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Purpose The purpose of this study was to investigate pulmonary function and health-related quality of life after traditional growing rod (TGR) procedures. Methods Between January 2006 and December 2017, a retrospective observational study of 17 early onset scoliosis (EOS) patients with a mean follow-up of 6.2 years (2.3 to 10.4) was conducted. The forced expiratory volume in one second (FEV1), expiratory forced vital capacity (FVC) and 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) score before the index surgery and at last follow-up were investigated. Results The mean percentage of predicted FEV1 improved from 50% (20% to 86%) to 53% (15% to 80%; p = 0.08); and the mean percentage of predicted FVC improved from 51% (24% to 81%) to 55% (25% to 89%; p = 0.06). The mean EOSQ-24 score was 78.2 (58 to 90) preoperatively and 77.2 (55 to 88) at last follow-up, there was no statistical difference (p = 0.70). The subdomain scores of pulmonary function (p < 0.01) and daily living (p < 0.01) significantly improved, whereas the subdomain scores of pain (p < 0.01), emotion (p < 0.01) and satisfaction (p = 0.02) significantly declined at last follow-up. Conclusion The TGR procedure was associated with stable pulmonary function and decline in EOSQ-24 pain, emotion and satisfaction scores. Level of Evidence Level III, retrospective cohort study.

Study Design: Retrospective case series. Objectives: To present outcomes concerning patients with early-onset mixed-type congenital scoliosis (EOMTCS) treated with the traditional single growing rod (TSGR), focusing on the growth of unsegmented levels (USLs). Methods: Patients with EOMTCS who underwent TSGR and had a minimum of 4 USLs, 4 distractions, and 3-year follow-up were enrolled. Spine radiographs before and after index surgery and at the latest follow-up were evaluated. The length of the concave and convex side of USLs and thoracic parameters were measured. The absolute value and percentage of growth were calculated. Results: Fourteen patients (mean age, 7.3 ± 2.8 years) were enrolled. The average follow-up duration was 4.9 ± 1.2 years, during which time 84 distractions and 8 final fusions were performed. The average number of USLs was 6.3 ± 2.2. The total and annual percent growth of concave side of USLs was significantly higher than convex side (32.2 ± 13.3% vs. 23.9 ± 9.5%, p = 0.007; 6.8 ± 2.7%/year vs. 5.1% ± 2.2%/year, p = 0.007, respectively). The concave-to-convex ratio of USLs increased from 58.6 ± 6.4 ± 7.6% at baseline to 68.8 ± 9.3% at the latest follow-up (p < 0.001). The Campbell’s space available for lung ratio increased from 74.9 ± 11.1% at baseline to 89.6 ± 7.0% at the latest follow-up (p < 0.001). Conclusions: In patients with EOMTCS, unilateral repetitive lengthening with TSGR can accelerate the growth of the concave side of USLs and improve the symmetry of the thorax.

Magnetically controlled growing rods (MCGR) have become an important treatment option in young patients with spinal deformities. This device allows for gradual lengthening on an outpatient setting with continuous neurological monitoring in an awake patient. With its growing popularity and interest, this study reports the tips, pitfalls, and complications of the MCGR for management of scoliosis. On 3 June 2015 at the University of Hong Kong, 32 participants from 16 regions shared their experience with MCGR. Current indications for surgery include early-onset scoliosis patients. Adolescent idiopathic scoliosis and congenital scoliosis patients have less favourable outcomes. The number of instrumented levels should be minimised, as all instrumented levels must be included in the definitive fusion surgery. Rod contouring is important and owing to the straight portion of the rod housing the magnet, there is limited proximal rod portion for proper contouring, which may predispose to proximal junctional kyphosis. There is currently no consensus on the rod configuration, timing, frequency, technique, and amount of distraction. Risk factors for distraction failure include larger patients, internal magnets too close to each other, and magnets too close to the apex of the major curve. Future studies should resolve the issues regarding the technique of distraction, optimal frequency and amount of distraction per session. More comprehensive cost analyses should be performed.

The magnetically controlled growing rod (MCGR) has had approximately 10 years of clinical experience worldwide. Clinical effectiveness to control early-onset scoliosis is consistent even at final surgery. MCGRs have significantly lower relative percentage of infection or wound complications as compared to traditional growing rods. Most common complications include foundation failure and failure of distraction. Contouring of the rod especially at the proximal segment while accommodating for the straight actuator remains a difficult task and its failure may lead to proximal junctional kyphosis. Unique complications of MCGR include clunking, temporary diminishing distraction gains, and metallosis. Temporary reductions in distraction gains are observed as the MCGR lengthens but return to normal baseline distraction gains after rod exchange. Lack of standardization for rod configuration, distraction strategies and decisions of whether to keep the rods in situ, remove without fusion surgery or to perform spinal fusion at skeletal maturity will require further study.

IntroductionA new method for the management of early-onset scoliosis (EOS) has been recently introduced: it consists of a magnetically controlled growing rod (MCGR) that allows gradual outpatient d...

IntroductionOne of the major disadvantages of traditional growing rod systems is the requirement for multiple surgical procedures to lengthen the rods as the patient grows. This has been avoided by...

IntroductionConventional growing systems allow spinal growth to continue and prevent curve progression but need multiple interventions that increase the risk of infection, complications of anesthes...

IntroductionEarly onset scoliosis normally found in children from the age of birth till 10 years old with female preponderance. Any lateral spinal curvature of 10 degrees or more by reference to Co...

Introduction Congenital and neuromuscular scoliosis occurring in children younger than 5 years have a high likelihood of progressing and end in severe curves. The concepts of treatment have changed with the emergence of distraction systems as VEPTR (vertical expandable prosthetic titanium rib) and growing rods. The aim of this study is to compare the clinical outcomes and complications that occur with the two systems used in the Instituto de Ortopedia Infantil Roosevelt. Methods An observational study of the transversal, comparative cut was designed by evaluating spinal surgeries performed between 2008 and 2012 at the Instituto de Ortopedia Infantil Roosevelt, including patients in whom implantation of an elongation system was performed and then underwent a program of periodic lengthening with VEPTR technique or growing rods. The number of elongations performed analyzed the surgical time, postoperative Cobb angle, bleeding, and complications. For quantitative variables, measures of central tendency and dispersion measures and confidence intervals were obtained; for those qualitative variables, ratios and confidence intervals at 95% were obtained. Statistical differences between groups were evaluated using the Student t test, Mann–Whitney U, Pearson chi-square, and Fisher exact tests depending on the nature of the variable. Analyses were performed using SPSS statistical software Statistics Version 21. Results A total of 40 patients met the selection criteria, 17 patients with growing rods and 23 patients with VEPTR system. The composition of the two groups had similar clinical characteristics. No significant differences in mean elongations number, bleeding, and implantation time were observed; however, the average correction of the deformity with the growing rods system (50.89 degrees) was 15.89 degrees higher than with the VEPTR (30.0 degrees) system. The complications were more frequent with VEPTR system: for the growing rod system six patients (35%) had complications, while for the VEPTR system was 10 patients (43%). However, complications because of the failures in the implanted materials were more frequent in patients with rods 35.3%, compared with 4.3% in the VEPTR, and clinical complications were more frequent in the VEPTR 43%, compared with 11.8% in growing rods. Conclusion When comparing different elongation systems of the spine, used to treat the congenital and neuromuscular scoliosis in children younger than 5 years, we conclude from this study that the correction of the scoliotic curve is higher with the growing rods system, but with more complications related with implant failures and minor clinical complications compared with VEPTR; these results are similar to those found in the literature.

Introduction Several different growing rod techniques have been described in the literature to treat progressive scoliosis in young children. The purpose of this retrospective clinical study is to evaluate the effect of dual growing rod and posterior apical convex fusion in early onset scoliosis (EOS). Material and Methods This study retrospectively reviewed the clinical records and radiographs of the 11 children with progressive EOS who failed to respond to conservative treatment and underwent fusionless surgery using dual growing rod and posterior apical convex fusion. Results Fusionless dual growing rod and posterior apical convex fusion allowed maintaining scoliosis correction in all the patients. At an average of 3.1 ± 0.8 years after initial surgery, 11 patients showed a correction of 39. 9% in the magnitude of the original curvature (the average preoperative Cobb angle was 56 [range, 40.96–89.5] and postoperative was 34.27 [range, 24.69–58]). Trunk height increase was documented in all patients. Rod failure was found in three patients. Conclusion Preliminary results from these series of patients show that the presented fusionless dual growing rod and posterior apical convex fusion allows maintaining correction of progressive EOS while permitting spinal growth with a low-complication rate. This procedure is efficacious as long as some guidelines are respected.

Introduction The spine is a key factor in the growth of thorax, abdomen, and pelvis. By the age of 5 years, the spine reaches 50% of its adult length. Therefore, spinal fusion in a 5-year-old child can result in about 12.5 cm loss of spinal growth. Disruption of the growth of the spine due to fusion performed in the treatment of early-onset scoliosis leads to thoracic insufficiency syndrome. The ideal technique should maintain the correction of the deformity, allow continued spinal growth, should not require postoperative immobilization, and also should have low complication rates. There are several growing rod techniques which have been defined but none of them fulfill all of these conditions. The aim of this article is to define a new modification on the growing rod technique. Patients and Methods Ten children have been operated in authors' institution, at an average age of 8 (range, 4–9) years. The surgical technique involved short segment instrumentation applied on the convex side of the apex of the deformity. Pedicle screws or hooks were used at stable anchor levels of the concave side of the deformity. Two rods, one proximal and one distal, were fixed to anchor sites and connected by a domino connector. After distracting the concave side, a transverse connector was used between the short segment and the long one, and this connector was compressed to maintain a translational force on the apex of the deformity. The frequency of lengthening procedure is 6 to 9 months. Results The average follow-up was 11 months. The average preoperative coronal plane curve was 46 degree and corrected to 13 degree showing 74% scoliosis correction after index surgery. Conclusion The main goal of the treatment of early-onset spinal deformities in children is to correct the deformity while maintaining the growth of the spine. All the described techniques up to now have been based on distraction of the concave side and the compression of the convex side of the deformity at stable vertebrae. The technique defined in this study, distracts the concave side while applying a translational force at the apex of the deformity by a transverse connector. The authors believe that this new technique will maintain more effective correction. Other advantages include less surgical dissection so less likely to cause a spontaneous fusion of the spine, shorter operation time, and low risk of surgery-associated complications. Long-term outcomes of the treatment by this new technique should be investigated by the mean spinal growth, and the correction of the spinal deformity.