Surgical Technique: Modern Luqué Trolley, a Self-growing Rod Technique

Ouellet, Jean

doi:10.1007/s11999-011-1783-4

Cited by 83 publications

(36 citation statements)

References 17 publications

(32 reference statements)

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“…Luque (Pratt et al, 1999) introduced a growth guidance system utilizing sublaminar wires along several spinous processes, a technique which removed the need for repeated lengthenings. This construct has been reported to achieve 90% of expected spinal growth across the instrumented spine (Ouellet, 2011). However, design concerns still exist, even with the modernized Luque trolley.…”

Section: Introductionmentioning

confidence: 99%

“…However, design concerns still exist, even with the modernized Luque trolley. These include the inability to control for rotational deformity and the occurrence of spontaneous fusion, possibly due to subperiosteal exposure during initial instrumentation and inferred from the loss of deformity correction in documented cases (Luque and Cardoso, 1977;Mardjetko et al, 1992;Moe et al, 1984;Ouellet, 2011). An alternative and more recent growing rod design is the semi-constrained growing rod (Medtronic, Memphis TN, USA).…”

Section: Introductionmentioning

confidence: 99%

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A biomechanical investigation of dual growing rods used for fusionless scoliosis correction

Quick

Grant

Adam

et al. 2015

Clinical Biomechanics

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A biomechanical investigation of dual growing rods used for fusionless scoliosis correction

Quick

Grant

Adam

et al. 2015

Clinical Biomechanics

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“…Therefore, other strategies that either maintain mobility or allow growth have been explored [9,10]. Examples are the application of tethering ligaments [11][12][13], growing rod systems [14,15] and passive or motor-driven lengthening implants [16]. These strategies still have considerable limitations, e.g., not attempting to recreate normal spinal anatomy, being too stiff or requiring additional operations.…”

Section: Introductionmentioning

confidence: 99%

Spinal shape modulation in a porcine model by a highly flexible and extendable non-fusion implant system

et al. 2016

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Purpose In vivo evaluation of scoliosis treatment using a novel approach in which two posterior implants are implanted: XSLAT (eXtendable implant correcting Scoliosis in LAT bending) and XSTOR (eXtendable implant correcting Scoliosis in TORsion). The highly flexible and extendable implants use only small, but continuous lateral forces (XSLAT) and torques (XSTOR), thereby allowing growth and preventing fusion. Methods Since (idiopathic) scoliosis does not occur spontaneously in animals, the device was used to induce a spinal deformity rather than correct it. Six of each implants were tested for their ability to induce scoliotic deformations in 12 growing pigs. Each implant spanned six segments and was attached to three vertebrae using sliding anchors. Radiological and histological assessments were done throughout the 8-week study. Results In all animals, the intended deformation was accomplished. Average Cobb angles were 19°for XSLAT and 6°for XSTOR. Average apical spinal torsion was 0°f or XSLAT and 9°for XSTOR. All instrumented segments remained mobile and showed 20 % growth. Moderate degeneration of the facet joints was observed and some debris was found in the surrounding tissue.Conclusions The approach accomplished the intended spinal deformation while allowing growth and preventing fusion.

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“…The goal of management of early-onset scoliosis is to control spinal deformity without interfering with spinal growth [2,13,14,21]. Surgical treatment should be considered for patients with progressive deformities when cast or brace treatment have failed or is contraindicated.…”

Section: Introductionmentioning

confidence: 99%

“…Many nonfusion options have been proposed and various types of spinal implants have been used to control deformity while allowing spinal and thoracic growth in immature spines [6,16,21,25,29]. Skaggs et al [25] had classified these systems into three categories based on the forces of correction: distraction-based systems, compression-based systems, and guided growth systems.…”

Section: Introductionmentioning

confidence: 99%

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

Enercan¹,

Kahraman²,

Ertürer³

et al. 2014

Clin Orthop Relat Res

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Background The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach. Description of Technique In the initial procedure, polyaxial pedicle screws were placed with a muscle-sparing technique. Rods were placed in situ after achieving correction with intraoperative skull-femoral traction. The most proximal and most distal screws were fixed and the rest of the screws were left with nonlocked set screws to allow vertical growth. The lengthening reoperations were performed every 6 months. Methods Between 2007 and 2011, we treated 19 patients surgically for early-onset scoliosis. Of those, 16 (29%) were treated with the modified growing rod technique by the senior author (AH); an additional three patients were treated using another technique that was being studied at the time by one of the coauthors (CO); those three were not included in this study. The 16 children included nine girls and seven boys (median, 5.5 years of age; range, 4-9 years), and all had progressive scoliosis (median, 64°; range, 38°-92°). All were available for followup at a minimum of 2 years (median, 4.5 years; range, 2-6 years). Results The initial curve Cobb angle of 64°(range, 38°-92°) improved to 21°(range, 4°-36°) and was maintained at 22°(range, 4°-36°) throughout followup. Preoperative thoracic kyphosis of 22°(range, 18°-46°) was maintained at 23°(range, 20°-39°) throughout followup without showing any substantial change. There was a 47 mm (range, 38-72 mm) increase in T1-S1 height throughout followup. The mean number of lengthening operations was 5.5 (range, 4-10). The mean T1-S1 length gain from the first lengthening was 1.18 cm (range, 1.03-2.24 cm) and decreased to 0.46 cm (range, 0,33-1.1 cm) after the fifth lengthening procedure (p = 0.009). The overall complication rate was 25% (four of 16 patients) and the procedural complication rate was 7% (seven of 102 procedures). We did not experience any rod breakages or other complications apart from two superficial wound infections managed without surgery during the treatment period. The only implant-related complications were loosening of two pedicle screws at the uppermost foundation in one patient.

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Surgical Technique: Modern Luqué Trolley, a Self-growing Rod Technique

Abstract: Modifications of the Luqué trolley may be useful for managing EOS without the morbidity of repetitive surgery. However, questions such as the effect of wear debris and the risk of spontaneous fusions still remain.

Cited by 83 publications

References 17 publications

A biomechanical investigation of dual growing rods used for fusionless scoliosis correction

A biomechanical investigation of dual growing rods used for fusionless scoliosis correction

Spinal shape modulation in a porcine model by a highly flexible and extendable non-fusion implant system

Apical and Intermediate Anchors Without Fusion Improve Cobb Angle and Thoracic Kyphosis in Early-onset Scoliosis

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