Is Expansion Thoracoplasty a Safe Procedure for Mobility and Growth Potential of the Spine? Spontaneous Fusion After Multiple Chest Distractions in Young Children

Yılgör, Çağlar; Demirkıran, Gökhan; Ayvaz, Mehmet; Yazıcı, Muharrem

doi:10.1097/bpo.0b013e318257d3a9

Cited by 10 publications

(4 citation statements)

References 31 publications

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“…They also noted development of high thoracic kyphosis. Spontaneous fusions of ribs and vertebrae have been reported by other authors 23,24 . At least one group reported increased kyphosis magnitude and rigidity with VEPTR treatment 9 .…”

Section: Discussionmentioning

confidence: 55%

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Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis

Dede

Motoyama

Yang

et al. 2014

The Journal of Bone and Joint Surgery

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Section: Discussionmentioning

confidence: 55%

“…Despite the previously proposed benefits of the VEPTR device, recent literature suggests that serious problems may be associated with this treatment method and long-term outcomes may be less optimistic than those reported in the earlier literature [20][21][22][23][24] .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis

Dede

Motoyama

Yang

et al. 2014

The Journal of Bone and Joint Surgery

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“…This suggests that reduced mobility (rather than complete immobilization) may be a factor in disc degeneration in human scoliosis, and may account for why expansion thoracoplasty has been associated with disc degeneration in young patients [21]. …”

Section: Discussionmentioning

confidence: 99%

Metabolic Effects of Angulation, Compression, and Reduced Mobility on Annulus Fibrosis in a Model of Altered Mechanical Environment in Scoliosis

et al. 2013

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Study Design Comparison of disc tissue from rat tails in six groups having different mechanical conditions imposed. Objectives To identify disc annulus changes associated with the supposed altered biomechanical environment in a spine with scoliosis deformity using an immature rat model that produces disc narrowing and wedging. Background Intervertebral discs become wedged and narrowed in a scoliosis curve, probably due in part to altered biomechanical environment. Methods Tail discs of 5-week-old immature Sprague-Dawley rats were subjected to an altered mechanical environment using an external apparatus applying permutations of loading and deformity for 5 weeks. Four groups of rats (A) 15 degrees Angulation, (B) Angulation with 0.1 MPa Compression, (C) 0.1 MPa Compression, and (R) Reduced mobility, together with a sham and a control group were studied. Disc height changes and matrix composition (water, DNA, GAG and HA content) were measured after 5 weeks, and proline and sulphate incorporation and mRNA expression were measured at 5 days and 5 weeks. Results After 5 weeks, disc space was significantly narrowed relative to internal controls in all four intervention groups. Water content and cellularity (DNA content) were not different at interventional levels relative to internal controls and not different between the concave and convex sides of the angulated discs. There was increased GAG content in compressed tissue (in Groups B and C), as expected, and compression resulted in a decrease in hyaluronic acid size. Slightly increased incorporation of tritiated-proline into the concave side of angulated discs and compressed discs was observed. Asymmetries of gene expression in Groups A and B, and some group-wise differences, did not identify consistent patterns associating the discs’ responses to mechanical alterations. Conclusions Intervertebral discs in this model underwent substantial narrowing after 5 weeks, with minimal alteration in tissue composition and minimal evidence of metabolic changes.

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“…In a biochemical study by Huber et al, the single-cell RNA sequencing of the affected site by an injury (that may apply to soft tissue injury caused by EOS surgery) revealed an early upregulation of Mesenchymal Progenitor Cell genes linked to pathways involving cell adhesion and extracellular matrix-receptor interactions leading to the development of cartilage and bone [ 19 ]. Nevertheless, autofusion has also been documented in EOS surgeries not intimately related to the spine, such as expansion thoracoplasty [ 20 , 21 ]. Betz et al [ 22 ] demonstrated that there was no significant difference in the fusion rate between two groups of adolescent idiopathic scoliosis patients who underwent posterior spinal fusion with and without graft.…”

Section: Probable Pathophysiologymentioning

confidence: 99%

Autofusion in growing rod surgery for early onset scoliosis; what do we know so far?

Hatem,

Elmorshidy,

Elkot

et al. 2024

SICOT-J

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The evolving landscape of early onset scoliosis management has shifted from the traditional paradigm of early definitive spinal fusion towards modern growth-friendly implants, particularly Growing Rods (GR). Despite the initial classification of GR treatment as a fusionless procedure, the phenomenon of autofusion has emerged as a critical consideration in understanding its outcomes. Studies have demonstrated the presence of autofusion since the early 1980s. The consequences of autofusion are extensive, impacting curve correction, diminishing trunk growth rate, and contributing to the “law of diminishing returns” in growing rod surgery. The literature suggests that autofusion may complicate definitive fusion surgery, leading to prolonged and intricate procedures involving multiple osteotomies. Additionally, it poses challenges in identifying anatomical landmarks during surgery, potentially increasing the risk of complications and revisions. While autofusion poses challenges to achieving optimal outcomes in growing rod treatment, it cannot be considered a standalone replacement for definitive fusion. Recent advances aim to limit autofusion and enhance treatment outcomes. In this review, we will delve into the existing literature on autofusion, examining studies that have documented its presence, probable causes, pathophysiology, potential implications for long-term patient outcomes, and possible new implants and techniques that decrease its incidence.

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Is Expansion Thoracoplasty a Safe Procedure for Mobility and Growth Potential of the Spine? Spontaneous Fusion After Multiple Chest Distractions in Young Children

Abstract: Level IV.

Cited by 10 publications

References 31 publications

Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis

Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis

Metabolic Effects of Angulation, Compression, and Reduced Mobility on Annulus Fibrosis in a Model of Altered Mechanical Environment in Scoliosis

Autofusion in growing rod surgery for early onset scoliosis; what do we know so far?

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