Skip to main content
SpringerLink
Log in

Convex Instrumented Hemiepiphysiodesis with Concave Distraction: A Preliminary Report

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The convex growth arrest (CGA) procedure has been well accepted for treatment of congenital scoliosis as it is a simpler procedure with successful results. However, unpredictability of curve behavior, slow and usually inadequate correction, and necessity of anterior surgery for completeness of the epiphysiodesis are its shortcomings.

Questions/purposes

In a preliminary study we asked whether a modification of the CGA procedure using convex instrumented hemiepiphysiodesis with concave distraction would correct the coronal plane Cobb angles and would correct or maintain sagittal plane local and global kyphosis angles. We also identified complications.

Patients and Methods

We retrospectively reviewed five female patients who underwent the modified procedure. Their mean age at the index operation was 40 months (range, 17–55 months). The patients underwent concave distractions every 6 months. The magnitude of the convex instrumented and concave distracted curves and sagittal plane parameters were determined on the preoperative and most recent followup radiographs. Minimum followup was 26 months (mean, 34 months; range, 26–40 months).

Results

In the coronal plane, the preoperative magnitude of the convex instrumented congenital curve averaged 48°. It was corrected to 36° (25%) postoperatively and was further improved to 27° (44%) at the latest followup. For the distracted segment, the mean preoperative curve was 35°, corrected to 16° postoperatively and to 8° at the latest followup, for an average correction of 77%. Sagittal plane alignment was minimally affected from the procedure. In four of the five patients we identified partial pullout of screws for the concave distraction; these were revised at the time of planned lengthening.

Conclusions

This procedure may obviate the need for multiple osteotomies and long thoracic fusions in young children with long sweeping thoracic deformities involving multiple anomalous vertebrae. Implant-related complications on the concave side may be avoided using paired pedicle screws at the proximal and distal anchor sites.

Level of Evidence

Level IV, therapeutic study. See the guidelines online for a complete description of level of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–D
Fig. 2A–H

Similar content being viewed by others

References

  1. Andrew T, Piggott H. Growth arrest for progressive scoliosis: combined anterior and posterior fusion of the convexity. J Bone Joint Surg Br. 1985;67:193–197.

    PubMed  CAS  Google Scholar 

  2. Bradford DS. Partial epiphyseal arrest and supplemental fixation for progressive correction of congenital spinal deformity. J Bone Joint Surg Am. 1982;64:610–614.

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  4. Cheung KM, Zhang JG, Lu DS, Luk KD, Leong JC. Ten-year follow-up study of lower thoracic hemivertebrae treated by convex fusion and concave distraction. Spine (Phila Pa 1976). 2002;27:748–753.

    Article  Google Scholar 

  5. Cil A, Yazici M, Daglioglu K, Aydingoz U, Alanay A, Acaroglu RE, Gulsen M, Surat A. The effect of pedicle screw placement with or without application of compression across the neurocentral cartilage on the morphology of the spinal canal and pedicle in immature pigs. Spine (Phila PA 1976). 2005;30:1287–1293.

    Article  Google Scholar 

  6. Cil A, Yazici M, Uzumcugil A, Kandemir U, Alanay A, Alanay Y, Acaroglu RE, Surat A. The evolution of sagittal segmental alignment of the spine during childhood. Spine (Phila PA 1976). 2005;30:93–100.

    Google Scholar 

  7. Dubousset J, Katti E, Seringe R. Epiphysiodesis of the spine in young children for congenital spinal deformities. J Pediatr Orthop B. 1993;1:123–130.

    Google Scholar 

  8. Elsebai HB, Yazici M, Thompson GH, Emans JB, Skaggs DL, Crawford AH, Karlin LI, McCarthy RE, Poe-Kochert C, Kostial P, Akbarnia BA. Safety and efficacy of growing rod technique for pediatric congenital spinal deformities. J Pediatr Orthop. 2011;31:1–5.

    Article  PubMed  Google Scholar 

  9. Ginsburg G, Mulconrey DS, Browdy J. Transpedicular hemiepiphysiodesis and posterior instrumentation as a treatment for congenital scoliosis. J Pediatr Orthop. 2007;27:387–391.

    Article  PubMed  Google Scholar 

  10. Keller PM, Lindseth RE, DeRosa GP. Progressive congenital scoliosis treatment using a transpedicular anterior and posterior convex hemiepiphysiodesis and hemiarthrodesis: a preliminary report. Spine (Phila PA 1976). 1994;19:1933–1939.

    Article  CAS  Google Scholar 

  11. Kieffer J, Dubousset J. Combined anterior and posterior convex epiphysiodesis for progressive congenital scoliosis in children aged < or = 5 years. Eur Spine J. 1994;3:120–125.

    Article  PubMed  CAS  Google Scholar 

  12. King AG, MacEwen GD, Bose WJ. Transpedicular convex anterior hemiepiphysiodesis and posterior arthrodesis for progressive congenital scoliosis. Spine (Phila PA 1976). 1992;17(8 suppl):S291–S294.

    Article  CAS  Google Scholar 

  13. Kioschos HC, Asher MA, Lark RG, Harner EJ. Overpowering the crankshaft mechanism: the effect of posterior spinal fusion with and without stiff transpedicular fixation on anterior spinal column growth in immature canines. Spine (Phila PA 1976). 1996;21:1168–1173.

    Article  CAS  Google Scholar 

  14. Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM. Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine (Phila Pa 1976). 2009;34:2213–2221.

    Article  Google Scholar 

  15. Marks DS, Sayampanathan SR, Thompson AG, Piggott H. Long-term results of convex epiphysiodesis for congenital scoliosis. Eur Spine J. 1995;4:296–301.

    Article  PubMed  CAS  Google Scholar 

  16. Roaf R. The treatment of progressive scoliosis by unilateral growth-arrest. J Bone Joint Surg Br. 1963;45:637–651.

    PubMed  CAS  Google Scholar 

  17. Smith JT. The use of growth-sparing instrumentation in pediatric spinal deformity. Orthop Clin North Am. 2007;38:547–552.

    Article  PubMed  Google Scholar 

  18. Thompson AG, Marks DS, Sayampanathan SR, Piggott H. Long-term results of combined anterior and posterior convex epiphysiodesis for congenital scoliosis due to hemivertebrae. Spine (Phila PA 1976). 1995;20:1380–1385.

    CAS  Google Scholar 

  19. Uzumcugil A, Cil A, Yazici M, Acaroglu E, Alanay A, Aksoy C, Surat A. Convex growth arrest in the treatment of congenital spinal deformities, revisited. J Pediatr Orthop. 2004;24:658–666.

    Article  PubMed  Google Scholar 

  20. Walhout RJ, van Rhijn LW, Pruijs JE. Hemi-epiphysiodesis for unclassified congenital scoliosis: immediate results and mid-term follow-up. Eur Spine J. 2002;11:543–549.

    Article  PubMed  CAS  Google Scholar 

  21. Winter RB. Convex anterior and posterior hemiarthrodesis and hemiepiphyseodesis in young children with progressive congenital scoliosis. J Pediatr Orthop. 1981;1:361–366.

    Article  PubMed  CAS  Google Scholar 

  22. Winter RB, Lonstein JE, Denis F, Sta-Ana de la Rosa H. Convex growth arrest for progressive congenital scoliosis due to hemivertebra. J Pediatr Orthop. 1988;8:633–638.

    Article  PubMed  CAS  Google Scholar 

  23. Yazici M, Emans J. Fusionless instrumentation systems for congenital scoliosis: expandable spinal rods and vertical expandable prosthetic titanium rib in the management of congenital spine deformities in the growing child. Spine (Phila Pa 1976). 2009;34:1800–1807.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Bilim University Faculty of Medicine, Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet cad. No: 290, ŞİŞLİ, Istanbul, Turkey

    Ahmet Alanay MD

  2. Hacettepe University Orthopaedic Surgery and Traumatology, Ankara, Turkey

    Ozgur Dede MD & Muharrem Yazici MD

Authors
  1. Ahmet Alanay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ozgur Dede MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muharrem Yazici MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmet Alanay MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Hacettepe University Faculty of Medicine Department of Orthopaedics and Traumatology, Ankara, Turkey.

About this article

Cite this article

Alanay, A., Dede, O. & Yazici, M. Convex Instrumented Hemiepiphysiodesis with Concave Distraction: A Preliminary Report. Clin Orthop Relat Res 470, 1144–1150 (2012). https://doi.org/10.1007/s11999-011-1878-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-1878-y

Keywords

Search

Navigation