Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Chen, Zhonghui; Song, Li; Qiu, Yong; Zhu, Zezhang; Chen, Xi; Xu, Liang; Sun, Xu

doi:10.3171/2017.7.peds17233

Cited by 13 publications

(9 citation statements)

References 24 publications

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“…Chen growth and coronal correction, these authors found better sagittal correction with GRs (44% vs 23%, p < 0.001). 25 Also, we do recommend rib fixation since ribs are very fragile in this condition, even if they are not dystrophic.…”

Section: Discussionmentioning

confidence: 99%

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

Bouthors¹,

Dukan²,

Glorion³

et al. 2020

Journal of Neurosurgery: Spine

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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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Section: Discussionmentioning

confidence: 99%

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

Bouthors¹,

Dukan²,

Glorion³

et al. 2020

Journal of Neurosurgery: Spine

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“…Incidence and mechanism of PJK after GR treatment According to previous studies, the incidence of PJK in EOS patients after GR treatment varied from 12% to 56%, which was mainly due to different inclusion criteria and surgical strategies [10][11][12]. The incidence of PJK in our study cohort was 21.1% over an average 52.8±22.2 months of follow-up.…”

Section: Discussionmentioning

confidence: 71%

“…This is also consistent with previous research. Chen et al [10] reported that hyperkyphotic EOS (TK≥50°) tended to experience increased complications, such as rod fracture and PJK. Lee et al [25] pointed out that correction surgery would impact the overall sagittal balance of the spine and PJK might be an early-stage adjustment of the overall balance compensation by the trunk.…”

Section: General Risk Factors Of Pjkmentioning

confidence: 99%

“…Chen [9] reported occurrence of PJK in 21 of 113 congenital scoliosis (CS) children who underwent posterior instrumented fusion. At the same time, PJK was reported in EOS patients who accepted growth-friendly treatment, such as vertical expandable prosthetic titanium rib technique(VEPTR) [10] and growing rods treatment(GR) [11], with a rate ranging from 12-56% [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Mismatch Between Proximal Rod Contour Angle and Proximal Junctional Angle: A Risk Factor Associated with Proximal Junctional Kyphosis After Growing Rods Treatment for Early-Onset Scoliosis

Yang

Qiu

et al. 2020

Preprint

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Study Design: A retrospective studyObjectives: To investigate the impact of radiological and surgical factors as well as proximal rod contouring angle (PRCA) on the development of proximal junctional kyphosis (PJK) in early-onset scoliosis(EOS) patients after growing rod (GR) treatment.Methods: We reviewed a consecutive series of EOS patients who had undergone growing rod (GR) treatment between 2009 and 2018 (minimum follow-up of 2 years) at a single institution. Patients were divided into PJK and non-PJK groups according to the occurrence of PJK or not during the follow-up periods. The demographic data, surgical strategies, and radiographic parameters were recorded and compared between the PJK and non-PJK groups. PJK was defined as a PJA＞10° at the last follow-up. PRCA was defined as the angle between the cephalad endplate of the UIV and the lower endplate of the second vertebra caudal to UIV and the PJA-PRCA was defined as the difference between the values of PJA and PRCA. Logistic regression was also performed to identify the risk factors for the occurrence of PJK.Results: This study finally included 95 patients. The mean age at the index surgery was 6.5±2.2 years. Mean follow-up lasted 4.4±1.9 years. Lengthening procedures averaged 4.0 ± 1.8 times. There were 20 patients who were observed with PJK (the incidence, 21.1%). In comparison with the non-PJK group, the PJK group showed a larger preoperative coronal cobb angle (81.8±20.6° vs 70.4±12.4°, P=0.041) and global kyphosis (GK) (56.0±15.3° vs. 45.9±12.9°, P=0.044), as well as a larger GK correction (40.4%±10.0% vs. 30.0%±14.2%, P=0.035). In addition, the PJK group had significantly larger postoperative PJA (10.8±3.1 vs. 5.3±3.1, P＜0.001) and greater postoperative PJA-PRCA (5.3±3.0 vs. 3.66±2.9, P=0.031). The proportion of patients with a value of PJA-PRCA greater than 5° in PJK group was significantly higher than that in the non-PJK group. Multiple logistic regression showed that preoperative GK＞50°, postoperative PJA＞10 and postoperative PJA-PRCA＞5° were the risk factors in predicting PJK after GR treatment.Conclusions: More than one-fifth EOS patients experienced PJK after GR treatment. Besides greater preoperative GK and larger postoperative PJA, PJA-PRCA mismatch may be an independent risk factor of PJK occurrence.

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“…This is also consistent with previous research. Chen et al [ 10 ] reported that hyperkyphotic EOS (TK ≥ 50°) tended to experience increased complications, such as rod fracture and PJK. Lee et al [ 25 ] pointed out that correction surgery would impact the overall sagittal balance of the spine and PJK might be an early-stage adjustment of the overall balance compensation by the trunk.…”

Section: Discussionmentioning

confidence: 99%

Unmatched rod contouring at the proximal end predisposes to occurrence of junctional kyphosis in early-onset scoliosis patients undergoing traditional growing rods treatment

Yang

Wang

et al. 2022

BMC Musculoskelet Disord

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Study design A retrospective case series. Objective To investigate whether unmatched rod contouring at the proximal end predisposed to the occurrence of proximal junctional kyphosis (PJK) in early-onset scoliosis (EOS) patients after traditional growing rods (TGR) treatment. Summary of background data TGR treatment has become a mainstay of treatment for EOS patients. PJK is one of the most common alignment-related complications. Methods A consecutive series of EOS patients who had undergone TGR treatment were retrospectively reviewed. They were divided into PJK and non-PJK groups according to the occurrence of PJK or not. Demographic data, surgical strategies, and radiographic parameters were recorded and compared between groups. Proximal junctional angle (PJA) was defined as the angle between the caudal endplate of the UIV and the cephalad endplate of the second supradjacent vertebra above the UIV, while proximal rod contouring angle (PRCA) was defined as the angle of proximal rod contouring, which was represented by the angle between the cephalad endplate of the UIV and the caudal endplate of the second vertebra caudal to the UIV. Unmatched proximal rod contouring was regarded if the postoperative PRCA-PJA difference was greater than 5°. Results This study finally included 73 patients. The mean age at the index surgery was 6.5 ± 2.2 years (range, 2–10 years). Mean follow-up lasted 5.0 ± 1.7 years (range, 2–9 years). They received mean 4.6 ± 1.6 lengthening procedures. There were 13 patients who were observed with PJK (18%). In comparison with the non-PJK group, the PJK group showed a larger preoperative major curve (82 ± 21° vs 70 ± 17°, P = 0.041) and global kyphosis (57 ± 6° vs. 44 ± 15°, P = 0.044). In addition, the PJK group had significantly larger postoperative PJA (10 ± 3 vs. 5 ± 3, P<0.001) and greater postoperative PJA-PRCA (6 ± 3 vs. 3 ± 3, P = 0.031). The proportion of patients with unmatched proximal rod contouring in PJK group was significantly higher than that in the non-PJK group (69% vs. 25%). Multiple logistic regression showed that preoperative GK>50°, postoperative PJA>10 and postoperative unmatched proximal rod contouring were the risk factors in predicting PJK after TGR treatment. Conclusion Approximately 18% EOS patients experienced PJK after TGR treatment. Unmatched proximal rod contouring may be an independent risk factor of PJK occurrence, in addition to greater preoperative GK and larger postoperative PJA. Level of evidence 3.

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Evolution of the postoperative sagittal spinal profile in early-onset scoliosis: is there a difference between rib-based and spine-based growth-friendly instrumentation?

Cited by 13 publications

References 24 publications

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

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

Mismatch Between Proximal Rod Contour Angle and Proximal Junctional Angle: A Risk Factor Associated with Proximal Junctional Kyphosis After Growing Rods Treatment for Early-Onset Scoliosis

Unmatched rod contouring at the proximal end predisposes to occurrence of junctional kyphosis in early-onset scoliosis patients undergoing traditional growing rods treatment

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