Spring-Assisted Distraction: Principles and Techniques

  • Noor Ul Owase JeelaniEmail author
Living reference work entry


Calvarial distraction resulting in osteogenesis within the bone gaps created is an established technique in craniofacial surgery. Multiple distractor types are utilized, both internal and external to achieve this aim. Spring-like devices have increasingly been used as distractors for over two decades now, with positive results and an acceptable morbidity profile. Advantages include the minimalistic nature of the surgeries and the reduced socioeconomic costs. Furthermore, distraction over larger distances may be achieved compared to other types of distractors. This is coupled with a reduced degree of control over the distraction process once the springs have been implanted. The use of springs does require stringent planning of the osteotomies and the type of force vectors (springs) used. Preoperative finite element modeling provides an excellent platform for planning these procedures as well as undertaking informed consent from the families. Patient selection remains key to good outcomes. In this chapter, we have elaborated on the above, utilizing our single institution experience of over 300 cases undertaken over the past decade.


Spring-assisted distraction Cranioplasty Craniosynostosis Cranial vault distraction Spring biomechanics Calvarial remodeling 



I would like to thank Dr. L.S. van de Lande and Dr. A. Borghi for their help with the technical notes, the diagrams, and valuable assistance with compiling this chapter.


  1. Alessandro Borghi NRF, Jeelani O, Dunaway D, Schievano S (2018) Population-derived material properties for craniosynostosis patients improve outcome predictions in craniofacial surgery. In: Abstract for 8th world congress of biomechanicsGoogle Scholar
  2. Arko LT, Swanson JW, Fierst TM, Henn RE, Chang D, Storm PB, Bartlett SP, Taylor JA, Heuer GG (2015) Spring-mediated sagittal craniosynostosis treatment at the Children’s Hospital of Philadelphia: technical notes and literature review. Neurosurg Focus 38:E7CrossRefGoogle Scholar
  3. Borghi A, Schievano S, Rodriguez Florez N, Mcnicholas R, Rodgers W, Ponniah A, James G, Hayward R, Dunaway D, Jeelani NUO (2017) Assessment of spring cranioplasty biomechanics in sagittal craniosynostosis patients. J Neurosurg Pediatr 20:400–409CrossRefGoogle Scholar
  4. Borghi A, Rodriguez-Florez N, Rodgers W, James G, Hayward R, Dunaway D, Jeelani O, Schievano S (2018) Spring assisted cranioplasty: a patient specific computational model. Med Eng Phys 53:58–65CrossRefGoogle Scholar
  5. Costa MA, Ackerman LL, Tholpady SS, Greathouse ST, Tahiri Y, Flores RL (2015) Spring-assisted cranial vault expansion in the setting of multisutural craniosynostosis and anomalous venous drainage: case report. J Neurosurg Pediatr 16:80–85CrossRefGoogle Scholar
  6. Danelson KA, Gordon ES, David LR, Stitzel JD (2009) Using a three dimensional model of the pediatric skull for pre-operative planning in the treatment of craniosynostosis – biomed 2009. Biomed Sci Instrum 45:358–363PubMedGoogle Scholar
  7. David LR, Gewalli F, Guimaraes-Ferreira J, Sanger C, Glazier S, Argenta LC (2002) Dynamic spring-mediated cranioplasty in a rabbit model. J Craniofac Surg 13:794–801CrossRefGoogle Scholar
  8. David LR, Plikaitis CM, Couture D, Glazier SS, Argenta LC (2010) Outcome analysis of our first 75 spring-assisted surgeries for scaphocephaly. J Craniofac Surg 21:3–9CrossRefGoogle Scholar
  9. Davis C, Lauritzen CG (2008) Spring-assisted remodeling for ventricular shunt-induced cranial deformity. J Craniofac Surg 19:588–592CrossRefGoogle Scholar
  10. De Jong T, Van Veelen ML, Mathijssen IM (2013) Spring-assisted posterior vault expansion in multisuture craniosynostosis. Childs Nerv Syst 29:815–820CrossRefGoogle Scholar
  11. Guimaraes-Ferreira J, Gewalli F, David L, Olsson R, Friede H, Lauritzen CG (2003) Spring-mediated Cranioplasty compared with the modified pi-plasty for sagittal synostosis. Scand J Plast Reconstr Surg Hand Surg 37:208–215CrossRefGoogle Scholar
  12. Howe PW, Cooper MG (2012) Blood loss and replacement for paediatric cranioplasty in Australia – a prospective national audit. Anaesth Intensive Care 40:107–113PubMedGoogle Scholar
  13. Ilizarov GA (1971) Basic principles of transosseous compression and distraction osteosynthesis. Ortop Travmatol Protez 32:7–15PubMedGoogle Scholar
  14. Karp NS, Thorne CH, Mccarthy JG, Sissons HA (1990) Bone lengthening in the craniofacial skeleton. Ann Plast Surg 24:231–237CrossRefGoogle Scholar
  15. Lauritzen C, Sugawara Y, Kocabalkan O, Olsson R (1998) Spring mediated dynamic craniofacial reshaping. Case report. Scand J Plast Reconstr Surg Hand Surg 32:331–338CrossRefGoogle Scholar
  16. Lauritzen CG, Davis C, Ivarsson A, Sanger C, Hewitt TD (2008) The evolving role of springs in craniofacial surgery: the first 100 clinical cases. Plast Reconstr Surg 121:545–554CrossRefGoogle Scholar
  17. Mackenzie KA, Davis C, Yang A, Macfarlane MR (2009) Evolution of surgery for sagittal synostosis: the role of new technologies. J Craniofac Surg 20:129–133CrossRefGoogle Scholar
  18. Maltese G, Tarnow P, Lauritzen CG (2007) Spring-assisted correction of hypotelorism in metopic synostosis. Plast Reconstr Surg 119:977–984CrossRefGoogle Scholar
  19. Pyle J, Glazier S, Couture D, Sanger C, Gordon S, David L (2009) Spring-assisted surgery-a surgeon’s manual for the manufacture and utilization of springs in craniofacial surgery. J Craniofac Surg 20:1962–1968CrossRefGoogle Scholar
  20. Rodgers W, Glass GE, Schievano S, Borghi A, Rodriguez-Florez N, Tahim A, Angullia F, Breakey W, Knoops P, Tenhagen M, O’hara J, Ponniah A, James G, Dunaway DJ, Jeelani NUO (2017) Spring-assisted cranioplasty for the correction of nonsyndromic scaphocephaly: a quantitative analysis of 100 consecutive cases. Plast Reconstr Surg 140:125–134CrossRefGoogle Scholar
  21. Sgouros S, Goldin JH, Hockley AD, Wake MJ (1996) Posterior skull surgery in craniosynostosis. Childs Nerv Syst 12:727–733CrossRefGoogle Scholar
  22. Sun J, Ter Maaten NS, Mazzaferro DM, Wes AM, Naran S, Bartlett SP, Taylor JA (2018) Spring-mediated cranioplasty in sagittal synostosis: does age at placement affect expansion? J Craniofac Surg 29:632–635PubMedGoogle Scholar
  23. Van Veelen ML, Mathijssen IM (2012) Spring-assisted correction of sagittal suture synostosis. Childs Nerv Syst 28:1347–1351CrossRefGoogle Scholar
  24. Van Veelen MC, Kamst N, Touw C, Mauff K, Versnel S, Dammers R, De Jong THR, Prasad V, Mathijssen IM (2018) Minimally invasive, spring-assisted correction of sagittal suture synostosis: technique, outcome, and complications in 83 cases. Plast Reconstr Surg 141:423–433PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Paediatric NeurosurgeonGreat Ormond Street HospitalLondonUK

Section editors and affiliations

  • Concezio Di Rocco
    • 1
  • Rocco, F Di
    • 2
  1. 1.International Department of NeurosurgeryNeuroscience InstituteHannoverGermany
  2. 2.University of ParisParisFrance

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