Growing rod technique with prior foundation surgery and sublaminar taping for early-onset scoliosis

Chiba, Takafumi; Inami, Satoshi; Moridaira, Hiroshi; Takeuchi, Daisaku; Sorimachi, Tsuyoshi; Ueda, Haruki; Ohe, Makoto; Aoki, Hiromichi; Iimura, Takuya; Nohara, Yutaka; Taneichi, Hiroshi

doi:10.3171/2020.4.spine2036

Cited by 5 publications

(4 citation statements)

References 17 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The optimal distal anchor configurations have been subject to much debate, and a foundation composed of four pedicle screws with a cross-link has been reported to confer the strongest stability and failure loads (9). Although this type of DFA had been used in dTGR procedures, whether DFA can enhance the "bridge" role of sTGRs in the treatment of severe EOS remained unknown (14). In the current study, there were no significant differences in baseline clinical characteristics, most of the preoperative radiographic parameters, the duration of treatment and follow-up, or the number of lengthening procedures between the DFA, non-DFA, and dTGR groups.…”

Section: Discussionmentioning

confidence: 99%

Distal foundation augmentation enhances the “Bridge” role of single traditional growing rods in the treatment of severe early-onset scoliosis: a retrospective comparative cohort study

Hai¹,

Yang²,

Kang³

et al. 2023

Transl Pediatr

View full text Add to dashboard Cite

Background: Dual traditional growing rod (dTGR) implantation may not always be feasible for patients with severe early-onset scoliosis (EOS). The concave single traditional growing rod (sTGR) can serve as a starting construct. Distal foundation augmentation (DFA) with four pedicle screws with a cross-link can increase the spinal control provided by a dTGR. However, DFA has yet to be used with a sTGR. This study investigated the efficiency of DFA in patients with severe EOS who underwent sTGR implantation.Methods: From 2010 to 2021, 74 consecutive patients with severe EOS (major curve ≥80°) who underwent traditional growing rod implantation (48 sTGR and 26 dTGR) with a minimum 24-month follow-up were recruited. The sTGR cohort was further divided into two groups by whether or not DFA was performed.In our center, patients who were admitted for sTGR implantation after 2018 routinely underwent DFA.The implantation of a dTGR was based on the severity of thoracic torsion and BMI. Baseline clinical characteristics, complications, and radiographic parameters preoperatively, postoperatively, and at the last follow-up before conversion to a dual rod instrumentation were compared between the three groups.Results: There was no significant difference in baseline clinical characteristics between the three groups (P>0.05). Twenty-four patients in the sTGR cohort underwent DFA. There was no significant difference in preoperative radiographic parameters between the DFA and non-DFA group (P>0.05). Compared with the non-DFA group, the DFA group had superior results at the last follow-up in terms of maintaining the correction of the major curve (P=0.001), maximal kyphosis correction (P=0.001), the distance between the C7 plumb line and the central sacral vertical line (P=0.036), and distracting the growing thorax (P=0.032) and trunk (P=0.044). Furthermore, the incidence of implant-related complications (P=0.019), especially at the distal foundation (P=0.033), was significantly lower in the DFA group. There was no significant difference between the DFA and dTGR groups in radiographic outcomes or complications at the final follow-up (P>0.05).Conclusions: For patients with severe EOS who undergo sTGR implantation, DFA might better maintain the deformity correction, distract the growing spine, preserve balance, and decrease the incidence of implantrelated complications. The efficiency of sTGR with DFA was comparable to that of the gold-standard dTGR treatment. Further multicenter randomized controlled trials are needed for more convincing conclusions.

show abstract

Section: Discussionmentioning

confidence: 99%

Distal foundation augmentation enhances the “Bridge” role of single traditional growing rods in the treatment of severe early-onset scoliosis: a retrospective comparative cohort study

Hai¹,

Yang²,

Kang³

et al. 2023

Transl Pediatr

View full text Add to dashboard Cite

show abstract

“…23 In a recent study, combining the GR technique with sublaminar band fixation of the apical vertebra only has been discussed, for the purpose of increasing the stability of GR construct and decreasing implant related complications. 27 Similarly, sublaminar taping of the apex vertebra can be considered as an adjunct procedure to bring the apex closer to the midline, but exposing the apical segments creates a risk of unwanted fusion. Growth guidance techniques such as the Shilla can also be considered as alternatives, as they focus on correcting the apical deformity and bringing the apex closer to the central gravity line as well as preserving the capacity for longitudinal growth.…”

Section: Discussionmentioning

confidence: 99%

“…Halo gravity traction before the index surgery,21 combining GR with short-segment apical convex fusion25 and a single-stage posterior osteotomy and apical fusion combined with GR have all been described 23. In a recent study, combining the GR technique with sublaminar band fixation of the apical vertebra only has been discussed, for the purpose of increasing the stability of GR construct and decreasing implant related complications 27. Similarly, sublaminar taping of the apex vertebra can be considered as an adjunct procedure to bring the apex closer to the midline, but exposing the apical segments creates a risk of unwanted fusion.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Apical Vertebra Position on Growing Rod Treatment: A Clinical and Finite Element Study

Dursun

Çetik

Güzel

et al. 2022

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Background: Growing rods (GRs) is a commonly utilized technique for the management of early-onset scoliosis. The significance of the position of the apical vertebrae relative to the rods is not known. The purpose of this study is to analyze the potential effects of the position of the apical vertebrae in relation to the GRs on deformity control through plain radiographs and finite element analysis (FEA) modeling. Methods: We identified 140 patients treated with GR between 2000 and 2018. Patients who had a congenital vertebral anomaly or <2-year follow-up were excluded. Curve magnitude, traction radiograph under general anesthesia (TRUGA) flexibility, apical rotation, the lengths of T1-12, T1-S1, and the instrumented segments were recorded. Patients were divided into 3 groups according to the apical position on the postoperative radiographs: group 1 (both pedicles are between the rods), group 2 (convex rod is between the apical vertebra pedicles), group 3 (both pedicles are lateral to the convex rod). FEA models were created simulating the 3 groups. Both radiographic and FEA data were analyzed to compare the deformity control and growth in each group. Results: Fifty-eight patients were included in the final analyses (mean age 84 mo; range: 38 to 148). Ten patients (17%) were in group 1, 34 (59%) in group 2, and 14 (24%) in group 3. Difference between TRUGA flexibilities was statistically insignificant. Group 3 was the least successful in terms of both height gain and rotational control. FEA showed a decrease in rotation and displacement for every group, however, the residual rotation and displacement was highest in group 3. Conclusions: Bringing the apex in line with the GR increases the capacity of growth preservation as it results in largest height gain and better deformity control. FEA model demonstrated that distraction alone is inadequate for controlling rotation, and with increasing apical translation, residual rotation after distraction also increases. Level of Evidence: Level III.

show abstract

“…According to previous studies, early onset scoliosis is 4-8 cases per 10,000 births, with congenital scoliosis being the most common pediatric spinal deformity [5]. Clinically, common treatments for EOS include surgery, traction, and posterior spinal fusion (PSF) surgery [6]. PSF is a safe and effective procedure for treating early-onset scoliosis.…”

Section: Introductionmentioning

confidence: 99%

The Comparison of enhanced recovery after surgery versus traditional pathway in early-onset scoliosis surgery

Jian

Cui

et al. 2023

Preprint

View full text Add to dashboard Cite

The optimized enhanced recovery after surgery (ERAS) pathway in patients with early onset scoliosis (EOS) has not yet been comprehensively described. This study explored the efficacy and feasibility of an integral process of the ERAS pathway in posterior spinal fusion (PSF) surgery in EOS patients. A total of 70 patients were included in this study, with 35 patients receiving treatment using an ERAS pathway designed and implemented by a multidisciplinary team. The remaining 35 patients followed the traditional pathway (TP) perioperative care. Patient demographics, radiographic parameters, surgical data, and clinical information were collected and analyzed retrospectively. There were no significant differences in sex, height, weight, age, body mass index, preoperative hemoglobin level, fusion segments, number of screws, Cobb angle of the main curve, or surgical duration between the ERAS and TP groups. Regarding pain intensity, the estimated blood loss (EBL), first ambulation time, length of analgesic use, postoperative length of stay (LOS), drainage duration, drainage volume, and incidence of blood transfusion were significantly lower in the ERAS group than in the TP group. The ERAS pathway in EOS orthopedic surgery effectively reduces intraoperative bleeding, alleviates postoperative pain, reduces com-plications, accelerates recovery, and shortens hospital stays. Therefore, spinal surgeons should adopt the ERAS pathway in EOS surgery.

show abstract

Growing rod technique with prior foundation surgery and sublaminar taping for early-onset scoliosis

Cited by 5 publications

References 17 publications

Distal foundation augmentation enhances the “Bridge” role of single traditional growing rods in the treatment of severe early-onset scoliosis: a retrospective comparative cohort study

Distal foundation augmentation enhances the “Bridge” role of single traditional growing rods in the treatment of severe early-onset scoliosis: a retrospective comparative cohort study

The Effect of Apical Vertebra Position on Growing Rod Treatment: A Clinical and Finite Element Study

The Comparison of enhanced recovery after surgery versus traditional pathway in early-onset scoliosis surgery

Contact Info

Product

Resources

About