Abstract
Objective
To evaluate clinical and radiological outcomes of growing rod (GR) in the management of Early Onset Scoliosis (EOS) with intraspinal anomalies.
Background data
The effect of repeated distractions following GR, in the presence of intraspinal anomalies has not been studied.
Methods
During 2007–2012, 46 patients underwent fusionless surgery. Out of these 46 patients, 13 patients had one or more intraspinal anomalies. 11 patients had undergone prior neurosurgical procedure while 2 (filum terminale lipoma and syringomyelia) did not. A total of 88 procedures were conducted during the treatment period; 13 index surgeries, 74 distractions of GR and 1 unplanned surgery.
Results
The age at surgery was 6.8 ± 2.5 years (3.5–12 years). 11 patients had congenital scoliosis and 2 had idiopathic scoliosis. A total of 19 (41.30 %) intraspinal anomalies [Tethered Cord Syndrome (TCS) 08, Split Cord Malformation (SCM) 08, Syringomyelia 01, Meningomyelocele 01, Filum terminale Lipoma 01] were seen. The average lengthening procedures per patient were 5.7 (4–9) with distraction interval of 6.7 (6–7.25) months. Pre-operative Cobb angle was 78.50 ± 18.1 (54–114°) and improved to 53.10 ± 16.70 (36–84°) at final follow-up. A total of 15 complications related to implant (9), wound (2), anesthesia (2) and neurological (2) occurred in 7 patients. Among the two neurological complications, one patient sustained fall in the post-op period and reported to the emergency department with paraplegia and broken proximal screw. While other patient experienced MEP changes during index procedure. None of the patients had any neurological complications during repeated lengthening procedures.
Conclusion
The most common cord anomalies associated with EOS in our study are TCS and SCM. Although presence of previous intraspinal anomaly does not seem to increase the incidence of neurological deficit, use of neuromonitoring is advisable for all index procedure and selected distractions.
Study design
Level 4 (case series).
Similar content being viewed by others
References
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
Luque ER (1982) Paralytic scoliosis in growing children. Clin Orthop Relat Res 163:202–209
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:S46–S57
Fletcher ND, Bruce RW (2012) Early onset scoliosis: current concepts and controversies. Curr Rev Musculoskelet Med 5:102–110
McMaster MJ (1984) Occult intraspinal anomalies and congenital scoliosis. J Bone Joint Surg Am 66:588–601
Bradford DS, Heithoff KB, Cohen M (1991) Intraspinal abnormalities and congenital spine deformities: a radiographic and MRI study. J Pediatr Orthop 11:36–41
Basu PS, Elsebaie H, Noordeen MHH (2002) Congenital spinal deformity: a comprehensive assessment at presentation. Spine 27:2255–2259
Shen J, Wang Z, Liu J, Xue X, Qiu G (2013) Abnormalities associated with congenital scoliosis: a retrospective study of 226 chinese surgical cases. Spine 38:814–818
Dobbs MB, Lenke LG, Szymanski DA, Morcuende JA, Weinstein SL, Bridwell KH, Sponseller PD (2002) Prevalence of neural axis abnormalities in patients with infantile idiopathic scoliosis. J Bone Joint Surg Am 84-A:2230–2234
Pahys JM, Samdani AF, Betz RR (2009) Intraspinal anomalies in infantile idiopathic scoliosis: prevalence and role of magnetic resonance imaging. Spine 34:E434–E438
Wang S, Zhang J, Qiu G, Wang Y, Li S, Zhao Y, Shen J, Weng X (2012) Dual growing rods technique for congenital scoliosis: more than 2 years outcomes: preliminary results of a single center. Spine 37:E1639–E1644
Chandran S, McCarthy J, Noonan K, Mann D, Nemeth B, Guiliani T (2011) Early treatment of scoliosis with growing rods in children with severe spinal muscular atrophy: a preliminary report. J Pediatr Orthop 31:450–454
Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J, Lowe R, Asher MA, Marks DS (2005) Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine 30:2039–2044
Elsebai HB, Yazici M, Thompson GH et al (2011) Safety and efficacy of growing rod technique for pediatric congenital spinal deformities. J Pediatr Orthop 31:1–5
Yazici M, Emans J (2009) 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 34:1800–1807
Mehdian H, Stokes OM (2015) Growing rod construct for the treatment of early-onset scoliosis. Eur Spine J 24(Suppl 5):647–651
Prahinski JR, Polly DW Jr, McHale KA, Ellenbogen RG (2000) Occult intraspinal anomalies in congenital scoliosis. J Pediatr Orthop 20:59–63
Winter RB, Haven JJ, Moe JH, Lagaard SM (1974) Diastematomyelia and congenital spine deformities. J Bone Joint Surg Am 56:27–39
Pang D, Dias MS, Ahab-Barmada M (1992) Split cord malformation: part I: a unified theory of embryogenesis for double spinal cord malformations. Neurosurgery 31:451–480
Sinha S, Agarwal D, Mahapatra AK (2006) Split cord malformations: an experience of 203 cases. Childs Nerv Syst 22:3–7
Sankar WN, Skaggs DL, Emans JB, Marks DS, Dormans JP, Thompson GH, Shah SA, Sponseller PD, Akbarnia BA (2009) Neurologic risk in growing rod spine surgery in early onset scoliosis: is neuromonitoring necessary for all cases? Spine 34:1952–1955
Hui H, Luo Z-J, Yan M, Ye Z-X, Tao H-R, Wang H-Q (2013) Non-fusion and growing instrumentation in the correction of congenital spinal deformity associated with split spinal cord malformation: an early follow-up outcome. Eur Spine J 22:1317–1325
Hickey BA, Towriss C, Baxter G, Yasso S, James S, Jones A, Howes J, Davies P, Ahuja S (2014) Early experience of MAGEC magnetic growing rods in the treatment of early onset scoliosis. Eur Spine J 23(Suppl 1):S61–S65
Cheung KM-C, Cheung JP-Y, Samartzis D, Mak K-C, Wong Y-W, Cheung W-Y, Akbarnia BA, Luk KD-K (2012) Magnetically controlled growing rods for severe spinal curvature in young children: a prospective case series. Lancet 379:1967–1974
Dannawi Z, Altaf F, Harshavardhana NS, El Sebaie H, Noordeen H (2013) Early results of a remotely-operated magnetic growth rod in early-onset scoliosis. Bone Joint J 95-B:75–80
Pérez Cervera T, Lirola Criado JF, Farrington Rueda DM (2015) Ultrasound control of magnet growing rod distraction in early onset scoliosis. Rev Esp Cir Ortop Traumatol. doi:10.1016/j.recot.2015.01.001
Charroin C, Abelin-Genevois K, Cunin V, Berthiller J, Constant H, Kohler R, Aulagner G, Serrier H, Armoiry X (2014) Direct costs associated with the management of progressive early onset scoliosis: estimations based on gold standard technique or with magnetically controlled growing rods. Orthop Traumatol Surg Res 100:469–474
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics
Necessary clearance from Institute ethics committee was sought for the study.
Conflict of interest
The author hereby declares that none of the authors or their family members has received research or institutional support from any pharmaceutical or surgical company either directly or indirectly.
Rights and permissions
About this article
Cite this article
Jayaswal, A., Kandwal, P., Goswami, A. et al. Early onset scoliosis with intraspinal anomalies: management with growing rod. Eur Spine J 25, 3301–3307 (2016). https://doi.org/10.1007/s00586-016-4566-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-016-4566-5