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Outcomes of Pelvic Fixation in Growing Rod Constructs: An Analysis of Patients With a Minimum of 4 Years of Follow-up

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Abstract

Study Design

Retrospective review.

Objective

To evaluate which distal anchors in growing rod (GR) constructs optimally correct major curve, pelvic obliquity, sagittal alignment, T1–S1 length, thoracic kyphosis, and lumbar lordosis with the fewest complications at 4 or more years’ postoperative follow-up.

Summary of Background Data

Pelvic fixation to the ilium and/or sacrum in GR constructs is used to treat patients with early-onset scoliosis. No studies have evaluated radiographical outcomes and complications in these patients at 4 or more years’ follow-up.

Methods

Included were 38 patients from a multicenter early-onset-scoliosis database with dual GRs anchored to the pelvis. Radiographic data included major curve, T1–S1 length, T5–T12 kyphosis, lordosis, sagittal alignment, and pelvic obliquity at preoperative and latest follow-up time points. Complications were evaluated for all anchor subtypes.

Results

Mean follow-up time was 5.3 ± 0.1 years. GRs with distal anchors to the ilium significantly improved major curve (49%, p =.013) and pelvic obliquity (78%, p =.035) compared with constructs anchored to the sacrum only. Constructs with iliac fixation with S1 screws provided greater correction of lumbar kyphosis than constructs with iliac fixation and no S1 screws (p =.023). Constructs with a single caudal crosslink had a greater T1–S1 length at latest follow-up than constructs with combined cephalad and caudal crosslinks (p =.027). There were no significant differences in the rates of infection or instrumentation failure between iliac and sacral fixation groups. GR constructs with distal anchors that used a posterior superior iliac spine start point had a higher infection rate (60%) than those inserted via a sacral-alar-iliac technique (7%) (p =.002).

Conclusions

GR constructs anchored to the ilium provide significant improvements in the major curve and pelvic obliquity at a minimum of 4 years of follow-up versus constructs anchored to the sacrum alone.

Level of Evidence

Level III, retrospective cohort study.

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Correspondence to Paul D. Sponseller MD.

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Author Disclosures

JTB (none), AJ (none), FS-P-G (consultancy fees from DePuy Synthes; institutional grant from DePuy Synthes), DLS (consultancy fees from Biomet and Medtronic; payment for expert testimony as legal expert in medical malpractice cases; payment for lectures, including service on speakers bureaus from Biomet, Medtronic, and Stryker; patents from Medtronic [patent holder]; royalties from Wolters Kluwer Health–Lippincott Williams & Wilkins, and Biomet Spine; payment for development of educational presentations from Stryker; Biomet; Medtronic; other institutional support from Medtronic [fellowship program]), GHT (board membership, travel expenses and daily compensation for Shrine activities from Shriners Hospital for Children Medical Advisory Board; editor salary as coeditor, Journal of Pediatric Orthopaedics; employed at Department of Orthopaedic Surgery, Case Medical Center), BAA (consultancy fees [ongoing] from Ellipse Technologies and K2M, consultancy fees [past] from Kspine; institutional grants from Ellipse Technologies; royalties [ongoing] from K2M and Nuvasive, royalties [past] from DePuy Spine; stock/stock options in Ellipse Technologies, Kspine, and Nuvasive), PDS (consultancy fees from DePuy Synthes Spine and Globus; royalties from DePuy Synthes Spine and Globus).

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Brooks, J.T., Jain, A., Sanchez-Perez-Grueso, F. et al. Outcomes of Pelvic Fixation in Growing Rod Constructs: An Analysis of Patients With a Minimum of 4 Years of Follow-up. Spine Deform 4, 211–216 (2016). https://doi.org/10.1016/j.jspd.2015.11.004

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  • DOI: https://doi.org/10.1016/j.jspd.2015.11.004

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