J Korean Neurosurg Soc.  2019 Sep;62(5):577-585. 10.3340/jkns.2019.0094.

Comparison of the Effects of Magnetically Controlled Growing Rod and Tradiotinal Growing Rod Techniques on the Sagittal Plane in the Treatment of Early-Onset Scoliosis

• ErdoÄŸan S
• Polat B
• Atıcı Y
• Özyalvaç ON
• Öztürk C

• KMID: 2457948
• DOI: http://doi.org/10.3340/jkns.2019.0094

Abstract

OBJECTIVE
Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS).
METHODS
Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients' demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1-S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period.
RESULTS
Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8-15) and 4.8 (3-7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1-S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group.
CONCLUSION
There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

Keyword

Early-onset scoliosis; Growing rod; Magnetic growing rods; Spinopelvic parameters; Proximal junctional angle

MeSH Terms

Animals
Follow-Up Studies
Humans
Incidence
Kyphosis
Lordosis
Methods
Scoliosis*
Sex Distribution

Figure

• 

  Fig. 1. Preoperative AP/lateral X-ray of patienttreatedwith MCGR technique. AP : anteroposterior, MCGR : magnetically controlled growing rod.

• 

  Fig. 2. Last follow-up AP/lateral X-ray of patienttreatedwith MCGR technique. AP : anteroposterior, MCGR : magnetically controlled growing rod.

• 

  Fig. 3. Preoperative AP/lateral X-ray of patienttreatedwith TGR technique. AP : anteroposterior, TGR : traditional growing rod.

• 

  Fig. 4. Last follow-up AP/lateral X-ray of patienttreatedwith TGR technique. AP : anteroposterior, TGR : traditional growing rod.

Reference

References

1. Agarwal A, Agarwal AK, Jayaswal A, Goel V. Smaller ınterval distractions may reduce chances of growth rod breakage without ımpeding desired spinal growth: a finite element study. Spine Deform. 2:430–436. 2014.

2. Akbarnia BA, Cheung K, Noordeen H, Elsebaie H, Yazici M, Dannawi Z, et al. Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients with early-onset scoliosis. Spine (PhilaPa 1976). 38:665–670. 2013.

3. Akbarnia BA, Emans JB. Complications of growth-sparing surgery in early onset scoliosis. Spine (PhilaPa 1976). 35:2193–2204. 2010.

4. 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 (PhilaPa 1976). 30(17 Suppl):S46–S57. 2005.

5. Akbarnia BA, Pawelek JB, Cheung KM, Demirkiran G, Elsebaie H, Emans JB, et al. Traditional Growing rods versus magnetically controlled growing rods for the surgical treatment of early-onset scoliosis: a case-matched 2-year study. Spine Deform. 2:493–497. 2014.

6. Alanay A, Dede O, Yazici M. Convex instrumented hemiepiphysiodesis with concave distraction: a preliminary report. Clin Orthop Relat Res. 470:1144–1150. 2012.

7. Atici Y, Akman YE, Erdogan S, Sari S, Yavuz U, Carkci E, et al. The effect of growing rod lengthening technique on the sagittal spinal and the spinopelvic parameters. Eur Spine J. 24:1148–1157. 2014.

8. Bess S, Akbarnia BA, Thompson GH, Sponseller PD, Shah SA, El Sebaie H, et al. Complications of growing-rod treatment for early-onset scoliosis: analysis of one hundred and forty patients. J Bone Joint Surg Am. 92:2533–2543. 2010.

9. Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J. 15:415–422. 2006.

10. Campbell RM Jr, Smith MD, Hell-Vocke AK. Expansion thoracoplasty: the surgical technique of opening-wedge thoracostomy. Surgical technique. J Bone Joint Surg Am 86-A Suppl. 1:51–64. 2004.

11. Cho W, Mason JR, Smith JS, Shimer AL, Wilson AS, Shaffrey CI, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine. 19:445–453. 2013.

12. Choi E, Yazsay B, Mundis G, Hosseini P, Pawelek J, Alanay A, et al. Implant complications after magnetically controlled growing rods for early onset scoliosis: a multicenter retrospective review. J Pediatr Orthop. 37:e588–e592. 2017.

13. D’Astous JL. Casting and traction treatment methods for scoliosis. Orthop Clin North Am. 38:477–484. , v. 2007.

14. Eltorai AEM, Fuentes C. Magnetic growth modulation in orthopaedic and spine surgery. J Orthop. 15:59–66. 2018.

15. Inaparthy P, Queruz JC, Bhagawati D, Thakar C, Subramanian T, Nnadi C. Incidence of proximal junctional kyphosis with magnetic expansion control rods in early onset scoliosis. Eur Spine J. 25:3308–3315. 2016.

16. Kabirian N, Akbarnia BA, Pawelek JB, Alam M, Mundis GM Jr, Acacio R, et al. Deep surgical site ınfection following 2344 growing-rod procedures for early-onset scoliosis: risk factors and clinical consequences. J Bone Joint Surg Am. 96:e128. 2014.

17. Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 39:87–95. 2015.

18. Legaye J, Duval-Beaupère G, Hecquet J, Marty C. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J. 7:99–103. 1998.

19. Li WJ, Sun ZJ, Guo SG, Qiu GX, Zhang JG, Shen JX, et al. The effect of growing Rod treatment on coronal balance during serial lengthening surgeries in early onset scoliosis. BMC Musculoskelet Disord. 17:158. 2016.

20. Lowe TG, Lenke L, Betz R, Newton P, Clements D, Haher T, et al. Distal junctional kyphosis of adolescent idiopathic thoracic curves following anterior or posterior instrumented fusion: incidence, risk factors, and prevention. Spine (PhilaPa 1976). 31:299–302. 2006.

21. Moe JH, Kharrat K, Winter RB, Cummine JL. 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. 1984.

22. Sankar WN, Skaggs DL, Yazici M, Johnston CE 2nd, Shah SA, Javidan P, et al. Lengthening of dual growing rods and the law of diminishing returns. Spine (PhilaPa 1976). 36:806–809. 2011.

23. Shah SA, Karatas AF, Dhawale AA, Dede O, Mundis GM Jr, Holmes L Jr, et al. The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis. Spine (Phila Pa 1976). 39:E1311–E1317. 2014.

24. Takaso M, Moriya H, Kitahara H, Mimani S, Takahashi K, Isobe K, et al. New remote-controlled growing-rod spinal instrumentation possibly applicable for scoliosis in young children. J Orthop Sci. 3:336–340. 1998.

25. Thompson GH, Akbarnia BA, Kostial P, Poe-Kochert C, Armstrong DG, Roh J, et al. Comparison of single and dual growing rod techniques followed through definitive surgery: a preliminary study. Spine (PhilaPa 1976). 30:2039–2044. 2005.