Outcomes at Skeletal Maturity of 34 Children With Scoliosis Treated With a Traditional Single Growing Rod

Abstract

Study Design. Retrospective case series. Objectives. To analyze the outcomes at skeletal maturity of patients treated with a single traditional growing rod (GR). To compare results of patients according to whether posterior spinal fusion (PSF) was performed at treatment completion. Summary of Background Data. Few studies examined the end results of GRs at skeletal maturity. There is no agreement on requirement of PSF at GR treatment completion. Methods. Clinical and radiological analysis of consecutive patients with severe and/or progressive scoliosis treated initially with traditional single GR. Group comparisons of patients with PSF and without fusion surgery at treatment completion. Results. Thirty-four patients underwent traditional single GR implantation at a median age of 11.7 years. Median follow-up was 6.5 years. At last follow-up, T1-S1 distance was increased by a median 116 mm (P < 0.001) and median major curve Cobb angle was changed from 55° preoperatively to 30° (P < 0.001). Complications included 26 rod fractures, 1 implant prominence, 4 proximal junctional kyphosis, 2 proximal hook dislodgments, and 2 wound infections. At the beginning our experience, PSF was performed systematically in 17 patients. Relying on spinal ankylosis, 17 patients were subsequently not fused at GR treatment completion (single GR removed N = 2, single GR retained N = 7, dual GR surgery N = 8). There were no statistical differences between groups in improvements of radiological parameters from preoperative GR insertion to last follow-up. No GR fracture occurred after dual GR surgery. Conclusion. Single GR allows curve control and promotes spinal growth. Dual GR is, however, recommended for rod fracture prevention and better correction maintenance. In patients with satisfactory deformity correction at skeletal maturity, one may consider retaining dual GR instead of performing PSF. Level of Evidence: 4

Traditional Growing Rod for Early Onset Scoliosis in High Altitude Regions: a Retrospective Study

“…In our previous study, the growing rod treatment of early-onset scoliosis, in which main thoracic scoliosis and thoracic kyphosis were signi cantly improved at the last follow-up indicators compared with preoperative 18 .Single growing rods can effectively improve the angle of scoliosis and maintain spinal growth, although they are not equivalent with the dual rods in preventing internal xation breakage and maintaining the corrective angle. 19 In our study,30 patients (83.3%) were treated with a single rod, and 6 patients (26.1%) were treated with a dual rod(P < 0.05).Dual rod surgery has been mainly completed recently because the foundation has funded the treatment of children in high-altitude areas, with a total of 12 patients in the H-A group and 18 in the L-A group who underwent subcutaneous growing rod implantation, while the other patients were implanted growing rods submuscularly(P = 0.871).A meta-analysis of single and dual rod treatment of EOS have showed that dual growing rod implantation can achieve better deformity correction and spinal growth. The incidence of complications related to internal xation is low, while the dual rod group internal xation has a high complication rate.…”

“…Additionally, dual growing rods can be retained instead of performing nal fusion surgery. 19 In our study, the overall incidence of complications in the H-A and L-A groups was 60.9% and 63.9%, respectively, and the difference was not statistically signi cant(P = 0.815).The incidence of implant-related complications in the L-A group(63.9%) was higher than that in the H-A group(52.2%), but the difference was not statistically signi cant (P = 0.372).Most children with EOS in the H-A group have been subsidized through spinal rescue action recently, and the progress of the treatment concept, the improvement of surgical techniques, and the improvement of internal xation equipment all promote further reduction of implant-related complications.…”

Traditional Growing Rod for Early-Onset Scoliosis in High Altitude Regions: A Retrospective Study

“…19 Single growing rods can effectively improve the angle of scoliosis and maintain spinal growth,although they are not equivalent with the dual rods in preventing internal xation breakage and maintaining the corrective angle. 20 Here,30 patients (83.3%) were treated with a single rod, and 6 patients (26.1%) were treated with a dual rod(P < 0.05).Dual rod surgery has been mainly completed recently because the foundation has funded the treatment of children in high-altitude areas, with a total of 12 patients in the H-A group and 18 in the L-A group who underwent subcutaneous growing rod implantation, while the other patients were implanted with growing rods submuscularly(P = 0.871).A meta-analysis of single and dual rod treatment of EOS has showed that dual growing rod implantation can achieve better deformity correction and spinal growth. The incidence of complications related to internal xation was lower in the in the single rod group than in the dual rod group.…”

“…8,10,17 The incidence of internal xation-related complications was 54.2%,and the incidence of surgical site infection was 22.7%. 18 Bouthors 20 retrospectively analyzed 34 patients with single growing rods for EOS.Although single growing rods can achieve good results in deformity correction and maintenance of spinal growth, the IRCs are especially high. Hence, it is recommended that dual growing rods be used for patients over 8 years old as such rods can better prevent breakage and maintain the orthopedic effect for patients with satisfactory orthopedics after bone maturity.…”

The Minimally Invasive Bipolar Technique for the Treatment of Spinal Deformities in Children and Adolescents

“…Indeed, we observed a progressive and delayed stiffening of the spine in the oldest cases, induced by the presence of metallic rods implanted several years ago. 14,15 Finally, performing this technique early on, in an immature child, provides undeniable comfort to the patient as well as dispensing with the need for a brace. It reduces the overall cost of treatment for the public health service, thanks to the reduced number of implants, the low rate of complications and shorter hospital stays, especially in the ICU, when compared to the traditional techniques.…”