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.

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.

Longitudinal Pilot Analysis of Radiation Exposure During the Course of Growing Rod Treatment for Early-Onset Scoliosis

2016 ◽  
Vol 4 (1) ◽  
pp. 55-58 ◽  
Author(s):  
Gregory M. Mundis ◽  
Jeff B. Pawelek ◽  
Edward K. Nomoto ◽  
Michael W. Hennessy ◽  
Burt Yaszay ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod

scholarly journals Comparative Study of the Results and Complications of the Growing Rod System versus VEPTR System for the Treatment of Early Onset Scoliosis

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554429-s-0035-1554429
Author(s):  
Carlos Montero ◽  
David Meneses ◽  
Fernando Alvarado ◽  
Wilmer Godoy ◽  
Julian Zuluaga ◽  
...  
Keyword(s):  
Comparative Study ◽  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod ◽  
System Versus ◽  
Rod System

scholarly journals Optimization of X-ray Investigations in Dentistry Using Optical Coherence Tomography

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4554
Author(s):  
Ralph-Alexandru Erdelyi ◽  
Virgil-Florin Duma ◽  
Cosmin Sinescu ◽  
George Mihai Dobre ◽  
Adrian Bradu ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Radiation Dose ◽  
Imaging Techniques ◽  
Image Resolution ◽  
Optical Coherence ◽  
X Rays ◽  
High Quality ◽  
X Ray

The most common imaging technique for dental diagnoses and treatment monitoring is X-ray imaging, which evolved from the first intraoral radiographs to high-quality three-dimensional (3D) Cone Beam Computed Tomography (CBCT). Other imaging techniques have shown potential, such as Optical Coherence Tomography (OCT). We have recently reported on the boundaries of these two types of techniques, regarding. the dental fields where each one is more appropriate or where they should be both used. The aim of the present study is to explore the unique capabilities of the OCT technique to optimize X-ray units imaging (i.e., in terms of image resolution, radiation dose, or contrast). Two types of commercially available and widely used X-ray units are considered. To adjust their parameters, a protocol is developed to employ OCT images of dental conditions that are documented on high (i.e., less than 10 μm) resolution OCT images (both B-scans/cross sections and 3D reconstructions) but are hardly identified on the 200 to 75 μm resolution panoramic or CBCT radiographs. The optimized calibration of the X-ray unit includes choosing appropriate values for the anode voltage and current intensity of the X-ray tube, as well as the patient’s positioning, in order to reach the highest possible X-rays resolution at a radiation dose that is safe for the patient. The optimization protocol is developed in vitro on OCT images of extracted teeth and is further applied in vivo for each type of dental investigation. Optimized radiographic results are compared with un-optimized previously performed radiographs. Also, we show that OCT can permit a rigorous comparison between two (types of) X-ray units. In conclusion, high-quality dental images are possible using low radiation doses if an optimized protocol, developed using OCT, is applied for each type of dental investigation. Also, there are situations when the X-ray technology has drawbacks for dental diagnosis or treatment assessment. In such situations, OCT proves capable to provide qualitative images.

Retrieval and clinical analysis of distraction-based dual growing rod constructs for early-onset scoliosis

2017 ◽  
Vol 17 (10) ◽  
pp. 1506-1518 ◽  
Author(s):  
Genevieve Hill ◽  
Srinidhi Nagaraja ◽  
Behrooz A. Akbarnia ◽  
Jeff Pawelek ◽  
Paul Sponseller ◽  
...  
Keyword(s):  
Early Onset ◽  
Clinical Analysis ◽  
Early Onset Scoliosis ◽  
Growing Rod

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.

scholarly journals Radiation dose from common radiological investigations and cumulative exposure in children with cystic fibrosis: an observational study from a single UK centre

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017548 ◽  
Author(s):  
Rebecca Ward ◽  
William D Carroll ◽  
Paula Cunningham ◽  
Sheng-Ang Ho ◽  
Mary Jones ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Radiation Dose ◽  
Radiation Exposure ◽  
Cumulative Exposure ◽  
X Rays ◽  
Modern Equipment ◽  
Increased Risk ◽  
Risk Of Malignancy ◽  
The Mean ◽  
Cumulative Radiation Exposure

ObjectivesCumulative radiation exposure is associated with increased risk of malignancy. This is important in cystic fibrosis (CF) as frequent imaging is required to monitor disease progression and diagnose complications. Previous estimates of cumulative radiation are outdated as the imaging was performed on older equipment likely to deliver higher radiation. Our objectives were to determine the radiation dose delivered to children during common radiological investigations using modern equipment and to identify the number of such investigations performed in a cohort of children with CF to calculate their cumulative radiation exposure.Design, setting and participantsData including age at investigation and radiation exposure measured as estimated effective dose (EED) were collected on 2827 radiological studies performed on children at one UK paediatric centre. These were combined with the details of all radiological investigations performed on 65 children with CF attending the same centre to enable calculation of each child’s cumulative radiation exposure.ResultsThe mean EED for the common radiological investigations varied according to age. The range was 0.01–0.02 mSv for chest X-rays, 0.03–0.11 mSv for abdominal X-rays, 0.57–1.69 mSv for CT chest, 2.9–3.9 mSv for abdominal and pelvic CT, 0.20–0.21 mSv for sinus CT and 0.15–0.52 mSv for fluoroscopy-guided procedures. The mean EED was three to five times higher for helical compared with axial chest CT scans. The mean annual cumulative EED for our cohort of children with CF was 0.15 mSv/year with an estimated cumulative paediatric lifetime EED (0–18 years) of 3.5 mSv.ConclusionsThis study provides up-to-date estimations of the radiation exposure when using common radiological investigations. These doses and the estimates of cumulative radiation exposure in children with CF are lower than previously reported. This reflects the reduced EED associated with modern equipment and the use of age-specific scanning protocols.

Complications of Growing-Rod Treatment for Early-Onset Scoliosis

2010 ◽  
Vol 92 (15) ◽  
pp. 2533-2543 ◽  
Author(s):  
Shay Bess ◽  
Behrooz A Akbarnia ◽  
George H Thompson ◽  
Paul D Sponseller ◽  
Suken A Shah ◽  
...  
Keyword(s):  
Early Onset ◽  
Early Onset Scoliosis ◽  
Growing Rod
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