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Sarah F. Eby, Tricia St. Hilaire, Michael Glotzbecker, John Smith, Klane K. White, A. Noelle Larson and the Children’s Spine Study Group

. Scoliosis affects 2% to 4% of the general pediatric population, 7 , 17 but it is much more prevalent in children after thoracoabdominal surgical intervention. Scoliosis has been reported in 13% to 33% of children surviving congenital diaphragmatic hernia repair, 6 , 13 , 16 8.5% of children following cardiac surgery, 11 and as many as 50% of children following tracheoesophageal fistula repair. 3 Severe scoliosis has also been noted to occur following chest wall resection or laminectomy for spinal cord tumor and is often progressive. 5 , 8 Early-onset scoliosis can

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Kiril Mladenov, Lena Braunschweig, Jennifer Behrend, Heiko M. Lorenz, Urs von Deimling and Anna K. Hell

T he negative effects of progressive early-onset scoliosis (EOS) on thoracic growth and lung function are well known as thoracic insufficiency syndrome, 5 which can lead to substantial disability and/or death if left untreated. During the last decades, enormous efforts have been made to improve life expectancy mainly by using growth-friendly implants such as growing rods, vertical expandable prosthetic titanium ribs (VEPTRs), or magnetically controlled growing rods (MCGRs). 1 , 2 , 7 , 12 , 13 Most of these implants require repetitive surgeries over the years

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Zhonghui Chen, Song Li, Yong Qiu, Zezhang Zhu, Xi Chen, Liang Xu and Xu Sun

I n recent years, various types of spine growth–friendly instrumentation have been used with the goal of minimizing spinal deformities while maximizing spine and thoracic growth in children with early-onset scoliosis (EOS). Based on repeated distractive forces they exert on the spine, vertical expandable prosthetic titanium ribs (VEPTRs) and growing rod instrumentation (GRI) have been classified as distraction-based instrumentation by Skaggs et al. 20 As originally described by Campbell and Hell-Vocke, 5 VEPTR was applied to young children with thoracic

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Liang Xu, Yong Qiu, Zhonghui Chen, Benlong Shi, Xi Chen, Song Li, Changzhi Du, Zezhang Zhu and Xu Sun

: 567 – 572 , 1981 7336279 10.1097/00007632-198111000-00007 3 Acaroglu E , Yazici M , Alanay A , Surat A : Three-dimensional evolution of scoliotic curve during instrumentation without fusion in young children . J Pediatr Orthop 22 : 492 – 496 , 2002 10.1097/01241398-200207000-00014 12131446 4 Ahmad AA , Aker L , Hanbali Y , Sbaih A , Nazzal Z : Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis . Eur Spine J 26 : 1748 – 1755 , 2017 27942940

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Rodrigo Navarro-Ramirez, Oded Rabau, Alisson Teles, Susan Ge, Abdulaziz Bin Shebreen, Neil Saran and Jean Ouellet

Early-onset scoliosis (EOS) correction techniques have evolved slowly over the past 40 years and still remain a challenge for the spine surgeon. Avoiding spinal fusion in these patients is key to decreasing morbidity and mortality in this population.

Current treatments for EOS include both conservative and surgical options. The authors present the modified Luqué technique that has been performed at their institution for the past decade. This modified technique relies on Luqué’s principle, but with newer “gliding” implants through a less disruptive approach. The goal of this technique is to delay fusion as long as possible, with the intent to prevent deformity progression while preserving maximal growth.

Normally, these patients will have definitive fusion surgery once they have reached skeletal maturity or as close as possible. Out of 23 patients until present (close to 4-year follow-up), the authors have not performed any revision due to implant failure. Three patients have undergone final fusion as the curve progressed (one patient, 4 years out, had final fusion at age 12 years; two other patients had final fusion at 3 years). These implants, which have the CE mark in Europe, are available in Canada via a special access process with Health Canada. The implants have not yet been submitted to the FDA, as they are waiting on clinical data out of Europe and Canada.

In the following video the authors describe the modified Luqué technique step-by-step.

The video can be found here: https://youtu.be/k0AuFa9lYXY.

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Michel Lefranc, F. François Deroussen and Richard Gouron

Fusionless surgery coupled with growing rod techniques is increasingly advocated for the treatment of early-onset scoliosis in general and neuromuscular scoliosis in particular. Iliosacral screws have excellent biomechanical characteristics but are hard to place safely. Here, the authors report on robot-assisted iliosacral screw positioning as part of growing rod surgery for the fusionless correction of early-onset scoliosis. The technique is based on a bilateral double sliding rod construct anchored to the pelvis proximally with 6 hooks or sublaminar bands and distally with iliosacral screws placed by the robot.

The video can be found here: https://youtu.be/5HGH_DiD-ck.

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Andrew C. Vivas, Steven W. Hwang and Joshua M. Pahys

S keletally immature patients with progressive spinal deformity are commonly treated using “growth-guiding instrumentation.” 1 Options for growth guidance include traditional growing rods and the more recently introduced magnetically controlled growing rods (MCGRs). Both constructs allow for spinal deformity correction and continued growth of the spine and thorax in patients with severe, progressive, early-onset scoliosis. Patients with respiratory failure due to chronic hypoventilation syndrome, high cervical spinal cord injury (SCI), or progressive

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Jason R. Smith, Amer F. Samdani, Joshua Pahys, Ashish Ranade, Jahangir Asghar, Patrick Cahill and Randal R. Betz

often be predicted by the RVAD. Resolving IIS has been correlated with an RVAD < 20°, whereas an RVAD > 20° has been shown to demonstrate curve progression. 14 Treatment for patients with early-onset scoliosis is challenging, with limited interventions available. Numerous treatments have been attempted, including the following: fusion, convex hemiepiphysiodesis, Luque trolley, bracing, casting, and growing rods. 1 , 9 , 13 , 15 , 16 Desirable techniques for correction need to allow for continued growth as well as adequate correction of the deformity, without

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K. Aaron Shaw, Nicholas D. Fletcher, Dennis P. Devito and Joshua S. Murphy

E arly - onset scoliosis is commonly treated with growth-friendly procedures that allow for continued spinal growth in order to prevent iatrogenic thoracic insufficiency. 4 , 15 , 16 Many forms of instrumentation used to treat early-onset scoliosis require periodic lengthening procedures to facilitate continued growth. Although this has been shown to accommodate continued growth, 30 there is an increasing risk of complication, at a rate of 24% for each additional surgical lengthening. 2 Complications associated with growing spinal instrumentation have been

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Amer F. Samdani, Ashish Ranade, Henry J. Dolch, Reed Williams, Tricia St. Hilaire, Patrick Cahill and Randal R. Betz

any exposure of the spine, thus potentially limiting any spontaneous fusion that may occur. 13 However, using the ilium as an attachment site may limit mobility in the ambulatory child. In this paper we report on our experience with using bilateral VEPTRs from the ribs to the pelvis for children with severe, early onset scoliosis. Methods Study Design After obtaining Institutional Review Board approval, we identified 11 children who were treated using bilateral VEPTRs from the ribs to the pelvis. We excluded children who had undergone thoracostomies with