Growing Rods for Spinal Deformity: Characterizing Consensus and Variation in Current Use

Yang, Jenq-Lin; McElroy, Mark J.; Akbarnia, Behrooz A.; Salari, Pooria; Oliveira, Daniel Pinto de; Thompson, George H.; Emans, John B.; Yazıcı, Muharrem; Skaggs, David L.; Shah, Suken A.; Kostial, Patricia; Sponseller, Paul D.

doi:10.1097/bpo.0b013e3181d40f94

Cited by 105 publications

(53 citation statements)

References 8 publications

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“…Early identification of patients who will develop severe progressive curves can be of significant interest if early intervention options exist. However, [23,24]. These limitations have promoted ongoing work to establish solutions that can modulate natural growth of vertebrae without the possible need for fusion, to achieve favorable 3D alignment.…”

Section: Discussionmentioning

confidence: 99%

The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up

et al. 2013

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Purpose Non-fusion treatment for adolescent idiopathic scoliosis generates interest due to the potential for growth preservation and mobility. Using an established porcine scoliotic model, this study aims to evaluate the global alignment and the morphology of the spine with and without application of a non-fusion corrective tether. Methods At 12 weeks of age, 21 immature Yorkshire pigs had an induction of scoliosis. Once a 50°Cobb angle was obtained; animals were placed into one of the following groups: a scoliosis model group (SM, n = 11) where animals were euthanized, tether release group (TR, n = 5) where the inducing tether was removed, and an anterior correction group (AC, n = 5) where the inducing tether was removed and non-fusion corrective tether was applied. TR and AC were observed for a further 20 weeks and then euthanized. Post-mortem CT scans were used to create 3D spinal reconstructions to obtain global and morphologic parameters. Results Maximal Cobb angle of the scoliotic deformity was significantly lower for AC (27.9°± 12.0°) than for the two other groups (TR 52.7°± 10.0°, SM 48.3°± 7.6°). AC experienced an increase in kyphosis (24.2°± 15.9°) compared to TR (7.1°± 6.4°). Correction in the axial plane was also observed in AC versus TR. Correction of vertebral wedging was found for AC compared to SM and TR in the three apical vertebrae.Conclusions 3D realignment of scoliotic curves was observed with application of the corrective tether. The correction was the product of both mechanical action and growth modulation. These findings are encouraging for future development of a non-fusion device for the treatment of immature scoliotic curves.

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Section: Discussionmentioning

confidence: 99%

The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up

et al. 2013

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“…The consequence is an increasing rigidity of the spine deformity, preventing further rod lengthening and obliging to perform spine arthrodesis in relatively young patients [36]. In our series no autofusion was observed at the spine, except in the three patients with dollar-shaped construct.…”

Section: Discussionmentioning

confidence: 45%

“…Nowadays, fusionless surgery is the most common method of management of immature children with progressive scoliosis who fail to respond to nonoperative treatment [34]. Several techniques of rodding without fusion have been described (single growing rod, dual growing rods, hybrid growing rod with rib anchors proximally and spine anchors distally, Vertical Expandable Prosthetic Titanium Rib implant) [5,36], but usually with a high complication rate [15]. Implant failure, infection, and unintended autofusion are the most common complications [4,37] and are influenced by the number of lengthening procedures [2].…”

Section: Introductionmentioning

confidence: 99%

H3S2 (3 hooks, 2 screws) construct: a simple growing rod technique for early onset scoliosis

Miladi¹,

Journe²,

Mousny

2012

Eur Spine J

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Purpose The purpose of this study was to review the preliminary results of an original fusionless method of treatment for progressive scoliosis in young children. Methods This study retrospectively reviewed the clinical records and radiographs of 23 children with progressive scoliosis who failed to respond to conservative treatment and underwent fusionless surgery using a single solid growing rod construct. All of them were ambulatory and had a followup of minimum 2 years. Sixteen patients were treated by consecutive distraction of a single intramuscular rod, and seven patients with rodding and anterior apical convex fusion. The etiology of the scoliosis included 11 idiopathic, 6 syndromic, 4 congenital, and 2 neurofibromatosis. At initial surgery, the average age was 9.3 ± 2.8 years, with a mean Cobb angle of 68°± 32°. Six patients underwent progressive scoliosis correction in a Stagnara cast prior to surgery, and one patient with an external halo-pelvic Ilizarov device. Results Fusionless single rodding allowed to maintain scoliosis correction in all patients. At an average of 3.5 ± 0.9 years after initial surgery, the 23 patients showed a correction of 57 % in the magnitude of the original curvature. Trunk height increase was documented in all patients and ranged from 1.5 to 11.9 cm. Rod failure was found in three patients and two patients had hardware infection. Only four cases of proximal junctional kyphosis were found at last follow-up. Conclusions Preliminary results from these series of patients show that the presented fusionless single growing rod technique allows to maintain correction of progressive early onset scoliosis while permitting spinal growth, with low complication rate. With this technique, lengthening procedures are used only once in every 10 months and patients are more comfortable as no brace is needed in most cases. This technique does not require any specific spine device. The procedure is simple and efficacious as long as some guidelines are respected.

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“…While there is some agreement in practice and principle regarding the use of growing rods for curves over 60°in patients under the age of ten, no consensus yet exists regarding the optimal age for index surgery, the management of sagittal plane deformity, suitable diagnoses for growing rod treatment, the interval between lengthenings, types of foundations or the placement of rods subcutaneously or submuscularly [30,31].…”

Section: Controversiesmentioning

confidence: 99%

Growing rod concepts: state of the art

Yazıcı

Olgun

2012

Eur Spine J

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Introduction Early-onset spinal deformities present multiple challenges to the surgeon. They may be rapidly progressive and unresponsive to conservative treatment, necessitating surgical intervention at an early age. Materials and methods This text attempts to provide a review of current literature and to summarize the authors' opinions. Results This paper attempts to concisely review available literature regarding the growing rod's inception, evolution, technique, results, and complications and answers some of the controversy still surrounding it. Conclusions The growing rod is one of the first, most evolved, most popular and one of the most heatedly discussed technique of fusionless spinal instrumentation.

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Growing Rods for Spinal Deformity: Characterizing Consensus and Variation in Current Use

Cited by 105 publications

References 8 publications

The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up

The impact of a corrective tether on a scoliosis porcine model: a detailed 3D analysis with a 20 weeks follow-up

H3S2 (3 hooks, 2 screws) construct: a simple growing rod technique for early onset scoliosis

Growing rod concepts: state of the art

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