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New growth rod concept provides three dimensional correction, spinal growth, and preserved pulmonary function in early-onset scoliosis

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Abstract

Introduction

This study aims to describe a novel minimal invasive early-onset scoliosis (EOS) growth rod concept, the Cody Bünger (CB) Concept, which combines concave interval distraction and contralateral-guided growth with apical control and to investigate the 3D deformity correction, the spinal growth, and the pulmonary development.

Method

A series of 38 children with progressive EOS and growth potential, receiving a highly specialized surgical treatment, including primary and conversion cases. Mean age was 10.2 years (4.4–15.8) with a mean follow-up of 5.6 years, and they underwent 168/184 open/magnetic lengthening procedures. Outcomes were as follows: scoliosis, kyphosis, and lordosis angles; apical rotation; spinal length; apical translation; coronal and sagittal vertical alignment; complications; and pulmonary function in a subgroup.

Results

Scoliosis improved from mean 76° (46–129) to 35° (8–74) post-op and was 42° (13–83) at end of treatment. Apical rotation was reduced by 30% but was partially lost during treatment. Thoracic kyphosis initially decreased by mean 15° and was partially lost during treatment. Lordosis was largely unaltered during treatment. Mean T1-S1 height increased from 30.7 cm (22.7–39.2) to 34.6 cm (27.8–45.1) postop and further increased to 38.5 cm (30.1–48.1) during treatment. This corresponded to a T1-S1 growth rate of 12 mm/year, and positive growth rates were found in all height parameters evaluated. Frontal balance and apical translation improved, whereas sagittal balance was unaltered. Complications occurred in 22/38 patients, and 11/38 had an unintended reoperation. Pulmonary function (FVC and FEV) increased but the relative lung function was unchanged.

Conclusion

The new growth rod concept provided 3D correction and spinal growth at complication rates comparable with other growth-friendly techniques for EOS, while pulmonary function was preserved. Single magnetic rod distraction was incorporated successfully, replacing surgical elongations.

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Acknowledgments

We thank Lene Sloth, Kestutis Valancius, and Bente Schumacher for their contribution in the treatment of the patients, and Barbara Jensen and Jacob Brix for contributing to the database.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark

    Simon Toftgaard Skov, Haisheng Li, Ebbe Stender Hansen, Kristian Høy, Peter Helmig, Jan Duedal Rölfing & Cody Bünger

  2. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus, Denmark

    Simon Toftgaard Skov, Kristian Høy, Jan Duedal Rölfing & Cody Bünger

  3. Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, DK-8600, Silkeborg, Denmark

    Simon Toftgaard Skov

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  1. Simon Toftgaard Skov
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Correspondence to Cody Bünger.

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Ethical approval

Data collection was approved by the Danish Data Protection Agency (1-16-02-92-14) and the Regional Committee on Biomedical Research Ethics (Ref. 126/2014).

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Informed treatment consent was obtained from the parents or legal guardians.

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Level of evidence: IV, prospective case series (Therapeutic)

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Skov, S.T., Li, H., Hansen, E.S. et al. New growth rod concept provides three dimensional correction, spinal growth, and preserved pulmonary function in early-onset scoliosis. International Orthopaedics (SICOT) 44, 1773–1783 (2020). https://doi.org/10.1007/s00264-020-04604-y

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