A comparison of growth among growth-friendly systems for scoliosis: a systematic review

Wijdicks, Sebastiaan P.J.; Tromp, I.; Yazıcı, Muharrem; Kempen, Diederik H.R.; Castelein, René M.; Kruyt, Moyo C.

doi:10.1016/j.spinee.2018.08.017

Cited by 50 publications

(47 citation statements)

References 66 publications

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“…The minimal increase in rotation could indicate that this hybrid has apical control, although this assessment on plain X rays is relatively inaccurate. The mean T1S1 growth rate of 10 mm/year over 3 years is well acceptable and in accordance to physiological growth [19,20]. In general, we have the experience that conversion patients have a stiffer spine.…”

Section: Discussionsupporting

confidence: 62%

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

Wijdicks

Skov

et al. 2020

Spine Deform

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Study design Two-center retrospective cohort study. Objective The aim of this study is to investigate the clinical effectiveness and safety of the MCGR hybrid in terms of spinal growth, 3D correction, balance, and complications. Summary of background data The magnetic-controlled growing-rod (MCGR) growth instrumentation method has gained popularity for early onset scoliosis (EOS) treatment in the past years due to the non-invasiveness of the subsequent interval elongation procedures. To improve 3D correction and reduce the costs, we combined a single concave MCGR with a sliding rod on the convex side to control the apex. Methods A retrospective cohort study of 18 EOS children with an average 3-year follow-up (range 2.0-3.7) from two European spine centers treated with the single MCGR hybrid concept; 14 primary and 4 conversion cases. The primary and conversion cases were both evaluated preoperatively, postoperatively, 1 year, 2 years, and last follow-up. Results Mean age was 9.9 (SD ± 2.9 years). The average frontal Cobb angle was reduced from mean 65° to 30° postoperatively, and had increased to 37° at latest follow-up. Rotation of the apical vertebra improved from mean 27° to 20° postoperatively which was partially lost to 23°. Kyphosis and lordosis both increased by an average of 5° during the time of follow-up. Spinal balance was improved. The post-implantation T1-S1 spine growth rate averaged 10 mm/year at last follow-up. There were 13 implant-related complications in 6 out of 18 patients. No screw pull-outs and nor surgical site infections were registered. Conclusions This is the first medium-term results of a single MCGR hybrid construct. Maintenance of correction and growth are reasonable, and the complication rate is relatively low as compared to bilateral MCGR application. Level of evidence III.

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Section: Discussionsupporting

confidence: 62%

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

Wijdicks

Skov

et al. 2020

Spine Deform

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“…Having a department with a medical device certification (ISO 13,485) inside the academic hospitals allows us to develop, manufacture and use hospital-specific medical devices for clinical research, which is especially important because of the upcoming Medical Device Regulation (MDR) laws in the European Union. We first looked at the forces delivered with the MCGR and Table 1 Major curve, kyphosis, T1-T12 height and T1-S1 height per patient 1 Pre-op indicates the pre-operative X-ray before SDS implantation 2 Post-op indicates the post-operative X-ray directly after SDS implantation 3 2-year FU indicates X-ray at 2-year follow-up 4 Latest FU indicates the last available X-ray at the time of latest follow-up 5 Negative numbers indicate a lordosis and positive numbers a kyphosis When used as bilateral systems, these forces are doubled. However, these forces are applied as peak loads periodically and not continuously.…”

Section: Discussionmentioning

confidence: 99%

“…For freehand measurements, we measured the curved mid-spinal line T1-S1 on coronal and sagittal x-rays. This freehand line, that is not affected by shape changes, was drawn through the exact midpoint of the upper and lower endplate of every vertebra [3]. Finally, the spring lengths on coronal and sagittal x-rays were measured on post-operative radiographs and at latest follow-up.…”

Section: Data Collectionmentioning

confidence: 99%

“…When casts or brace treatment cannot control progression, implantation with internal growth-friendly systems is indicated [2]. Current growth-friendly systems can potentially stop curve progression while allowing the spine to maintain growth [3]. Some of these implants guide the reduced deformity by passive sliding, e.g., Shilla or Luque trolley techniques [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Although these techniques have dramatically improved our ability to treat early onset spinal deformities, some aspects can still be addressed to improve surgical outcomes: First, none of these systems dynamically stimulate growth and further reduction of the affected spinal segments. As a consequence, physiologic growth is not at all maintained [3]. Second, repeated anaesthesia and surgery, but also repeated outpatient visits and interventions have shown detrimental effects [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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The potential of spring distraction to dynamically correct complex spinal deformities in the growing child

et al. 2020

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Purpose Current treatment of progressive early onset scoliosis involves growth-friendly instrumentation if conservative treatment fails. These implants guide growth by passive sliding or repeated lengthenings. None of these techniques provide dynamic correction after implantation. We developed the spring distraction system (SDS), by using one or multiple compressed springs positioned around a standard sliding rod, to provide active continuous distraction of the spine to stimulate growth and further correction. The purpose of this study was to determine feasibility and proof of concept of the SDS. Methods We developed a versatile, dynamic spring distraction system for patients who would benefit from active continuous distraction. This prospective case series evaluates four patients with exceptional and progressive congenital spine deformities. Results Four patients had a mean age of 6.8 years at surgery with a mean follow-up of 36 months (range 25–45). The mean progressive thoracic lordosis, which was the reason for initiating surgical treatment in two patients, changed from 32° lordosis preoperatively to 1° kyphosis post-operatively. During follow-up, this further improved to 32° thoracic kyphosis. In the two other patients, with cervicothorcacic scoliosis, the main coronal curve improved from 79° pre-operatively to 56° post-operatively and further improved to 42°. The mean T1-S1 spine growth during follow-up for all patients was 1.3 cm/year. There was one reoperation because of skin problems and no device-failures. Conclusion These early results show the feasibility and the proof of concept of spring-based distraction as a dynamic growth-enhancing system with the potential of further correction of the deformity after implantation.

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Orthopedic mechanism analysis of growing rod distraction for early‐onset scoliosis based on 3D morphological parameters

Lu,

Wu,

Zhao

et al. 2023

Journal Orthopaedic Research

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Traditional growing rod provides a corrective moment for deformed segments to straighten the spine, whose clinical efficacy has proven positive and growth‐friendly. However, an insufficient understanding of orthopedic mechanisms can affect the development of clinical strategies. This research attempts to analyze the spine that has undergone four distraction operations, exploring the spinal orthopedic mechanism, including alignment, growth, and morphology. In this study, the spinal morphology curves were illustrated in three human planes to exhibit the changes in spinal alignment. The spinal growth characteristics were measured to discuss the unsynchronized and diminishing growth rate. The spinal deformations were evaluated to indicate asymmetric growth. As a result, the spinal alignment changes indicated the orthopedic process improved, but the re‐unbalance occurred after multiple distractions. Then, unsynchronized growth existed in the superior and inferior segments, and the growth rate over every distraction diminished. Finally, asymmetric growth was indicated as the axial/circumferential growth ratio getting greater and the cuneate level approaching normal. Accordingly, a traditional growing rod is growth‐friendly, but combining the osteotomy fusion of lumbar segments for severe early onset scoliosis may be an excellent choice to solve the insufficient corrective stimulation. Regarding the distraction process, reshaping before the final fusion can fix the balance loss, and a prolonged distraction frequency fits the law of diminishing return. In conclusion, studying orthopedic mechanisms based on morphological measurement can guide clinical strategy optimization.This article is protected by copyright. All rights reserved.

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A comparison of growth among growth-friendly systems for scoliosis: a systematic review

Cited by 50 publications

References 66 publications

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

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

The potential of spring distraction to dynamically correct complex spinal deformities in the growing child

Orthopedic mechanism analysis of growing rod distraction for early‐onset scoliosis based on 3D morphological parameters

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