J Korean Soc Spine Surg.  2013 Mar;20(1):8-15. 10.4184/jkss.2013.20.1.8.

Results of Dual Growing Rods Treatment for Progressive Pediatric Spinal Deformity

• Kim HB
• Chong HS
• Moon ES
• Lee HM
• Moon SH
• Park JO
• Yang JH
• Kim HS

• KMID: 2209495
• DOI: http://doi.org/10.4184/jkss.2013.20.1.8

Abstract

STUDY DESIGN: A prospective study.
OBJECTIVES
To report the results of new designed dual growing rods system for progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea.
MATERIALS AND METHODS
Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb's angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period.
RESULTS
Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb's angle of scoliosis curve was corrected from preoperative 80.2degrees(55-136) to 37.6degrees (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7degrees(12-101) and 38.3degrees(9-72) to 44.5degrees(12-75) and 18.8degrees(1-46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33-59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period.
CONCLUSIONS
New designed dual growing rods system for pediatric patients with progressive spinal deformity is an effective and relatively safe method because of adequate correction and acceptable rate of complications.

Keyword

Spinal deformity; Scoliosis; Growing rods

MeSH Terms

Animals
Congenital Abnormalities
Female
Follow-Up Studies
Humans
Kyphosis
Lordosis
Male
Osteochondrodysplasias
Osteoporosis
Preoperative Period
Prospective Studies
Scoliosis
Soft Tissue Infections
Osteoporosis

Figure

• 

  Fig. 1. This diagram shows three parts compositions of growing rods system. (A) conventional rod for lumbar contouring, (B) Growing tube, (C) Growing rod for thoraco-lumbar contouring.

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  Fig. 2. This clinical photo shows that there were two separated incisions for pedicle screw insertion and intramuscular rod placement.

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  Fig. 3. Serial radiographs of 7 years male patients with neuromuscular scoliosis due to lipomeningocele. (A) Preoperative whole spine PA view. (B) Whole spine PA view after primary surgery. (C) Whole spine PA view after first lengthening procedure for growing rods. (D) Whole spine PA view shows last follow up after fourth lengthening procedure.

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  Fig. 4. Serial radiographs of 10 years 9 month male patients with spondyloepiphyseal dysplasia. (A) Preoperative whole spine Lateral view. (B) Whole spine lateral view after primary surgery. (C) Whole spine lateral view after first lengthening procedure for growing rods. (D) Whole spine lateral view after second lengthening procedure for growing rods. (E) Whole spine PA view shows rod breakage of left distal lumbar rod(arrow) during follow up after second lengthening procedure for growing rods.

Reference

1.Akbarnia BA., Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (Phila Pa 1976). 2010. 35:2193–204.

2.Vitale MG., Gomez JA., Matsumoto H., Roye DP Jr. Vari-ability of expert opinion in treatment of early-onset scolio-sis. Clin Orthop Relat Res. 2011. 469:1317–22.

3.Mehta M., Morel G. The non-operative treatment of infan-tile idiopathic scoliosis. Zorab PA, Siezler D, editors. Scoliosis. 1st ed.London: Academic Press;1980. p. 71–84.

4.Winter RB., Moe JH. The results of spinal arthrodesis for congenital spinal deformity in patients younger than five years old. J Bone Joint Surg Am. 1982. 64:419–32.

5.Davies G., Reid L. Effect of scoliosis on growth of alveoli and pulmonary arteries and on right ventricle. Arch Dis Child. 1971. 46:623–32.

6.Dunnill M. Postnatal growth of the lung. Thorax. 1962. 17:329–33.

7.Emery JL., Mithal A. The number of alveoli in the termi-nal respiratory unit of man during late intrauterine life and childhood. Arch Dis Child. 1960. 35:544–7.

8.Thompson GH., Akbarnia BA., Kostial P, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine (Phila Pa 1976). 2005. 30:2039–44.

9.Elsebai HB., Yazici M., Thompson GH, et al. Safety and ef-ficacy of growing rod technique for pediatric congenital spinal deformities. J Pediatr Orthop. 2011. 31:1–5.

10.Kim JY., Moon ES., Chong HS., Lee SJ., Kim HS. Comparison of mechanical property of conventional rods versus growing rods for pediatric early onset scoliosis. J Korean Soc Spine Surg. 2010. 17:177–83.

11.Harrington PR. Treatment of scoliosis. Correction and in-ternal fixation by spine instrumentation. J Bone Joint Surg Am. 1962. 44:591–610.

12.Goldberg CJ., Moore DP., Fogarty EE., Dowling FE. Long-term results from in situ fusion for congenital vertebral deformity. Spine (Phila Pa 1976). 2002. 27:619–28.

13.Karol LA., Johnston C., Mladenov K., Schochet P., Walters P., Browne RH. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am. 2008. 90:1272–81.

14.Dubousset J., Herring JA., Shufflebarger H. The crankshaft phenomenon. J Pediatr Orthop. 1989. 9:541–50.

15.Shufflebarger HL., Clark CE. Prevention of the crankshaft phenomenon. Spine (Phila Pa 1976). 1991. 16(8 Suppl):S409–11.

16.Mardjetko SM., Hammerberg KW., Lubicky JP., Fister JS. The Luque trolley revisited: review of nine cases requiring revision. Spine (Phila Pa 1976). 1992. 17:582–9.

17.McCarthy RE., Sucato D., Turner JL., Zhang H., Hen-son MA., McCarthy K. Shilla growing rods in a cap-rine animal model: a pilot study. Clin Orthop Relat Res. 2010. 468:705–10.

18.Thompson GH., Akbarnia BA., Campbell RM Jr. Growing rod techniques in early-onset scoliosis. J Pediatr Orthop. 2007. 27:354–61.

19.Campbell RM., Smith MD., Hell-Vocke AK. Expansion thoracoplasty: the surgical technique of opening-wedge thoracostomy. Surgical technique. J Bone Joint Surg Am. 2004. 86(Suppl 1):S51–64.

20.Mineiro J., Weinstein S. Subcutaneous rodding for progressive spinal curvatures: early results. J Pediatr Orthop. 2002. 22:290–5.

21.Bess S., Akbarnia BA., Thompson GH, et al. Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am. 2010. 92:2533–43.

22.Akbarnia BA., Marks DS., Boachie-Adjei O., Thompson AG., Asher MA. Dual growing rod technique for the treatment of progressive early-onset scoliosis: a multicenter study. Spine (Phila Pa 1976). 2005. 30(17 Suppl):S46–57.