Advertisement

Surgical growth guidance with non-fused anchoring segments in early-onset scoliosis

  • Dezsö Jeszenszky
  • Bettina Kaiser
  • Martin Meuli
  • Tamas F. Fekete
  • Daniel HaschtmannEmail author
Original Article

Abstract

Purpose

Surgical treatment of early-onset scoliosis (EOS) requires a balance between maintained curve correction and the capacity for spinal and thoracic growth. Spinal fusion creates irreversible conditions that prevent the implementation of further treatment methods. Our hypothesis was that non-fused anchors in growth guidance show a comparable outcome as the technique described in the literature, which involves spondylodesis of the anchoring segments.

Methods

This retrospective study analysed 148 surgeries in 22 EOS patients (11 female, 11 male) over a 15-year period. Patients underwent surgery with non-fused anchors and growth guidance techniques. Scoliosis, kyphosis, growth and anchoring segments were measured. For the latter, a new measuring technique was developed. Complications were recorded and classified.

Results

The mean Cobb angle reduced from 73.5 ± 24.4° to 28.4 ± 16.2° (60.2 ± 22.9%, p < 0.001) at the last follow-up. Spinal growth T1–S1 and T1–T12 were 41.1 ± 23.3 mm and 24.9 ± 16.6 mm (p < 0.001), respectively. Growth at the cranial and caudal anchoring segment was 1.5 mm/segment/year and 1.9 mm/segment/year, respectively. A total of 63 complications were documented in 20 patients, with 40 requiring unplanned revision surgery. Definitive spondylodesis was performed in three patients.

Conclusion

Patients demonstrated a significant spinal growth including the anchoring segments. A comparable correction in Cobb angle and the type of complications was noted, although the rate of device-related complications was higher. No permanent impairment was reported. The rate of device-related complications is acceptable and outweighed by the significant degree of growth preservation and more flexible and individualised treatment strategy for patients with EOS.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Early-onset scoliosis Early-onset spinal deformities Growing rods Growth guidance Non-fusion anchoring 

Notes

Acknowledgements

The authors would like to thank Anne F. Mannion for helping to prepare the manuscript, Dave O’Riordan for his assistance with statistical analysis and Susanne Fekete for the distinguished drawing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_5934_MOESM1_ESM.pptx (254 kb)
Supplementary material 1 (PPTX 253 kb)

References

  1. 1.
    Mundis GM Jr, Akbarnia BA (2011) Idiopathic scoliosis: infantile and juvenile. In: Akbarnia BA, Yazici M, Thompson GH (eds) The growing spine. Management of spinal disorders in young children. Springer, Heidelberg, pp 199–212Google Scholar
  2. 2.
    Vitale MG, Wright J (2011) Outcomes in children with early onset scoliosis. In: Akbarnia BA, Yazici M, Thompson GH (eds) The growing spine. Management of spinal disorders in young children. Springer, Heidelberg, pp 547–553Google Scholar
  3. 3.
    Olgun ZD, Ahmadiadli H, Alanay A, Yazici M (2012) Vertebral body growth during growing rod instrumentation: growth preservation or stimulation? J Pediatr Orthop 23(2):184–189.  https://doi.org/10.1097/BPO.0b013e3182471915 Google Scholar
  4. 4.
    Skaggs DL, Akbarnia BA, Flynn JM, Myung KS, Sponseller PD, Vitale MG (2014) A classification of growth friendly spine implants. J Pediatr Orthop 34(3):260–274.  https://doi.org/10.1097/BPO.0000000000000073 Google Scholar
  5. 5.
    Hell AK, Hefti F, Campbell FM Jr (2004) Treatment of congenital scoliosis with the vertical expandable prosthetic titanium rib implant. Orthopade 33(8):911–918.  https://doi.org/10.1007/s00132-004-0694-4 Google Scholar
  6. 6.
    Hall H (1961) Stapling of the Spine for Scoliosis. Proc R Soc Med 54(12):1106–1107Google Scholar
  7. 7.
    Crawford CH 3rd, Lenke LG (2010) Growth modulation by means of anterior tethering resulting in progressive correction of juvenile idiopathic scoliosis: a case report. J Bone Joint Surg Am 92(1):202–209.  https://doi.org/10.2106/JBJS.H.01728 Google Scholar
  8. 8.
    Ahmad AA, Aker L, Hanbali Y, Sbaih A, Nazzal Z (2017) Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis. Eur Spine J 26(6):1748–1755.  https://doi.org/10.1007/s00586-016-4910-9 Google Scholar
  9. 9.
    Luqué ER, Cardoso A (1977) Treatment of scoliosis without arthrodesis or external support, preliminary report. Orthop Trans 1:37–38Google Scholar
  10. 10.
    Rosenfeld S, Schlechter J, Smith B (2018) Achievement of guided growth in children with low-tone neuromuscular early-onset scoliosis using a segmental sublaminar instrumentation technique. Spine Deform 6(5):607–613.  https://doi.org/10.1016/j.jspd.2018.02.012 Google Scholar
  11. 11.
    McCarthy RE, Luhmann S, Lenke L, McCullough FL (2014) The Shilla growth guidance technique for early-onset spinal deformities at 2-year follow-up: a preliminary report. J Pediatr Orthop 34(1):1–7.  https://doi.org/10.1097/BPO.0b013e31829f92dc Google Scholar
  12. 12.
    Skov ST, Wijdicks SPJ, Bünger C, Castelein RM, Li H, Kruyt MC (2018) Treatment of early-onset scoliosis with a hybrid of a concave magnetic driver (magnetic controlled growth rod) and a contralateral passive sliding rod construct with apical control: preliminary report on 17 cases. Spine J 18(1):122–129.  https://doi.org/10.1016/j.spinee.2017.06.027 Google Scholar
  13. 13.
    Mundis GM Jr, Akbarnia BA (2011) Biomechanics in the growing spine. In: Akbarnia BA, Yazici M, Thompson GH (eds) The growing spine. Management of spinal disorders in young children. Springer, Heidelberg, pp 43–46Google Scholar
  14. 14.
    Akbarnia BA, Mundis GM Jr, Salari P (2011) Dual growing rods. In: Akbarnia BA, Yazici M, Thompson GH (eds) The growing spine. Management of spinal disorders in young children. Springer, Heidelberg, pp 449–468Google Scholar
  15. 15.
    Akbarnia BA (2007) Management themes in early onset scoliosis. J Bone Joint Surg Am 89(Suppl 1):42–54.  https://doi.org/10.2106/JBJS.F.01256 Google Scholar
  16. 16.
    Ruf M, Koch H, Melcher RP, Harms J (2006) Anatomic reduction and monosegmental fusion in high-grade developmental spondylolisthesis. Spine 31(3):269–274.  https://doi.org/10.1097/01.brs.0000197204.91891.eb Google Scholar
  17. 17.
    Winter R (1977) Scoliosis and spinal growth. Orthop Rev 6:17–20Google Scholar
  18. 18.
    Smith JT, Johnston C, Skaggs D, Flynn J, Vitale M (2015) A new classification system to report complications in growing spine surgery: a multicenter consensus study. J Pediatr Orthop 35(8):798–803.  https://doi.org/10.1097/BPO.0000000000000386 Google Scholar
  19. 19.
    Jeszenszky DJ, Haschtmann D, Kleinstück FS, Sutter M, Eggspühler A, Weiss M, Fekete TF (2014) Posterior vertebral column resection in early onset spinal deformities. Eur Spine J 23(1):198–208.  https://doi.org/10.1007/s00586-013-2924-0 Google Scholar
  20. 20.
    Ruf M, Harms J (2002) Pedicle screws in 1- and 2-year-old children: technique, complications, and effect on further growth. Spine 27(21):460–466.  https://doi.org/10.1097/01.BRS.0000030203.48525.E3 Google Scholar
  21. 21.
    Fekete TF, Kleinstück FS, Mannion AF, Kendik ZS, Jeszenszky DJ (2011) Prospective study of the effect of pedicle screw placement on development of the immature vertebra in an in vivo porcine model. Eur Spine J 20(11):1892–1898.  https://doi.org/10.1007/s00586-011-1889-0 Google Scholar
  22. 22.
    Cobb J (1948) Outline for the study of scoliosis. Am Acad Orthop Surg Instr Course Lect 5:261–275Google Scholar
  23. 23.
    Jeszenszky D (2013) Vertebral column lengthening with open wedge osteotomy in congenital bars. Practical tips, tricks, pitfalls. In: 7th international congress on early onset scoliosis and growing spine (ICEOS). San Diego, California, USAGoogle Scholar
  24. 24.
    Fekete TF, Haschtmann D, Kleinstueck F, Sutter M, Eggspuehler A, Jeszenszky D (2014) Concave side opening wedge osteotomy with growing rods for the treatment of scoliosis in young children. In: 21st international meeting on advanced spine techniques—IMAST. Valencia, SpainGoogle Scholar
  25. 25.
    Akbarnia BA, Marks DS, Boachie-Adjei O, Thompson AG, Asher MA (2005) Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine 30(17 Suppl):46–57Google Scholar
  26. 26.
    Schroerlucke SR, Akbarnia BA, Pawelek JB, Salari P, Mundis GM Jr, Yazici M et al (2012) How does thoracic kyphosis affect patient outcomes in growing rod surgery? Spine 37(15):1303–1309.  https://doi.org/10.1097/BRS.0b013e318246d8a0 Google Scholar
  27. 27.
    Flynn JM, Tomlinson LA, Pawelek J, Thompson GH, McCarthy R, Akbarnia BA et al (2013) Growing-rod graduates: lessons learned from ninety-nine patients who completed lengthening. J Bone Joint Surg Am 95(19):1745–1750.  https://doi.org/10.2106/JBJS.L.01386 Google Scholar
  28. 28.
    Watanabe K, Uno K, Suzuki T, Kawakami N, Tsuji T, Yanagida H et al (2013) Risk factors for complications associated with growing-rod surgery for early-onset scoliosis. Spine 38(8):E464–E468.  https://doi.org/10.1097/BRS.0b013e318288671a Google Scholar
  29. 29.
    Wang S, Zhang J, Qiu G, Wang Y, Li S, Zhao Y et al (2012) Dual growing rods technique for congenital scoliosis: more than 2 years outcomes: preliminary results of a single center. Spine 37(26):E1639–E1644.  https://doi.org/10.1097/BRS.0b013e318273d6bf Google Scholar
  30. 30.
    Sucato DJ (2010) Management of severe spinal deformity: scoliosis and kyphosis. Spine 35(25):2186–2192.  https://doi.org/10.1097/BRS.0b013e3181feab19 Google Scholar
  31. 31.
    Gomez JA, Grzywna A, Hanstein R, Emans JB, Hresko MT, Hedequist D et al (2017) Staged growing rods with preimplantation of spinal anchors for complex early onset scoliosis. J Pediatr Orthop 37(8):e606–e611.  https://doi.org/10.1097/BPO.0000000000000957 Google Scholar
  32. 32.
    Odent T, Ilharreborde B, Miladi L, Khouri N, Violas P, Ouellet J et al (2015) Fusionless surgery in early-onset scoliosis. Orthop Traumatol Surg Res 101(6 Suppl):S281–S288.  https://doi.org/10.1016/j.otsr.2015.07.004 Google Scholar
  33. 33.
    Enercan M, Kahraman S, Erturer E, Ozturk C, Hamzaoglu A (2014) Apical and intermediate anchors without fusion improve Cobb angle and thoracic kyphosis in early-onset scoliosis. Clin Orthop Relat Res 472(12):3902–3908.  https://doi.org/10.1007/s11999-014-3815-3 Google Scholar
  34. 34.
    Akbarnia BA, Breakwell LM, Marks DS, McCarthy RE, Thompson AG, Canale SK et al (2008) Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 33(9):984–990.  https://doi.org/10.1097/BRS.0b013e31816c8b4e Google Scholar
  35. 35.
    Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J et al (2005) Comparison of single and dual growing rod techniques followed through definitive surgery. Spine 30(18):2039–2044Google Scholar
  36. 36.
    Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H et al (2010) Complications of growing-rod treatment for early-onset scoliosis: analysis of hundred and forty patients. J Bone Joint Surg Am 92(15):2533–2543.  https://doi.org/10.2106/JBJS.I.01471 Google Scholar
  37. 37.
    Shah SA, Karatas AF, Dhawale AA, Dede O, Mundis GM Jr, Holmes L Jr et al (2014) The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine 39(22):E1311–E1317.  https://doi.org/10.1097/BRS.0000000000000565 Google Scholar
  38. 38.
    Thompson GH, Akbarnia BA, Campbell RM Jr (2007) Growing rod techniques in early-onset scoliosis. J Pediatr Orthop 27(3):354–361.  https://doi.org/10.1097/BPO.0b013e3180333eea Google Scholar
  39. 39.
    Lenke LG, Betz RR, Harms J, Bridwell KH, Clements DH, Lowe TG et al (2001) Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am. 83-A(8):1169–1181Google Scholar
  40. 40.
    Campbell RM Jr (2009) Spine deformities in rare congenital syndromes: clinical issues. Spine 34(17):1815–1827.  https://doi.org/10.1097/BRS.0b013e3181ab64e9 Google Scholar
  41. 41.
    Akbarnia BA, Emans JB (2010) Complications of growth-sparing surgery in early onset scoliosis. Spine 35(25):2193–2204.  https://doi.org/10.1097/BRS.0b013e3181f070b5 Google Scholar
  42. 42.
    Yang JS, Sponseller PD, Thompson GH, Akbarnia BA, Emans JB, Yazici M et al (2011) Growing rod fracutres: risk factors and opportunities for prevention. Spine 36(20):1639–1644.  https://doi.org/10.1097/BRS.0b013e31822a982f Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Spine Surgery and NeurosurgerySchulthess KlinikZurichSwitzerland
  2. 2.University Children’s Hospital of ZurichDepartment of Paediatric SurgeryZurichSwitzerland

Personalised recommendations