Growing rod technique with prior foundation surgery and sublaminar taping for early-onset scoliosis

View More View Less
  • 1 Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu;
  • | 2 Department of Orthopaedic Surgery, Gotenyama Hospital, Kanuma; and
  • | 3 Department of Orthopaedic Surgery, Kamitsuga General Hospital, Kanuma, Tochigi, Japan
Free access

OBJECTIVE

The aim of this study was to show the surgical results of growing rod (GR) surgery with prior foundation surgery (PFS) and sublaminar taping at an apex vertebra.

METHODS

Twenty-two early-onset scoliosis (EOS) patients underwent dual GR surgery with PFS and sublaminar taping. PFS was performed prior to rod placement, including exposure of distal and proximal anchor areas and anchor instrumentation filled with a local bone graft. After a period of 3–5 months for the anchors to become solid, dual rods were placed for distraction. The apex vertebra was exposed and fastened to the concave side of the rods using sublaminar tape. Preoperative, post–GR placement, and final follow-up radiographic parameters were measured. Complications during the treatment period were evaluated using the patients’ clinical records.

RESULTS

The median age at the initial surgery was 55.5 months (range 28–99 months), and the median follow-up duration was 69.5 months (range 25–98 months). The median scoliotic curves were 81.5° (range 39°–126°) preoperatively, 30.5° (range 11°–71°) after GR placement, and 33.5° (range 12°–87°) at the final follow-up. The median thoracic kyphotic curves were 45.5° (range 7°–136°) preoperatively, 32.5° (range 15°–99°) after GR placement, and 42° (range 11°–93°) at the final follow-up. The median T1–S1 lengths were 240.5 mm (range 188–305 mm) preoperatively, 286.5 mm (range 232–340 mm) after GR placement, and 337.5 mm (range 206–423 mm) at the final follow-up. Complications occurred in 6 patients (27%). Three patients had implant-related complications, 2 patients had alignment-related complications, and 1 patient had a wound-related complication.

CONCLUSIONS

A dual GR technique with PFS and sublaminar taping showed effective correction of scoliotic curves and a lower complication rate than previous reports when a conventional dual GR technique was used.

ABBREVIATIONS

EOS = early-onset scoliosis; GR = growing rod; PFS = prior foundation surgery.

OBJECTIVE

The aim of this study was to show the surgical results of growing rod (GR) surgery with prior foundation surgery (PFS) and sublaminar taping at an apex vertebra.

METHODS

Twenty-two early-onset scoliosis (EOS) patients underwent dual GR surgery with PFS and sublaminar taping. PFS was performed prior to rod placement, including exposure of distal and proximal anchor areas and anchor instrumentation filled with a local bone graft. After a period of 3–5 months for the anchors to become solid, dual rods were placed for distraction. The apex vertebra was exposed and fastened to the concave side of the rods using sublaminar tape. Preoperative, post–GR placement, and final follow-up radiographic parameters were measured. Complications during the treatment period were evaluated using the patients’ clinical records.

RESULTS

The median age at the initial surgery was 55.5 months (range 28–99 months), and the median follow-up duration was 69.5 months (range 25–98 months). The median scoliotic curves were 81.5° (range 39°–126°) preoperatively, 30.5° (range 11°–71°) after GR placement, and 33.5° (range 12°–87°) at the final follow-up. The median thoracic kyphotic curves were 45.5° (range 7°–136°) preoperatively, 32.5° (range 15°–99°) after GR placement, and 42° (range 11°–93°) at the final follow-up. The median T1–S1 lengths were 240.5 mm (range 188–305 mm) preoperatively, 286.5 mm (range 232–340 mm) after GR placement, and 337.5 mm (range 206–423 mm) at the final follow-up. Complications occurred in 6 patients (27%). Three patients had implant-related complications, 2 patients had alignment-related complications, and 1 patient had a wound-related complication.

CONCLUSIONS

A dual GR technique with PFS and sublaminar taping showed effective correction of scoliotic curves and a lower complication rate than previous reports when a conventional dual GR technique was used.

ABBREVIATIONS

EOS = early-onset scoliosis; GR = growing rod; PFS = prior foundation surgery.

In Brief

The objective of the study was to show the surgical results of growing rod surgery after prior foundation surgery and sublaminar taping. This technique yielded effective correction of scoliotic curves and a lower complication rate than those in previous reports. This technique is significant because it produces a good surgical result in patients with early-onset scoliosis.

Surgical intervention is indicated in cases of progressive and severe early-onset scoliosis (EOS) that do not respond to nonoperative treatment. The surgical technique includes distraction-based systems and guided growth constructs.1–5 A growing rod (GR) technique is a widely performed distraction-based technique that is effective in spinal deformity correction, spinal growth, and thoracic growth.1,2,5 The postoperative complication rates of the GR technique remain high, however, and implant-related complications have been reported as the most common complication in previous studies.6,7 Staged insertion of a GR to enhance anchor site strength has been reported in some papers, but implant-related complications have still not been resolved.8,9 Sublaminar wires are used in the Luque trolley method for multiple anchors,10 but this method has resulted in unwanted fusion and is not in standard use today.11 However, multiple anchors would create a more stable construct than fewer anchors.

Our GR procedures have included prior foundation surgery (PFS) to enhance anchor site strength and sublaminar tape fastening of only the apex vertebra to the concave-side rod with the intention of increasing the stability of the instrument. Since the GR technique with both PFS and sublaminar taping has not been proposed in previous studies, the effectiveness of combining the two techniques is unclear.

This study was conducted to determine the surgical results of the GR technique with both PFS and sublaminar taping for treating EOS and to evaluate the efficacy of the technique, focusing on postoperative complications.

Methods

This was a single-institution retrospective study of patients undergoing dual GR placement with PFS and sublaminar taping for EOS between the years 2007 and 2016. All patients were followed up for at least 2 years. Demographic and surgical data were retrospectively reviewed from the patients’ clinical charts. Preoperative, post–GR placement, and final follow-up radiographic parameters were measured, which included the main scoliotic Cobb angle, maximal thoracic kyphosis, T12–S1 lumbar lordosis, T1–S1 length, and Campbell’s space available for the lung ratio.12 All radiographic parameters were measured using measurement software (Centricity Enterprise Web version 3.0, GE Healthcare Japan).

Postoperative complications, including implant-related, alignment-related, wound-related, and neurological injuries, were evaluated.

The Wilcoxon rank-sum test was used to compare radiographic parameters. The level of significance was set at 0.05. Statistical analyses were performed using a software package (JMP version 9.0, SAS).

Surgical Technique

PFS was developed to enhance anchor site strength. In PFS, proximal and distal anchor areas were exposed in a subperiosteal fashion, anchor instruments (hook or screw) were inserted with local bone grafts around the implants, and short rods connecting the instruments were placed. Local bone grafts were taken from the spinous processes in the anchor area. The choice of anchor levels depended on characteristics of the curvature. The upper anchor levels were usually at T2 or T3. The lower anchor levels were at the most stable vertebra.

Following an interval of about 4 months after PFS for the foundation to become solid, the long rods for distraction between the 2 anchors were placed intramuscularly. The proximal and distal rods were connected by tandem or side-to-side connectors. The connectors were placed at the thoracolumbar level (T10–L2), which is the inflection region of thoracic kyphosis and lumbar lordosis. The lamina of only the apex vertebra was also exposed in a subperiosteal fashion and fastened to the concave-side rod using sublaminar tape (ultra-high-molecular-weight polyethylene fiber cable, 3.5 mm in width). Exposure was limited in the upper and lower edges and center part of the lamina to avoid damage to the facet joint capsule, which might cause unwanted spontaneous fusion. If the connectors would disturb the fastening of the apex lamina and rod, the next lamina was used. Sublaminar tape was tightened as much as the lamina could tolerate to enhance scoliosis correction.

Rod lengthening was performed at intervals of around 6 months, continuing until the spine was mature enough to proceed with final fusion (Fig. 1). No patients were prescribed a brace during the postoperative period.

FIG. 1.
FIG. 1.

Case 11. Clinical example in the treatment of a 45-month-old girl with idiopathic scoliosis. A and B: Posteroanterior (PA) and lateral radiographs after PFS (scoliotic Cobb angle 83°). C and D: PA and lateral radiographs after rod placement (scoliotic Cobb angle 30°). The T10 lamina is fastened to the left-side rod by sublaminar tape. E and F: PA and lateral radiographs after 8 lengthening procedures (scoliotic Cobb angle 33°).

Results

Patient Demographics

Twenty-two EOS patients (4 boys and 18 girls) whose median age at initial surgery was 55.5 months (range 28–99 months) were included. The median treatment/follow-up period was 69.5 months (range 25–98 months). EOS etiologies included 10 idiopathic, 10 syndromic, 1 neuromuscular, and 1 congenital. Curve types were 5 double thoracic, 10 main thoracic, 2 thoracolumbar, and 5 double major. The proximal foundations used a hook in 19 and a pedicle screw in 3. The distal foundations used a hook in 13 and pedicle screw in 9. The patients had a median of 8 rod-lengthening procedures (range 4–15); 18 patients are still undergoing lengthening procedures, and 4 patients underwent final fusion (Table 1). In total, 188 surgeries were performed, excluding PFS.

TABLE 1.

Summary of clinical data for all 22 patients

Case No.SexAge (mos)DiagnosisCurve PatternInstrumented LevelsNo. of Lengthening OpsAge at Final Fusion (mos)Treatment Period (mos)
1F51SEMDDouble majorT3–L41414598
2M74NF-1Main thoracicT1–L139533
3M49IdiopathicMain thoracicT2–L11197
4F56IdiopathicMain thoracicT2–L21313494
5F32IdiopathicDouble thoracicT3–L3987
6F55Ehlers-DanlosDouble thoracicT2–L41087
7F97TurnerMain thoracicT5–L2715180
8F76Russell-SilverMain thoracicT2–L3887
9F82MarfanDouble majorT3–L4881
10M45IdiopathicMain thoracicT2–L3884
11F45IdiopathicMain thoracicT3–L4871
12F75IdiopathicMain thoracicT2–L1868
13F28MarfanDouble majorT2–L4870
14F69Cerebral palsyMain thoracicT2–L3869
15M41IdiopathicDouble thoracicT3–L3868
16F53IdiopathicDouble thoracicT2–L3848
17F53Chromosomal abnormalityDouble majorT2–L3557
18F48IdiopathicMain thoracicT3–L2659
19F68Axenfeld-RiegerDouble thoracicT1–L3247
20F56Metatrophic dysplasiaDouble majorT2–L3325
21F60IdiopathicMain thoracicT3–L1537
22F99Scimitar, congenitalThoracolumbarT3–L4327

NF-1 = neurofibromatosis type 1; SEMD = spondyloepimetaphyseal dysplasia; — = final fusion not yet reached.

Treatment period denotes initial surgery to final follow-up or final fusion.

Radiographic Parameters

The median Cobb angles were 81.5° (range 39°–126°) preoperatively, 30.5° (range 11°–71°; median correction rate 62.5%) after GR placement, and 33.5° (range 12°–87°; median correction rate 58.9%) at final follow-up. The median thoracic kyphotic angles were 45.5° (range 7°–136°) preoperatively, 32.5° (range 15°–99°) after GR placement, and 42° (range 11°–93°) at the final follow-up.

The median lumbar lordosis angles were 44.5° (range 13°–88) preoperatively, 36° (range 7°–64°) after GR placement, and 59° (range 31°–83°) at the final follow-up. The median T1–S1 lengths were 240.5 mm (range 188–305 mm) preoperatively, 286.5 mm (range 232–340 mm) after GR placement, and 337.5 mm (range 206–423 mm) at the final follow-up. The median spaces available for the lung ratio were 86% (range 67%–98%) preoperatively, 95.5% (range 82%–99%) after GR placement, and 96% (range 86%–99%) at the final follow-up (Tables 2 and 3).

TABLE 2.

Coronal and sagittal alignment

Scoliotic Cobb Angle (°)Thoracic Kyphosis Angle (°)Lumbar Lordotic Angle (°)
Case No.PreopAfter GR PlacementFinal Follow-UpPreopAfter GR PlacementFinal Follow-UpPreopAfter GR PlacementFinal Follow-Up
11267133985011444631
269364937341216739
3411112331551482640
41035033675037365883
5822734472487453462
6952831353848324058
7653132353216405066
8862939682641613762
975243471526323155
10702730412060503557
11833033322238482346
12672930443038545372
13773540211913133857
141014348522350362762
15853341613737353545
16672532151544272951
179343681364682614763
18813638804039323258
199353871099993503562
20965656843543886060
21391515373346566060
22512730515359596469
Median81.5*30.5*33.545.5*32.5*4244.5*3659*

Denotes significant differences (p < 0.05) between these groups in the respective angle categories.

Denotes significant differences (p < 0.05) between these groups in the respective angle categories.

TABLE 3.

Spinal length and complications

Case No.T1–S1 (mm)
PreopAfter GR PlacementFinal Follow-UpGrowth (mm/yr)ComplicationsComments
118923237618Curve progression, flat-back syndromeAnterior fusion for lumbar curve after 10th lengthening
229431642312
326930141418
426529036813
518824127111PJKProximal hooks changed to screws during 7th lengthening
621024532015
72752913779
822426632414
930134040816Screw breakageA screw was exchanged during 3rd lengthening
1023527433414
1122526833018
1226930038020
1326829036316
1423528536422Rod breakageA rod was exchanged during 7th lengthening
1524126532114
1627429634117
1724028831115Hook dislodgmentAnterior fusion for lumbar curve concurrent with PFS. Proximal hooks moved from T2 to T1 during 3rd lengthening
1821625831520
19215234206−2Deep infectionInstrumentation was removed after 2nd lengthening due to MRSA infection
2019026728545
2130532134713
2224929431127
Median240.5*286.5*337.5*15.5

MRSA = methicillin-resistant Staphylococcus aureus; PJK = proximal junctional kyphosis; — not applicable.

Denotes significant differences (p < 0.05) between these groups.

Postoperative Complications

Six postoperative complications occurred in 6 patients (27%). No PFS-related complication occurred, and all complications occurred in the rod-lengthening period. Implant-related complications included 1 screw fracture, 1 hook dislodgment, and 1 rod fracture. Alignment-related complications included 1 lumbar curve progression with flat-back syndrome and 1 junctional kyphosis. A deep infection occurred in 1 patient. The procedure-related complication rate was 3.2% (6 complications/188 procedures). Only a deep infection was managed with unplanned surgery. No patient had neurological complications (Table 3).

Discussion

Because single GR surgery for EOS had poor outcomes and a high complication rate,6,13 a dual GR technique was developed by Akbarnia et al.,1 and it resulted in fewer complications than the single GR technique.14 However, several papers reported that the postoperative complication rate in dual GR surgery remains high. Watanabe et al.7 reported that 50 (57%) of 88 patients—and 22% of surgical procedures—had complications during a 3.9-year follow-up period. Bess et al.6 reported that 38 (55%) of 69 patients had complications, with complications in 18% of the overall procedures during dual GR surgery, with a 53.8-month follow-up period. Recently, Schelfaut et al.9 reported on a series of staged dual GR procedures; 9 (60%) of 15 patients experienced complications, and 14 complications occurred (0.93/patient) during 49.5 months of follow-up. In the current study, 6 (27%) of 22 patients experienced complications, and the complication rate per surgical procedure was 3.2%, with a median of 8 rod-lengthening procedures and a 69.5-month treatment period. The complication rate in the current study was much lower than previously reported complication rates.

To show the characteristics of our GR technique with combined PFS and sublaminar taping, it is necessary to focus discussion on implant-related complications. Dual GR series from the Growing Spine Study Group database showed that 29 (42%) of 69 patients had implant-related complications (16 patients [23%] had foundation-related complications and 18 patients [26%] had rod breakage).6 To the best of our knowledge, only 2 previous studies8,9 reported the implant-related complication rates when using a dual GR technique with PFS. Gomez et al.8 reported 4 foundation-related complications and 6 rod breakages in 8 patients. Schelfaut et al.9 reported that 4 (27%) of 15 patients had implant-related complications (no foundation-related complications and 6 rod breakages in 4 patients). In the current study, 3 (14%) of 22 patients had implant complications (1 patient [5%] with a foundation-related complication, 1 patient [5%] with rod breakage, and 1 patient [5%] with screw breakage). The implant-related complication rate was clearly lower in the current study than in those previously reported. Our dual GR procedure combined with PFS and sublaminar taping would make a stronger construct that results in fewer implant-related complications. A possible reason for hook dislodgment (case 17) is great preoperative hyperkyphosis (thoracic kyphosis of 136°). Previous studies have reported that implant-related complications are more common in hyperkyphotic patients and increase linearly with increasing kyphotic curvature.7,15

Rod breakage is a common complication even in the dual GR procedure, with a reported rate of greater than 20% in several past studies.6,7,9 Although a recently reported dual GR study with PFS used a 6-mm rod, the breakage rate did not decrease.9 The rod breakage rate in the current study was clearly lower (i.e., 5%) than in past studies. Moreover, all patients in the present study did not require external support (e.g., brace or body cast) during the entire treatment course. These results mean that the dual GR technique using only PFS could reduce foundation-related complications but not rod breakage; on the other hand, with combined PFS and sublaminar taping, both foundation-related complications and rod breakage could be reduced. To the best of our knowledge, there have been no published reports on dual GR surgery in which sublaminar taping was used. Though no previous study has shown the mechanical effect of apical sublaminar taping in GR surgery, we speculate that fixing an apex of the scoliotic curve to the rod would be crucial to stabilizing the construct and reducing the mechanical stress that causes rod breakage.

The Cobb angle correction rate from before to after rod placement has been reported to be 32%–53% in previous dual GR studies.1,7,9 In the current study, the correction rate was 62.5%, which is higher than in previous reports. PFS can make a stronger anchor site, which can tolerate large correction forces, and sublaminar taping can produce translation force to the apex vertebra of scoliosis. The reason for the good correction rate in the present study is that the combination of PFS and sublaminar taping provided greater correction force than conventional dual GR techniques.

The median thoracic kyphosis and lumbar lordosis increased between GR placement and the final follow-up in the current study. This trend of change in sagittal alignment is similar to the data in previous studies on conventional dual GR techniques.1,5 Shah et al. reviewed the cases of 43 children treated with a dual GR technique and wrote that the trend of increases in thoracic kyphosis and lumbar lordosis with age seen in healthy children was also observed after lengthening of the GR.5

One of the possible adverse effects of sublaminar taping may be autofusion due to exposure of the lamina when placing the tape. Sublaminar wire and rod constructs without fusion10 in growing children have been shown to inhibit spinal growth due to subperiosteal dissection that causes heterotopic bone and autofusion.11 On the other hand, McCarthy and McCullough4 reported that the placement of apical instrumentation and fusion, including 3 to 4 segments, are crucial for controlling the curve and compared favorably with GR in terms of the growth of spinal length. In the current study, an increase in spinal growth of 15.5 mm/year was seen at T1–S1 from the preoperative period to the final follow-up, which is comparable to that seen in previous conventional dual GR surgery reports.1,16 It may safely be said that sublaminar taping at an apex lamina does not inhibit spinal growth.

There are several limitations to this study. First, this was retrospective study with a small sample size and no control group. Second, this study did not control the selection of anchor implant type. Hooks were used in all patients at the beginning of this series and recently in patients with too narrow a pedicle for screw placement. Schelfaut et al.9 reported improved stability at the foundation when performing PFS with hooks. Now, pedicle screws are used in all patients when possible because studies in an immature animal model confirmed that prior pedicle screw insertion improved stability at the bone-implant interface by osseointegration.17 Therefore, we consider that PFS with both hooks and screws efficiently enhances anchor stability, and the difference in implant types would not have affected the results of this study. Third, although the follow-up period in this study was 69.5 months, which was longer than the period in past dual GR studies,1,2,6,7,9 the majority of patients were still in the growing phase and had not reached the time for the final fusion surgery at the final follow-up. The complication rate could still be higher because late-onset complications can occur during extended follow-up. The complication rate of the patients reaching final fusion will be reported in a future study.

Conclusions

In this study in which 22 EOS patients were treated with a dual GR procedure with combined PFS and sublaminar taping, the Cobb angle correction rate was 62.5%, and postoperative implant-related complications affected 14% of the patient population. These results mean that this technique can yield good correction of the scoliotic curve with fewer complications.

Disclosures

Dr. Taneichi reports support of non–study-related clinical or research efforts that he oversees from Stryker and Medtronic.

Author Contributions

Conception and design: Inami, Taneichi. Acquisition of data: Chiba, Ohe. Analysis and interpretation of data: Inami, Chiba. Drafting the article: Inami, Chiba. Critically revising the article: Inami. Reviewed submitted version of manuscript: Inami, Taneichi. Approved the final version of the manuscript on behalf of all authors: Inami. Statistical analysis: Chiba. Administrative/technical/material support: Moridaira, Takeuchi, Sorimachi, Ueda, Ohe, Aoki, Iimura, Nohara, Taneichi. Study supervision: Nohara, Taneichi.

References

  • 1

    Akbarnia BA, Marks DS, Boachie-Adjei O, et al. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine (Phila Pa 1976). 2005;30(17)(suppl):S46S57.

    • Search Google Scholar
    • Export Citation
  • 2

    Akbarnia BA, Breakwell LM, Marks DS, et al. Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine (Phila Pa 1976). 2008;33(9):984990.

    • Search Google Scholar
    • Export Citation
  • 3

    Campbell RM Jr. VEPTR: past experience and the future of VEPTR principles. Eur Spine J. 2013;22(suppl 2):S106S117.

  • 4

    McCarthy RE, McCullough FL. Shilla growth guidance for early-onset scoliosis: results after a minimum of five years of follow-up. J Bone Joint Surg Am. 2015;97(19):15781584.

    • Search Google Scholar
    • Export Citation
  • 5

    Shah SA, Karatas AF, Dhawale AA, et al. The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine (Phila Pa 1976). 2014;39(22):E1311E1317.

    • Search Google Scholar
    • Export Citation
  • 6

    Bess S, Akbarnia BA, Thompson GH, et al. Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am. 2010;92(15):25332543.

    • Search Google Scholar
    • Export Citation
  • 7

    Watanabe K, Uno K, Suzuki T, et al. Risk factors for complications associated with growing-rod surgery for early-onset scoliosis. Spine (Phila Pa 1976). 2013;38(8):E464E468.

    • Search Google Scholar
    • Export Citation
  • 8

    Gomez JA, Grzywna A, Hanstein R, et al. Staged growing rods with preimplantation of spinal anchors for complex early onset scoliosis. J Pediatr Orthop. 2017;37(8):e606e611.

    • Search Google Scholar
    • Export Citation
  • 9

    Schelfaut S, Dermott JA, Zeller R. Staged insertion of growing rods in severe scoliosis. Eur Spine J. 2018;27(9):22032212.

  • 10

    Luque ER. Paralytic scoliosis in growing children. Clin Orthop Relat Res. 1982;(163):202209.

  • 11

    Mardjetko SM, Hammerberg KW, Lubicky JP, Fister JS. The Luque trolley revisited. Review of nine cases requiring revision. Spine (Phila Pa 1976). 1992;17(5):582589.

    • Search Google Scholar
    • Export Citation
  • 12

    Campbell RM Jr, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85(3):399408.

    • Search Google Scholar
    • Export Citation
  • 13

    Mineiro J, Weinstein SL. Subcutaneous rodding for progressive spinal curvatures: early results. J Pediatr Orthop. 2002;22(3):290295.

  • 14

    Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (Phila Pa 1976). 2010;35(25):21932204.

    • Search Google Scholar
    • Export Citation
  • 15

    Schroerlucke SR, Akbarnia BA, Pawelek JB, et al. How does thoracic kyphosis affect patient outcomes in growing rod surgery? Spine (Phila Pa 1976). 2012;37(15):13031309.

    • Search Google Scholar
    • Export Citation
  • 16

    Sankar WN, Skaggs DL, Yazici M, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine (Phila Pa 1976). 2011;36(10):806809.

    • Search Google Scholar
    • Export Citation
  • 17

    Shiba K, Taneichi H, Namikawa T, et al. Osseointegration improves bone-implant interface of pedicle screws in the growing spine: a biomechanical and histological study using an in vivo immature porcine model. Eur Spine J. 2017;26(11):27542762.

    • Search Google Scholar
    • Export Citation

Illustration of S1 pedicle subtraction osteotomy for the treatment of sacral fractures and high-grade spondylolisthesis (spondy). Copyright University of California, San Francisco, Department of Neurosurgery. Published with permission. See the article by Lau et al. (pp 577–587).

  • View in gallery

    Case 11. Clinical example in the treatment of a 45-month-old girl with idiopathic scoliosis. A and B: Posteroanterior (PA) and lateral radiographs after PFS (scoliotic Cobb angle 83°). C and D: PA and lateral radiographs after rod placement (scoliotic Cobb angle 30°). The T10 lamina is fastened to the left-side rod by sublaminar tape. E and F: PA and lateral radiographs after 8 lengthening procedures (scoliotic Cobb angle 33°).

  • 1

    Akbarnia BA, Marks DS, Boachie-Adjei O, et al. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine (Phila Pa 1976). 2005;30(17)(suppl):S46S57.

    • Search Google Scholar
    • Export Citation
  • 2

    Akbarnia BA, Breakwell LM, Marks DS, et al. Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine (Phila Pa 1976). 2008;33(9):984990.

    • Search Google Scholar
    • Export Citation
  • 3

    Campbell RM Jr. VEPTR: past experience and the future of VEPTR principles. Eur Spine J. 2013;22(suppl 2):S106S117.

  • 4

    McCarthy RE, McCullough FL. Shilla growth guidance for early-onset scoliosis: results after a minimum of five years of follow-up. J Bone Joint Surg Am. 2015;97(19):15781584.

    • Search Google Scholar
    • Export Citation
  • 5

    Shah SA, Karatas AF, Dhawale AA, et al. The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine (Phila Pa 1976). 2014;39(22):E1311E1317.

    • Search Google Scholar
    • Export Citation
  • 6

    Bess S, Akbarnia BA, Thompson GH, et al. Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am. 2010;92(15):25332543.

    • Search Google Scholar
    • Export Citation
  • 7

    Watanabe K, Uno K, Suzuki T, et al. Risk factors for complications associated with growing-rod surgery for early-onset scoliosis. Spine (Phila Pa 1976). 2013;38(8):E464E468.

    • Search Google Scholar
    • Export Citation
  • 8

    Gomez JA, Grzywna A, Hanstein R, et al. Staged growing rods with preimplantation of spinal anchors for complex early onset scoliosis. J Pediatr Orthop. 2017;37(8):e606e611.

    • Search Google Scholar
    • Export Citation
  • 9

    Schelfaut S, Dermott JA, Zeller R. Staged insertion of growing rods in severe scoliosis. Eur Spine J. 2018;27(9):22032212.

  • 10

    Luque ER. Paralytic scoliosis in growing children. Clin Orthop Relat Res. 1982;(163):202209.

  • 11

    Mardjetko SM, Hammerberg KW, Lubicky JP, Fister JS. The Luque trolley revisited. Review of nine cases requiring revision. Spine (Phila Pa 1976). 1992;17(5):582589.

    • Search Google Scholar
    • Export Citation
  • 12

    Campbell RM Jr, Smith MD, Mayes TC, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am. 2003;85(3):399408.

    • Search Google Scholar
    • Export Citation
  • 13

    Mineiro J, Weinstein SL. Subcutaneous rodding for progressive spinal curvatures: early results. J Pediatr Orthop. 2002;22(3):290295.

  • 14

    Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (Phila Pa 1976). 2010;35(25):21932204.

    • Search Google Scholar
    • Export Citation
  • 15

    Schroerlucke SR, Akbarnia BA, Pawelek JB, et al. How does thoracic kyphosis affect patient outcomes in growing rod surgery? Spine (Phila Pa 1976). 2012;37(15):13031309.

    • Search Google Scholar
    • Export Citation
  • 16

    Sankar WN, Skaggs DL, Yazici M, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine (Phila Pa 1976). 2011;36(10):806809.

    • Search Google Scholar
    • Export Citation
  • 17

    Shiba K, Taneichi H, Namikawa T, et al. Osseointegration improves bone-implant interface of pedicle screws in the growing spine: a biomechanical and histological study using an in vivo immature porcine model. Eur Spine J. 2017;26(11):27542762.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 328 183 0
Full Text Views 235 197 42
PDF Downloads 207 164 38
EPUB Downloads 0 0 0