A re-evaluation of the effects of dual growing rods on apical vertebral rotation in patients with early-onset scoliosis and a minimum of two lengthening procedures: a CT-based study

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OBJECTIVE

This study aimed to evaluate the correction results of traditional dual growing rods (DGRs) on axial rotation using CT scans and to further explore the relationships between axial and torso deformities in patients with early-onset scoliosis (EOS).

METHODS

Patients with EOS who were treated with traditional DGRs between January 2006 and December 2014 were retrospectively reviewed. Plain radiographs were used to assess the degree of coronal and sagittal deformity. The apical vertebral rotation (AVR) and rib hump (RH) were measured on CT scans at the apical vertebra. Pearson or Spearman rank correlation analyses were used to analyze the associations between spinal and torso deformities.

RESULTS

A total of 27 patients (10 boys and 17 girls, average age 6.5 ± 1.7 years) were enrolled in this study. The average number of lengthenings per patient was 5.0 ± 1.9, with a mean follow-up duration of 52.9 ± 18.2 months. The apical vertebral translation, apical vertebral body–rib ratio (AVB-R), AVR, and RH parameters were significantly decreased after the initial surgery (p < 0.05) but showed notable progression at the latest follow-up evaluation (p < 0.05). The preoperative AVR and its correction after index surgery were significantly correlated with the preoperative values as well as with the corrections of the major Cobb angle, AVB-R, and RH. During the follow-up period, significant correlations were found between the deterioration of AVR and the AVB-R and also between the deterioration of AVR and the RH from the initial surgery to the latest follow-up.

CONCLUSIONS

Significant AVR correction can be achieved by DGR techniques after the initial surgery. However, this technique weakly prevents the deterioration of AVR during the follow-up period.

ABBREVIATIONS AVB-R = apical vertebral body–rib ratio; AVR = apical vertebral rotation; AVT = apical vertebral translation; DGR = dual growing rod; EOS = early-onset scoliosis; ICC = intraclass correlation coefficient; LL = lumbar lordosis; RH = rib hump; TK = thoracic kyphosis.

Article Information

Correspondence Xu Sun: Nanjing University Medical School, Nanjing, China. drsunxu@163.com.

INCLUDE WHEN CITING Published online June 15, 2018; DOI: 10.3171/2018.3.PEDS1832.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Illustration of the AVR, the angle between two longitudinal axes of the apical vertebra and the pelvis.

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    A: Standing radiographs (upper) and axial CT images (lower) from a 7-year-old girl with congenital EOS who received treatment using DGRs. B: Both the main curve and AVR were remarkably corrected postoperatively. C: After 51 months of follow-up (5 lengthenings), the main curve was maintained whereas the AVR significantly increased to 32°.

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    A: Standing radiographs (upper) and axial CT images (lower) from an 8-year-old girl with idiopathic EOS who received surgical treatment with DGRs. B: After the initial surgery, the AVR was remarkably corrected. C: After completion of the 7-year follow-up period (6 lengthenings), definitive fusion was performed, but the AVR notably increased. D: Although definitive fusion was performed, nonsignificant corrections in the AVR were noted.

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