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Abstract

This study retrospectively reviewed the clinical records and radiographs of 11 patients with progressive early-onset scoliosis who failed to respond to nonoperative management and who underwent consecutive distraction of subcutaneous rods. Eleven children were treated by consecutive distraction of subcutaneous rods, and in two patients with rodding and anterior apical fusion. At surgery, the average patient age was 5.66 years, with a mean Cobb angle of 74 degrees and an average Pedriole angle of 39 degrees. The etiology of the scoliosis included four syndromic and one each congenital, post-rib resection, post-spinal tumor resection, neurofibromatosis, myelomeningocele, infantile idiopathic, and juvenile idiopathic. Subcutaneous rodding halted curve progression in all patients. At an average of 5.1 years after surgery, one patient showed no deterioration of the curve and nine patients showed an improvement of > or =40% in the magnitude of the original curvature. Eight of these patients had already had definitive surgery performed with segmental spinal instrumentation and fusion. Spinal growth occurred in all 11 patients and ranged from 0.5 to 4.5 cm (mean 2.0). Early results from these patients show that subcutaneous rodding with consecutive distraction allows correction of progressive early-onset scoliosis that failed to respond to nonsurgical management, preserving the individual growth potential of the spinal column and delaying definitive surgical treatment. Rotational deformity did not deteriorate radiographically, but clinical deformity increased subjectively. The amount of growth achieved and the number of procedures required to obtain these results raises the question of whether patients would be better served by a single anterior, posterior fusion and instrumentation at a young age.

Results of the spine-to-rib-cage distraction in the treatment of early onset scoliosis

“…In the study group, patients with curves > 60° Cobb in the frontal plane or bending < 50% were addressed with staged anterior annulotomy and fusion 1 week prior to implantation of a growing spine profiler (GSP) rod. Less severe and rigid curves were treated with posterior implantation of GSP only 34. Anterior fusion is a growth arrest procedure traditionally aiming at preventing the occurrence of continuous anterior growth and “crankshaft” worsening deformity when serious EOS is only operated posteriorly 2–46.…”

“…Less severe and rigid curves were treated with posterior implantation of GSP only 34. Anterior fusion is a growth arrest procedure traditionally aiming at preventing the occurrence of continuous anterior growth and “crankshaft” worsening deformity when serious EOS is only operated posteriorly 2–46. Anterior fusion is performed through a thoracotomy or a thoracoabdominal approach depending on the level of maximum spinal deformity to be addressed.…”

“…Only the bottom end vertebra was decorticated and no bone graft was applied in situ to promote local arthrodesis. Two rods were then contoured for sagittal balance, connected to the hooks and/or screws and implanted in a subfascial position on the concavity of the coronal curvature as in previously designed spinal systems 47. At 10-s time interval every 2 mm of distraction was observed in order to allow for the viscoelastic properties of the spinal soft tissues to act 89.…”

“…These distraction surgeries were repeated until the child reached the maximum predicted spinal growth as indicated by the progressive ossification of the iliac apophyses and triradiate cartilages, i.e., normally around puberty 34. Between elongations, patients were prescribed the use of a molded spinal Milwakee-type brace to protect the instrumentation from undue force vectors.…”

“…The terms encompass a range of posterior spinal instrumentation techniques—namely single or dual growing rods and expandable ribs—having the common goal of obtaining progressive deformity correction without halting the growth of the spine and lungs 3. Traditional single growing rods have a reported incidence of rod breakage and deep infection of 42% and 9%, respectively 4. Dual growing rods implanted subfascially have a reported 22% rate of implant failure and a 9% rate of deep infection 2.…”