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Fusionless procedures for the management of early-onset spine deformities in 2011: what do we know?

  • Current Concept Review
  • Published:
Journal of Children's Orthopaedics

Abstract

While attempts to understand them better and treat them more effectively, early-onset deformities have gained great pace in the past few years. Large patient series with long follow-ups that would provide high levels of evidence are still almost non-existent. That there is no safe treatment algorithm defined and agreed upon for this patient population continues to pose a challenge for pediatric spine surgeons. In this review, authors who are well known for their research and experience in the treatment of early-onset scoliosis (EOS) have come together in order to answer those questions which are most frequently asked by other surgeons. The most basic eight questions in this field have been answered succinctly by these authors and a current overview is provided.

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References

  1. Campbell RM Jr, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N et al (2003) The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 85-A(3):399–408

    Google Scholar 

  2. Karol LA, Johnston C, Mladenov K, Schochet P, Walters P, Browne RH (2008) Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am 90(6):1272–1281

    Article  Google Scholar 

  3. Yang JS, McElroy MJ, Akbarnia BA, Salari P, Oliveira D, Thompson GH et al (2010) Growing rods for spinal deformity: characterizing consensus and variation in current use. J Pediatr Orthop 30(3):264–270

    Article  Google Scholar 

  4. Sponseller PD, Yazici M, Demetracopoulos C, Emans JB (2007) Evidence basis for management of spine and chest wall deformities in children. Spine (Phila Pa 1976) 32(19 Suppl):S81–S90

    Article  Google Scholar 

  5. Vitale MG, Gomez JA, Matsumoto H, Roye DP Jr (2010) Variability of expert opinion in treatment of early-onset scoliosis. Clin Orthop Relat Res 469(5):1317–1322

    Article  Google Scholar 

  6. Sanders JO, D’Astous J, Fitzgerald M, Khoury JG, Kishan S, Sturm PF (2009) Derotational casting for progressive infantile scoliosis. J Pediatr Orthop 29(6):581–587

    Article  Google Scholar 

  7. 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 (Phila Pa 1976) 30(17 Suppl):S46–S57

    Article  Google Scholar 

  8. McCarthy RE, Sucato D, Turner JL, Zhang H, Henson MA, McCarthy K (2010) Shilla growing rods in a caprine animal model: a pilot study. Clin Orthop Relat Res 468(3):705–710

    Article  Google Scholar 

  9. Campbell RM Jr (2005) Operative strategies for thoracic insufficiency syndrome by vertical expandable prosthetic titanium rib expansion thoracoplasty. Oper Tech Orthop 15(4):315–325

    Article  Google Scholar 

  10. Skaggs DL (2008) A classification system for the treatment of early onset scoliosis. In: Proceedings of the 2nd International Congress on Early Onset Scoliosis and Growing Spine, Montreal, Québec, Canada, November 2008

  11. Sankar W, Skaggs DL, Yazici M, Johnston C, Javidan P, Kadakia R et al (2009) Lengthening of dual growing rods: is there a law of diminishing return? J Child Orthop 3(6):503–533

    Article  Google Scholar 

  12. 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 one hundred and forty patients. J Bone Joint Surg Am 92(15):2533–2543

    Article  Google Scholar 

  13. Vitale MG, Corona J, Matsumoto H, Avendano J, Pinder D, Miller DJ et al (2010) Development and initial validation of a disease specific outcome measure for early onset scoliosis. Stud Health Technol Inform 158:172–176

    Google Scholar 

  14. Campbell RM Jr, Hell-Vocke AK (2003) Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J Bone Joint Surg Am 85-A(3):409–420

    Google Scholar 

  15. Swank SM, Winter RB, Moe JH (1982) Scoliosis and cor pulmonale. Spine (Phila Pa 1976) 7(4):343–354

    Article  CAS  Google Scholar 

  16. Dimeglio A (1993) Growth of the spine before age 5 years. J Pediatr Orthop B 1:102–107

    Article  Google Scholar 

  17. Dimeglio A, Bonnel F (1990) Le rachis en croissance. Springer, Paris

    Google Scholar 

  18. Dimeglio A (2005) Growth in pediatric orthopaedics. In: Morrissey RT, Weinstein SL (eds) Lovell and Winter’s pediatric orthopaedics. Lippincott William & Wilkins, Philadelphia, pp 35–65

    Google Scholar 

  19. Dimeglio A (2001) Growth in pediatric orthopaedics. J Pediatr Orthop 21(4):549–555

    CAS  Google Scholar 

  20. Charles YP, Dimeglio A, Marcoul M, Bourgin JF, Marcoul A, Bozonnat MC (2008) Influence of idiopathic scoliosis on three-dimensional thoracic growth. Spine (Phila Pa 1976) 33(11):1209–1218

    Article  Google Scholar 

  21. Skaggs DL, Sankar WN, Albrektson J, Wren TA, Campbell RM (2009) Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome. Spine (Phila Pa 1976) 34(23):2530–2533

    Article  Google Scholar 

  22. Canavese F, Dimeglio A, Volpatti D, Stebel M, Daures JP, Canavese B et al (2007) Dorsal arthrodesis of thoracic spine and effects on thorax growth in prepubertal New Zealand white rabbits. Spine (Phila Pa 1976) 32(16):E443–E450

    Article  Google Scholar 

  23. Pehrsson K, Larsson S, Oden A, Nachemson A (1992) Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine (Phila Pa 1976) 17(9):1091–1096

    Article  CAS  Google Scholar 

  24. Gillingham BL, Fan RA, Akbarnia BA (2006) Early onset idiopathic scoliosis. J Am Acad Orthop Surg 14(2):101–112

    Google Scholar 

  25. Giampietro PF, Dunwoodie SL, Kusumi K, Pourquié O, Tassy O, Offiah AC et al (2009) Progress in the understanding of the genetic etiology of vertebral segmentation disorders in humans. Ann N Y Acad Sci 1151:38–67

    Article  CAS  Google Scholar 

  26. Vitale MG, Matsumoto H, Bye MR, Gomez JA, Booker WA, Hyman JE et al (2008) A retrospective cohort study of pulmonary function, radiographic measures, and quality of life in children with congenital scoliosis: an evaluation of patient outcomes after early spinal fusion. Spine (Phila Pa 1976) 33(11):1242–1249

    Article  Google Scholar 

  27. Vitale MG, Matsumoto H, Roye DP Jr, Gomez JA, Betz RR, Emans JB et al (2008) Health-related quality of life in children with thoracic insufficiency syndrome. J Pediatr Orthop 28(2):239–243

    Article  Google Scholar 

  28. Campbell RM Jr, Smith MD (2007) Thoracic insufficiency syndrome and exotic scoliosis. J Bone Joint Surg Am 89(Suppl 1):108–122

    Article  Google Scholar 

  29. Sucato DJ (2007) Spine deformity in spinal muscular atrophy. J Bone Joint Surg Am 89(Suppl 1):148–154

    Article  Google Scholar 

  30. Sponseller PD, Thompson GH, Akbarnia BA, Glait SA, Asher MA, Emans JB et al (2009) Growing rods for infantile scoliosis in Marfan syndrome. Spine (Phila Pa 1976) 34(16):1711–1715

    Article  Google Scholar 

  31. Shapiro JR, Sponsellor PD (2009) Osteogenesis imperfecta: questions and answers. Curr Opin Pediatr 21(6):709–716

    Article  Google Scholar 

  32. Akbarnia BA (2007) Management themes in early onset scoliosis. J Bone Joint Surg Am 89(Suppl 1):42–54

    Article  Google Scholar 

  33. Betz RR, D’Andrea LP, Mulcahey MJ, Chafetz RS (2005) Vertebral body stapling procedure for the treatment of scoliosis in the growing child. Clin Orthop Relat Res (434):55–60

  34. Sponseller PD, Yang JS, Thompson GH, McCarthy RE, Emans JB, Skaggs DL et al (2009) Pelvic fixation of growing rods: comparison of constructs. Spine (Phila Pa 1976) 34(16):1706–1710

    Article  Google Scholar 

  35. Mehta MH (1972) The rib–vertebra angle in the early diagnosis between resolving and progressive infantile scoliosis. J Bone Joint Surg Br 54(2):230–243

    CAS  Google Scholar 

  36. Schreier H, Ladakakos C, Morabito D, Chapman L, Knudson MM (2005) Posttraumatic stress symptoms in children after mild to moderate pediatric trauma: a longitudinal examination of symptom prevalence, correlates, and parent-child symptom reporting. J Trauma 58(2):353–363

    Article  Google Scholar 

  37. Carrion VG, Weems CF, Reiss AL (2007) Stress predicts brain changes in children: a pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus. Pediatrics 119(3):509–516

    Article  Google Scholar 

  38. Nagata S, Funakosi S, Amae S, Yoshida S, Ambo H, Kudo A et al (2008) Posttraumatic stress disorder in mothers of children who have undergone surgery for congenital disease at a pediatric surgery department. J Pediatr Surg 43(8):1480–1486

    Article  Google Scholar 

  39. Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B (1983) Changes in the normal maximal expiratory flow–volume curve with growth and aging. Am Rev Respir Dis 127(6):725–734

    CAS  Google Scholar 

  40. Murray JF (1986) Postnatal growth and development of the lung. In: Murray JF (ed) The normal lung, 2nd edn. WB Saunders, Philadelphia, pp 23–59

    Google Scholar 

  41. Boyden EA (1977) Development and growth of the airways. In: Hodson WA (ed) Development of the lung. Marcel Dekker, New York, pp 3–35

    Google Scholar 

  42. Vanamo K, Rintala R, Sovijärvi A, Jääskeläinen J, Turpeinen M, Lindahl H et al (1996) Long-term pulmonary sequelae in survivors of congenital diaphragmatic defects. J Pediatr Surg 31(8):1096–1099; discussion 1099–100

    Article  CAS  Google Scholar 

  43. Oberklaid F, Danks DM, Mayne V, Campbell P (1977) Asphyxiating thoracic dysplasia. Clinical, radiological, and pathological information on 10 patients. Arch Dis Child 52(10):758–765

    Article  CAS  Google Scholar 

  44. Mehta HP, Snyder BD, Callender NN, Bellardine CL, Jackson AC (2006) The reciprocal relationship between thoracic and spinal deformity and its effect on pulmonary function in a rabbit model: a pilot study. Spine (Phila Pa 1976) 31(23):2654–2664

    Article  Google Scholar 

  45. Davies G, Reid L (1971) Effect of scoliosis on growth of alveoli and pulmonary arteries and on right ventricle. Arch Dis Child 46(249):623–632

    Article  CAS  Google Scholar 

  46. Goldberg CJ, Gillic I, Connaughton O, Moore DP, Fogarty EE, Canny GJ et al (2003) Respiratory function and cosmesis at maturity in infantile-onset scoliosis. Spine (Phila Pa 1976) 28(20):2397–2406

    Article  CAS  Google Scholar 

  47. Grissom LE, Harcke HT (1998) Thoracic deformities and the growing lung. Semin Roentgenol 33(2):199–208

    Article  CAS  Google Scholar 

  48. Peetsold MG, Vonk-Noordegraaf A, Heij HH, Gemke RJ (2007) Pulmonary function and exercise testing in adult survivors of congenital diaphragmatic hernia. Pediatr Pulmonol 42(4):325–331

    Article  Google Scholar 

  49. Van Biezen FC, Bakx PA, De Villeneuve VH, Hop WC (1993) Scoliosis in children after thoracotomy for aortic coarctation. J Bone Joint Surg Am 75(4):514–518

    Google Scholar 

  50. Motoyama EK, Deeney VF, Fine GF, Yang CI, Mutich RL, Walczak SA et al (2006) Effects on lung function of multiple expansion thoracoplasty in children with thoracic insufficiency syndrome: a longitudinal study. Spine (Phila Pa 1976) 31(3):284–290

    Article  Google Scholar 

  51. Motoyama EK, Yang CI, Deeney VF (2009) Thoracic malformation with early-onset scoliosis: effect of serial VEPTR expansion thoracoplasty on lung growth and function in children. Paediatr Respir Rev 10(1):12–17

    Article  Google Scholar 

  52. Hsia CC (2004) Signals and mechanisms of compensatory lung growth. J Appl Physiol 97(5):1992–1998

    Article  Google Scholar 

  53. Thurlbeck WM (1982) Postnatal human lung growth. Thorax 37(8):564–571

    Article  CAS  Google Scholar 

  54. Zeltner TB, Burri PH (1987) The postnatal development and growth of the human lung. II. Morphology. Respir Physiol 67(3):269–282

    Article  CAS  Google Scholar 

  55. Zeltner TB, Caduff JH, Gehr P, Pfenninger J, Burri PH (1987) The postnatal development and growth of the human lung. I. Morphometry. Respir Physiol 67(3):247–267

    Article  CAS  Google Scholar 

  56. Moe JH (1980) Modern concepts of treatment of spinal deformities in children and adults. Clin Orthop Relat Res (150):137–153

  57. Mineiro J, Weinstein SL (2002) Subcutaneous rodding for progressive spinal curvatures: early results. J Pediatr Orthop 22(3):290–295

    Google Scholar 

  58. Acaroglu E, Yazici M, Alanay A, Surat A (2002) Three-dimensional evolution of scoliotic curve during instrumentation without fusion in young children. J Pediatr Orthop 22(4):492–496

    Google Scholar 

  59. Dimeglio A, Bonnel F, Canavese F (2009) Normal growth of the spine and thorax. In: Akbarnia BA, Yazici M, Thompson GH (eds) The growing spine. Springer, New York, pp 11–41

    Google Scholar 

  60. 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 (Phila Pa 1976) 33(9):984–990

    Article  Google Scholar 

  61. Elsebaie HB, Salah H (2009) Distal pedicle screws migration in growing rods: does it really happen? In: Proceedings of the 3rd International Congress on Early Onset Scoliosis and Growing Spine, Istanbul, Turkey, November 2009

  62. Bowen JR, Johnson WJ (1984) Percutaneous epiphysiodesis. Clin Orthop Relat Res (190):170–173

  63. Stokes IA, Spence H, Aronsson DD, Kilmer N (1996) Mechanical modulation of vertebral body growth. Implications for scoliosis progression. Spine (Phila Pa 1976) 21(10):1162–1167

    Article  CAS  Google Scholar 

  64. Yilmaz G, Huri G, Demirkran G, Dağloğlu K, Ozkan C, Alanay A et al (2010) The effect of posterior distraction on vertebral growth in immature pigs: an experimental simulation of growing rod technique. Spine (Phila Pa 1976) 35(7):730–733

    Google Scholar 

  65. Olgun ZD, Ahmadiadli H, Alanay A, Yazici M (2009) Vertebral body growth during growing rod instrumentation: growth preservation or stimulation? In: Proceedings of the 3rd International Congress on Early Onset Scoliosis and Growing Spine, Istanbul, Turkey, November 2009

  66. Kahanovitz N, Arnoczky SP, Levine DB, Otis JP (1984) The effects of internal fixation on the articular cartilage of unfused canine facet joint cartilage. Spine (Phila Pa 1976) 9(3):268–272

    Article  CAS  Google Scholar 

  67. Cahill PJ, Marvil S, Cuddihy L, Schutt C, Idema J, Clements DH et al (2010) Autofusion in the immature spine treated with growing rods. Spine (Phila Pa 1976) 35(22):E1199–E1203

    Article  Google Scholar 

  68. Kroeber MW, Unglaub F, Wang H, Schmid C, Thomsen M, Nerlich A et al (2002) New in vivo animal model to create intervertebral disc degeneration and to investigate the effects of therapeutic strategies to stimulate disc regeneration. Spine (Phila Pa 1976) 27(23):2684–2690

    Article  Google Scholar 

  69. Kroeber M, Unglaub F, Guehring T, Nerlich A, Hadi T, Lotz J et al (2005) Effects of controlled dynamic disc distraction on degenerated intervertebral discs: an in vivo study on the rabbit lumbar spine model. Spine (Phila Pa 1976) 30(2):181–187

    Article  Google Scholar 

  70. Guehring T, Unglaub F, Lorenz H, Omlor G, Wilke HJ, Kroeber MW (2006) Intradiscal pressure measurements in normal discs, compressed discs and compressed discs treated with axial posterior disc distraction: an experimental study on the rabbit lumbar spine model. Eur Spine J 15(5):597–604

    Article  Google Scholar 

  71. Hee HT, Chuah YJ, Tan BH, Setiobudi T, Wong HK (2011) Vascularization and morphological changes of the endplate after axial compression and distraction of the intervertebral disc. Spine (Phila Pa 1976) 36(7):505–511

    Article  Google Scholar 

  72. 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: a preliminary study. Spine (Phila Pa 1976) 30(18):2039–2044

    Article  Google Scholar 

  73. Völkl-Kernstock S, Felber M, Schabmann A, Inschlag N, Karesch L, Ponocny-Seliger E et al (2008) Comparing stress levels in children aged 2–8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms. Wien Klin Wochenschr 120(13–14):414–421

    Article  Google Scholar 

  74. Kayaalp L, Bozkurt P, Odabasi G, Dogangun B, Cavusoglu P, Bolat N et al (2006) Psychological effects of repeated general anesthesia in children. Paediatr Anaesth 16(8):822–827

    Google Scholar 

  75. Thompson GH, Akbarnia BA, Campbell RM Jr (2007) Growing rod techniques in early-onset scoliosis. J Pediatr Orthop 27(3):354–361

    Article  Google Scholar 

  76. Moe JH, Kharrat K, Winter RB, Cummine JL (1984) Harrington instrumentation without fusion plus external orthotic support for the treatment of difficult curvature problems in young children. Clin Orthop Relat Res (185):35–45

  77. Blakemore LC, Scoles PV, Poe-Kochert C, Thompson GH (2001) Submuscular Isola rod with or without limited apical fusion in the management of severe spinal deformities in young children: preliminary report. Spine (Phila Pa 1976) 26(18):2044–2048

    Article  CAS  Google Scholar 

  78. Klemme WR, Denis F, Winter RB, Lonstein JW, Koop SE (1997) Spinal instrumentation without fusion for progressive scoliosis in young children. J Pediatr Orthop 17(6):734–742

    CAS  Google Scholar 

  79. Osmond DG (1995) Functional anatomy of the chest wall. In: Roussos C (ed) The thorax, part A: physiology, 2nd edn. Marcel Dekker, New York, pp 413–444

    Google Scholar 

  80. Comtois AS, Rochester DF (1995) Respiratory muscle blood flow. In: Roussos C (ed) The thorax, part A: physiology, 2nd edn. Marcel Dekker, New York, pp 633–657

    Google Scholar 

  81. Openshaw P, Edwards S, Helms P (1984) Changes in rib cage geometry during childhood. Thorax 39(8):624–627

    Article  CAS  Google Scholar 

  82. Derenne JP, Whitelaw WA (1995) An abbreviated history of the respiratory muscles from antiquity to the classical age. In: Roussos C (ed) The thorax, part A: physiology, 2nd edn. Marcel Dekker, New York, pp 399–417

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of California, San Diego, CA, USA

    Behrooz A. Akbarnia

  2. Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Robert M. Campbell & Jack M. Flynn

  3. Service de Chirurgie Orthopedique Pediatrique, CHU Lapeyronie, Montpellier, Cedex 5, France

    Alain Dimeglio

  4. Pulmonary Division, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Gregory J. Redding

  5. Johns Hopkins Medical Institution, Baltimore, MD, USA

    Paul D. Sponseller

  6. Children’s Hospital of New York, New York, NY, USA

    Michael G. Vitale

  7. Department of Orthopaedics, Faculty of Medicine, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey

    Muharrem Yazici

Authors
  1. Behrooz A. Akbarnia
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  2. Robert M. Campbell
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  3. Alain Dimeglio
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  4. Jack M. Flynn
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  5. Gregory J. Redding
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  6. Paul D. Sponseller
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  7. Michael G. Vitale
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  8. Muharrem Yazici
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Correspondence to Muharrem Yazici.

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Akbarnia, B.A., Campbell, R.M., Dimeglio, A. et al. Fusionless procedures for the management of early-onset spine deformities in 2011: what do we know?. J Child Orthop 5, 159–172 (2011). https://doi.org/10.1007/s11832-011-0342-6

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  • DOI: https://doi.org/10.1007/s11832-011-0342-6

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