Growing rod concepts: state of the art

BackgroundThe therapeutic efficacy of serial casting on idiopathic scoliosis has been gradually documented. However, literatures on serial casting for congenital scoliosis (CS) remain extremely rare. This paper aimed to compare the treatment outcomes of serial casting between CS and non-CS patients to comprehensively evaluate the therapeutic characteristics of serial casting on CS patients.MethodsA total of 23 early-onset scoliosis cases were included and divided into congenital scoliosis (CS, n = 8) and non-congenital group (non-CS, n = 15). Therapeutic outcomes including the major curve Cobb angle, thoracic kyphosis angle, lumbar lodosis angle, and thoracic spine growing rate were compared between groups at precast, after the first cast, and at the latest follow-up, respectively.ResultsAll patients received the first cast at the age of 3.25 ± 1.20 years and 5.70 ± 1.18 times of cast corrections. The average casting time was 17.17 ± 3.38 months, and the mean follow-up time was 23.91 ± 12.28 months. Both CS and non-CS groups had significant decrease in Cobb angle after the first cast and at the latest follow-up (all P < 0.05). Cobb angle was significantly lower in non-CS group than in CS group at both time points (all P < 0.01). The correction rate of Cobb angle was significantly higher in non-CS group than in CS group (around 50 vs. 20%, both P < 0.01). The mean thoracic growth rate was significantly lower in CS group than in non-CS group (0.72 ± 0.20 vs. 1.42 ± 0.22 cm/year, P < 0.001). At the latest follow-up, there are 2 cases receiving growing rod surgery, 8 cases wearing a brace, and 13 cases continuing serial casting.ConclusionsAlthough the therapeutic efficacy of casting on CS patients is not as good as that on non-CS patients, casting is still an efficient treatment option for CS patients to delay the need for initial surgery.

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“…Growing rod surgery is a most widely used operative technique [5]. However, its implant-related complications are frequent [6, 7].…”

Section: Introductionmentioning

confidence: 99%

The therapeutic characteristics of serial casting on congenital scoliosis: a comparison with non-congenital cases from a single-center experience

et al. 2017

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“…Growing rods (36) are used for adjustable fixation constructs in scoliosis correction surgery (Figs 9, 10). In a growing rod construct, one or two rods are fixed to the screws or hooks above and below the scoliotic curve.…”

Section: Rodsmentioning

confidence: 99%

Postoperative Spinal CT: What the Radiologist Needs to Know

Ghodasara

Clark

et al. 2019

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During the past 2 decades, the number of spinal surgeries performed annually has been steadily increasing, and these procedures are being accompanied by a growing number of postoperative imaging studies to interpret. CT is accurate for identifying the location and integrity of implants, assessing the success of decompression and intervertebral arthrodesis procedures, and detecting and characterizing related complications. Although postoperative spinal CT is often limited owing to artifacts caused by metallic implants, parameter optimization and advanced metal artifact reduction techniques, including iterative reconstruction and monoenergetic extrapolation methods, can be used to reduce metal artifact severity and improve image quality substantially. Commonly used and recently available spinal implants and prostheses include screws and wires, static and extendable rods, bone grafts and biologic materials, interbody cages, and intervertebral disk prostheses. CT assessment and the spectrum of complications that can occur after spinal surgery and intervertebral arthroplasty include those related to the position and integrity of implants and prostheses, adjacent segment degeneration, collections, fistulas, pseudomeningoceles, cerebrospinal fluid leaks, and surgical site infections. Knowledge of the numerous spinal surgery techniques and devices aids in differentiating expected postoperative findings from complications. The various types of spinal surgery instrumentation and commonly used spinal implants are reviewed. The authors also describe and illustrate normal postoperative spine findings, signs of successful surgery, and the broad spectrum of postoperative complications that can aid radiologists in generating reports that address issues that the surgeon needs to know for optimal patient management.©RSNA, 2019.

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“…1,6 Harrington rods are considered the precursors of the lengthening methods available nowadays. 7 In the late 70s and early 80s, these rods were used without vertebral fusion in patients with EPAT. They were inserted under the subcutaneous cellular tissue to produce stabilizing effects, rather like an "internal brace", which was complemented with an external postoperatory brace.…”

Section: Introductionmentioning

confidence: 99%

“…They were inserted under the subcutaneous cellular tissue to produce stabilizing effects, rather like an "internal brace", which was complemented with an external postoperatory brace. 7 The rods were periodically elongated upon finding an increase of 10 or more degrees in the deformity, which explains the unsatisfactory results of this treatment. 7 In addition, the instrumented segments only achieved 84% of the expected longitudinal growth, which contravened the purpose of the treatment.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Growing Rods in the Treatment of Scoliosis in Children Under 10

et al. 2019

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Objective: To determine the efficacy and safety of growing rods in the treatment of scoliosis in children aged under 10 years. Methods: A retrospective review of medical records of patients under 10 with scoliosis, treated with growing rods from the period between 1997 and 2012. Results: We identified 35 patients treated with growing rods who met the selection criteria. The average age at the start of treatment was 5.9 ± 2.3 years. Most of the patients (51.4%) showed idiopathic etiology scoliosis. Pre-surgery and post-surgery radiographic change showed a 47.7% reduction in Cobb angle (p>0.001). We identified 8 patients with some complication, the most prevalent being instrumentation failure (22.9%). The only predicting factor for post-operative complications was the total number of lengthenings performed (OR=7.03; CI 95% [1.1-45.4]; p=0.040). Conclusions: Treatment of scoliosis with growing rods in patients aged under 10 achieved a significant reduction in the magnitude of the deformity before final bone fusion. However, the rate of complications is rather high, therefore we recommend reducing the frequency of lengthenings to the minimum needed to maintain correction and longitudinal growth of the spine. Level of Evidence IV; Case series.

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Growing rod concepts: state of the art

Cited by 39 publications

References 38 publications

The therapeutic characteristics of serial casting on congenital scoliosis: a comparison with non-congenital cases from a single-center experience

The therapeutic characteristics of serial casting on congenital scoliosis: a comparison with non-congenital cases from a single-center experience

Postoperative Spinal CT: What the Radiologist Needs to Know

Efficacy and Safety of Growing Rods in the Treatment of Scoliosis in Children Under 10

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