESULTSFrom to 2008 to 2017, 18 patients (6 male, 12 female) underwent GR surgery (14 single GRs, 4 dual GRs) at a mean age of 8 ± 2.1 years. Mean follow-up was 5 ± 2.4 years. Fifty-five lengthenings were performed at a mean rate of 3 lengthenings per patient (range 0–7). Ten of 14 single GRs (71%) were converted into dual GRs during treatment. No patient underwent definitive posterior spinal fusion (PSF) at GR treatment completion. The mean initial and last follow-up major curves were 57° and 36°, respectively (p < 0.001, 37% correction). The average T1–S1 increase was 13 mm/yr. Six of 9 hyperkyphotic patients had normal kyphosis at last follow-up. There were 26 complications involving 13 patients (72%), with 1 patient who required unplanned revision. The primary complications were instrumentation related, consisting of 17 proximal hook dislodgments, 6 distal pedicle screw pullouts, and 2 rod fractures. Only 1 patient experienced a mechanical complication after dual GR implantation. There were no wound infections.CONCLUSIONSThe GR technique provided satisfactory spinal deformity control in EOS patients with NF1 while allowing substantial spinal growth. Adequately contoured dual GRs with proximal hooks placed in nondystrophic regions should be used to minimize implant-related complications. Surgeons should not attempt to correct kyphosis at GR implantation.

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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

The Bone & Joint Journal ◽

10.1302/0301-620x.100b9.bjj-2018-0031.r2 ◽

2018 ◽

Vol 100-B (9) ◽

pp. 1187-1200 ◽

Cited By ~ 12

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.

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Magnetically controlled growing rods in the treatment of early onset scoliosis

Bone & Joint Open ◽

10.1302/2633-1462.17.bjo-2020-0099.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 405-414

Author(s):

Ahmed Abdelaal ◽

Sudarshan Munigangaiah ◽

Jayesh Trivedi ◽

Neil Davidson

Keyword(s):

Cobb Angle ◽

Early Onset ◽

Deformity Correction ◽

Early Onset Scoliosis ◽

Growing Rods ◽

Angle Correction ◽

Independent Risk Factors ◽

The Mean ◽

Magnetically Controlled Growing Rods

Aims Magnetically controlled growing rods (MCGR) have been gaining popularity in the management of early-onset scoliosis (EOS) over the past decade. We present our experience with the first 44 MCGR consecutive cases treated at our institution. Methods This is a retrospective review of consecutive cases of MCGR performed in our institution between 2012 and 2018. This cohort consisted of 44 children (25 females and 19 males), with a mean age of 7.9 years (3.7 to 13.6). There were 41 primary cases and three revisions from other rod systems. The majority (38 children) had dual rods. The group represents a mixed aetiology including idiopathic (20), neuromuscular (13), syndromic (9), and congenital (2). The mean follow-up was 4.1 years, with a minimum of two years. Nine children graduated to definitive fusion. We evaluated radiological parameters of deformity correction (Cobb angle), and spinal growth (T1-T12 and T1-S1 heights), as well as complications during the course of treatment. Results The mean Cobb angles pre-operatively, postoperatively, and at last follow-up were 70° (53 to 103), 35° (15 to 71) and 39° (15 to 65) respectively (p < 0.001). Further, there was a mean of 14° (-6 to 27) of additional Cobb angle correction upon graduation from MCGR to definitive fusion. Both T1-T12 and T1-S1 showed significant increase in heights of 27 mm and 45 mm respectively at last follow-up (p < 0.001). Ten children (23%) developed 18 complications requiring 21 unplanned operations. Independent risk factors for developing a complication were single rod constructs and previous revision surgery. Conclusion MCGR has the benefit of avoiding multiple surgeries, and is an effective tool in treatment of early-onset scoliosis. It also maintains the flexibility of the spine, allowing further correction at the time of definitive fusion. Cite this article: Bone Joint Open 2020;1-7:405–414.

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Management and results of early-onset scoliosis with dual magnetically controlled growing rods: Additional preliminary results of spinal fusion surgery

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.49 ◽

2021 ◽

Vol 32 (2) ◽

pp. 478-488

Author(s):

Ömer Faruk Kılıçaslan ◽

Mehmet Ali Tokgöz ◽

Şevket Bütün ◽

Vugar Nabi ◽

Serdar Akalın

Keyword(s):

Spinal Fusion ◽

Early Onset ◽

Early Onset Scoliosis ◽

Fusion Surgery ◽

Growing Rods ◽

Spinal Fusion Surgery ◽

Length Increase ◽

The Mean ◽

Magnetically Controlled Growing Rods

Objectives: The aim of this study was to evaluate the clinical and radiographic outcomes and complications of dual magnetically controlled growing rods (MCGRs) in the treatment of early-onset scoliosis (EOS) and to investigate the results of patients with definitive spinal fusion following MCGR. Patients and methods: A total of 15 patients (7 males, 8 females; mean age: 8.7±1.7 years; range, 6 to 10 years) with EOS who underwent dual MCGR and were prospectively followed between February 2013 and March 2019 were included in this retrospective study. The Cobb angle, thoracic kyphosis, and the length of the spine between T1-T12 and T1-S1 were measured on preoperative, postoperative, and follow-up radiographs. The 24-Item Early-Onset Scoliosis Questionnaire (EOSQ-24) was used to assess the functional outcomes before and after the operation. All complications during the treatment were recorded. Results: The mean follow-up was 27.8±10.4 (range, 12 to 60) months. The mean curve correction immediately after the index surgery and latest follow-up was 47.6% and 42.4%, respectively (p>0.05). At the last follow-up, there were no significant changes in mean Cobb and kyphosis angles. The mean T1-T12 length increase was 26.2±7.1 (range, 16 to 40) mm, while the mean T1-S1 length increase was 43.3±15.0 (range, 24 to 70) mm. Complications developed in four (26.6%) of 15 patients. Definitive spinal fusion surgery was performed in seven patients. Total mean Cobb angle difference between the final follow-up and fusion surgery was 9.3° (p=0.016) and kyphosis angle difference was -2.1° (p=0.349). After fusion surgery, total lengthening in T1-T12 and T1-S1 distance was 10.5 mm (p=0.036) and 15.0 mm (p=0.022), respectively. A significant increase in all subdomain scores of the EOSQ-24 (p<0.05), except for financial impact, was recorded in all patients. Conclusion: Dual MCGR technique is an effective, reliable, and robust treatment alternative for primary EOS. However, surgeons should be aware of the relatively high rate of complications. In addition, residual deformity can be corrected successfully with definitive surgery.

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Pulmonary function and health-related quality of life in patients with early onset scoliosis after repeated traditional growing rod procedures

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.210021 ◽

2021 ◽

pp. 1-7

Author(s):

Wen-Chieh Chang ◽

Kuei-Hsiang Hsu ◽

Chi-Kuang Feng

Keyword(s):

Quality Of Life ◽

Pulmonary Function ◽

Early Onset ◽

Early Onset Scoliosis ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

The Mean

Purpose The purpose of this study was to investigate pulmonary function and health-related quality of life after traditional growing rod (TGR) procedures. Methods Between January 2006 and December 2017, a retrospective observational study of 17 early onset scoliosis (EOS) patients with a mean follow-up of 6.2 years (2.3 to 10.4) was conducted. The forced expiratory volume in one second (FEV1), expiratory forced vital capacity (FVC) and 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) score before the index surgery and at last follow-up were investigated. Results The mean percentage of predicted FEV1 improved from 50% (20% to 86%) to 53% (15% to 80%; p = 0.08); and the mean percentage of predicted FVC improved from 51% (24% to 81%) to 55% (25% to 89%; p = 0.06). The mean EOSQ-24 score was 78.2 (58 to 90) preoperatively and 77.2 (55 to 88) at last follow-up, there was no statistical difference (p = 0.70). The subdomain scores of pulmonary function (p < 0.01) and daily living (p < 0.01) significantly improved, whereas the subdomain scores of pain (p < 0.01), emotion (p < 0.01) and satisfaction (p = 0.02) significantly declined at last follow-up. Conclusion The TGR procedure was associated with stable pulmonary function and decline in EOSQ-24 pain, emotion and satisfaction scores. Level of Evidence Level III, retrospective cohort study.

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Thoracogenic spinal deformity: a rare cause of early-onset scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2018.4.spine171389 ◽

2018 ◽

Vol 29 (6) ◽

pp. 674-679 ◽

Cited By ~ 5

Author(s):

Sarah F. Eby ◽

Tricia St. Hilaire ◽

Michael Glotzbecker ◽

John Smith ◽

Klane K. White ◽

...

Keyword(s):

Cobb Angle ◽

Chest Wall ◽

Early Onset ◽

Early Onset Scoliosis ◽

Congenital Defects ◽

Scoliosis Surgery ◽

Severe Scoliosis ◽

Spine Deformities ◽

The Mean

OBJECTIVESurgery for severe congenital defects, such as congenital diaphragmatic hernia, congenital heart defects, and tracheoesophageal disorders, are life-saving treatments for many infants. However, the incidence of scoliosis following thoracoabdominal surgery has been reported to range from 8% to 50%. Little is known about severe scoliosis that occurs after chest wall procedures in infants. The authors sought to determine the prevalence of thoracogenic scoliosis, disease severity, and need for scoliosis surgery in patients who underwent chest wall procedures in early childhood.METHODSA multicenter database of patients with early-onset scoliosis was queried to identify patients with a history of thoracogenic or acquired iatrogenic scoliosis. Patients with significant congenital spine deformities were excluded. Forty-one patients (1.6%) were noted to have thoracogenic scoliosis. Of these patients, 14 patients were observed; 10 received casts and/or braces; and 17 underwent treatment with rib-based distraction rods, Shilla procedures, or spine-based growing rod devices. Radiographs, complications, and patient characteristics were reviewed.RESULTSThe mean age at scoliosis diagnosis for the 41 patients was 6.0 years. The mean time to follow-up was 2.9 years (4.5 years in the 17 surgical patients). The mean preoperative coronal Cobb angle in the surgical group was 65° and improved to 47° postoperatively (p = 0.01). The mean Cobb angle for the nonoperative group was 31° initially and 32° at follow-up (p = 0.44). Among the 17 patients undergoing surgery for scoliosis, there were 13 complications in 7 patients, including a brachial plexus palsy following rib-based distraction rod placement. This resolved with revision of the rib hooks. There were no known complications in the nonoperative cohort.CONCLUSIONSSevere scoliosis can develop after thoracoabdominal surgeries during infancy. Further work is needed to understand the pathogenesis of scoliosis in this population so as to implement measures for prevention and early diagnosis and to guide appropriate treatment.

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

Journal of Medical Devices ◽

10.1115/1.4033737 ◽

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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Magnetically controlled growing rods in the treatment of early onset scoliosis

Bone & Joint Open ◽

10.1302/2046-3758.17.bjo-2020-0099.r1 ◽

2020 ◽

Vol 1 (7) ◽

pp. 405-414

Author(s):

Ahmed Abdelaal ◽

Sudarshan Munigangaiah ◽

Jayesh Trivedi ◽

Neil Davidson

Keyword(s):

Cobb Angle ◽

Early Onset ◽

Deformity Correction ◽

Early Onset Scoliosis ◽

Growing Rods ◽

Angle Correction ◽

Independent Risk Factors ◽

The Mean ◽

Magnetically Controlled Growing Rods

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Frequent Small Distractions with a Magnetically Controlled Growing Rod for Early-Onset Scoliosis and Avoidance of the Law of Diminishing Returns

Journal of Orthopaedic Surgery ◽

10.1177/1602400312 ◽

2016 ◽

Vol 24 (3) ◽

pp. 332-337 ◽

Cited By ~ 25

Author(s):

Jason Pui Yin Cheung ◽

Cora Bow ◽

Dino Samartzis ◽

Kenny Kwan ◽

Kenneth Man Chee Cheung

Keyword(s):

Cobb Angle ◽

Early Onset ◽

Early Onset Scoliosis ◽

Growing Rod ◽

Diminishing Returns ◽

The Mean ◽

The Law ◽

Magnetically Controlled Growing Rod ◽

Length Gain

Purpose To assess the effect of frequent small distractions with a magnetically controlled growing rod (MCGR) on spinal length gain and achieved distraction length in children with early-onset scoliosis (EOS), and to determine whether the law of diminishing returns applies to this group of patients with MCGR. Methods A consecutive series of 3 males and 4 females with EOS who underwent MCGR implantation at a mean age of 10.2 years and were followed up for a mean of 3.8 years were reviewed. Distraction was aimed at 2 mm monthly. The coronal Cobb angle, T1-S1 length gain, and achieved distraction length were measured at 6-monthly intervals. Results The mean total number of distractions was 31. Four of the patients had problems that may have affected distractions. The mean coronal Cobb angle improved post-operatively and was maintained throughout the follow-up period. The mean T1-S1 length gain and achieved distraction length varied over the follow-up period and did not diminish with repeated lengthening. Conclusions Frequent small distractions with the MCGR for EOS enable T1-S1 and achieved distraction length gain without significant reduction in gain after repeated lengthening.

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