Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

Abstract Background Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. Methods In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. Results A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5–8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24–55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. Conclusions Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

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

10.21203/rs.3.rs-1078273/v1 ◽

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.

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Outcomes of growing rod surgery for severe compared with moderate early-onset scoliosis

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1490.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 772-779 ◽

Cited By ~ 5

Author(s):

I. J. Helenius ◽

H. M. Oksanen ◽

A. McClung ◽

J. B. Pawelek ◽

M. Yazici ◽

...

Keyword(s):

Neurological Deficit ◽

Early Onset ◽

Early Onset Scoliosis ◽

Major Curve ◽

Growing Rods ◽

Growing Rod ◽

Initial Surgery ◽

Severe Group ◽

The Mean

AimsThe aim of this study was to compare the outcomes of surgery using growing rods in patients with severe versus moderate early-onset scoliosis (EOS).Patients and MethodsA review of a multicentre EOS database identified 107 children with severe EOS (major curve ≥ 90°) treated with growing rods before the age of ten years with a minimum follow-up of two years and three or more lengthening procedures. From the same database, 107 matched controls with moderate EOS were identified.ResultsThe mean preoperative major curve was 101° (90 to 139) in the severe group and 67° (33° to 88°) in the moderate group (p < 0.001), which was corrected at final follow-up to 57° (10° to 96°) in the severe group and 40° (3° to 85°) in the moderate group (p < 0.001). T1-S1 height increased by a mean of 54 mm (-8 to 131) in the severe group and 27 mm (-4 to 131) in the moderate group at the initial surgery (p < 0.001), and by 50 mm (-17 to 200) and 54 mm (-11 to 212), respectively, during distraction (p = 0.84). The mean number of complications per patient was 2.6 (0 to 14) in the severe group and 1.9 (0 to 10) in the moderate group (p = 0.040). Five patients (4.7%) in the severe group and three (2.8%) in the moderate group developed a neurological deficit postoperatively (p = 0.47).ConclusionSevere EOS can be treated effectively using growing rods, but the risk of complications is high. Cite this article: Bone Joint J 2018;100-B:772–9.

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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

Spine Deformity ◽

10.1007/s43390-021-00335-1 ◽

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04221-9 ◽

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.

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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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Short Segment Spinal Instrumentation in Early-onset Scoliosis Patients Treated With Magnetically Controlled Growing Rods

Spine ◽

10.1097/brs.0000000000002265 ◽

2017 ◽

Vol 42 (24) ◽

pp. 1888-1894 ◽

Cited By ~ 7

Author(s):

Ahmed Majid Heydar ◽

Serdar Şirazi ◽

Erhan Okay ◽

Görkem Kiyak ◽

Murat Bezer

Keyword(s):

Early Onset ◽

Spinal Instrumentation ◽

Early Onset Scoliosis ◽

Short Segment ◽

Growing Rods ◽

Magnetically Controlled Growing Rods

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Paper #20 Health-Related Quality of Life in Early-Onset Scoliosis Patients Treated Surgically: EOSQ Scores in Traditional Growing Rod vs. Magnetically-Controlled Growing Rods

Spine Deformity ◽

10.1016/j.jspd.2016.09.025 ◽

2016 ◽

Vol 4 (6) ◽

pp. 455

Author(s):

Muharrem Yazici ◽

H. Gokhan Demirkiran ◽

Z. Deniz Olgun ◽

Gizem Irem Kinikli ◽

Senol Bekmez ◽

...

Keyword(s):

Quality Of Life ◽

Early Onset ◽

Early Onset Scoliosis ◽

Health Related Quality ◽

Growing Rods ◽

Growing Rod ◽

Related Quality ◽

Health Related ◽

Magnetically Controlled Growing Rods

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Sagittal Plane Deformities in Children with SMA2 following Posterior Spinal Instrumentation

Children ◽

10.3390/children8080703 ◽

2021 ◽

Vol 8 (8) ◽

pp. 703

Author(s):

Matthew A. Halanski ◽

Rewais Hanna ◽

James Bernatz ◽

Max Twedt ◽

Sarah Sund ◽

...

Keyword(s):

Thoracic Kyphosis ◽

Sagittal Plane ◽

Muscular Atrophy ◽

Posterior Instrumentation ◽

Spinal Instrumentation ◽

Spinal Muscular Atrophy Type ◽

Growing Rods ◽

Sagittal Deformity

This is a retrospective radiographic review to assess post-operative sagittal plane deformities in patients with Spinal Muscular Atrophy type 2 that had been treated with posterior spinal instrumentation. Thirty-two patients with a history of either spinal fusion (N = 20) or growing rods (N = 12) were identified with an average of 7.6 (2.1–16.6) years post-operative follow-up. Forty percent (13/32) of the patients were identified as having obvious “tucked chin” (N = 4), “tipped trunk” (N = 9), or both (N = 3). Sacral incidence was the only parameter that was statistically significant change between pre-operative or immediate post-operative measurements (66.9° vs. 55.2° p = 0.03). However, at final follow-up, the post-operative thoracic kyphosis had decreased over time in those that developed a subsequent sagittal deformity (24.2°) whereas it increased in those that did not (44.7°, p = 0.008). This decrease in thoracic kyphosis throughout the instrumented levels, resulted in a greater lordotic imbalance (30.4° vs. 5.6°, p = 0.001) throughout the instrumented levels in the group that developed the subsequent cervical or pelvic sagittal deformities. In conclusion, sagittal plane deformities commonly develop outside the instrumented levels in children with SMA type 2 following posterior spinal instrumentation and may be the result of lordotic imbalance that occurs through continued anterior growth following posterior instrumentation.

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Traditional growing rod for early-onset scoliosis in high-altitude regions: a retrospective study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02639-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Haijun Jiang ◽

Junrui Jonathan Hai ◽

Peng Yin ◽

Qingjun Su ◽

Shiqi Zhu ◽

...

Keyword(s):

Cobb Angle ◽

High Altitude ◽

Early Onset ◽

Repeated Measures ◽

Early Onset Scoliosis ◽

Sacral Slope ◽

Growing Rods ◽

Initial Surgery ◽

Radiographic Measurements

Abstract Background Children with early-onset scoliosis living in high-altitude areas have severe deformities and poor nutritional status. However, no reports on early-onset scoliosis treatment using traditional growing rods in such children exist. Thus, we analyzed the outcomes of traditional growing rods treatment in such patients and the effect of altitude on therapy. Methods Between September 2007 and December 2017, 59 consecutive patients with EOS underwent systematic surgical correction using traditional growing rods. They were divided into the high-altitude and low-altitude groups, and differences in surgical efficacy and complications between the groups were analyzed pre- and postoperatively. Radiographic measurements, including the Cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 and T1–T12 heights, sagittal and coronal balance, distance between C7PL and sagittal vertical axis, pelvic incidence, sacral slope, and pelvic tilt were assessed preoperatively, postoperatively, and at the last follow-up. Continuous data were analyzed using paired or independent Student’s t tests, and they were compared preoperatively, postoperatively, and at the last follow-up using a repeated measures analysis of variance. Enumerated data were analyzed using the χ2 test. Results The mean patient age at the initial surgery and mean follow-up duration were 8.9 ± 2.4(5–14) years and 51.91 ± 25.23 months, respectively. Altogether, 234 operations were conducted for all patients with an average interval between operations of 11.4 ± 3.0 months. The average Cobb angle was similar in both groups preoperatively and at the last follow-up, it was significantly different postoperatively. TK was significantly different in all three periods. T1–S1 and T1–T12 heights were significantly different only during the preoperative period. The overall rates of complications and implant-related complications did not differ significantly between the groups. Conclusions Deformity in patients with EOS in high-altitude areas was more severe, and treatment using TGRs yielded a satisfactory therapeutic effect.

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