Jean Ouellet1. 1. Division of Orthopaedic Surgery, McGill University Health Centre, Montreal Children Hospital, 2300 Tupper Street, Montreal, QC H3H 1P3, Canada. jean.ouellet@muhc.mcgill.ca
Abstract
BACKGROUND: The challenge when managing early-onset scoliosis (EOS) is to prevent curve progression while maintaining spinal growth. Current surgical treatments (growing rods, VEPTR) require repetitive interventions to lengthen the implants. QUESTIONS/PURPOSES: We asked whether a modern Luqué trolley construct could achieve and maintain scoliosis correction in EOS during spinal growth without the need for repetitive surgeries, thus decreasing the morbidity of the surgical treatment. METHODS: We retrospectively reviewed five patients who underwent a modern Luqué trolley construct between 2003 and 2008. This construct consists of inserting apical gliding spinal anchors using muscle-sparing techniques to the proximal and distal fixed anchors found in the dual growing rod construct. We documented age at surgery, correction and maintenance of deformity, spinal growth, number of procedures, and complications. RESULTS: The primary curve was corrected from 60° to 21° and was maintained at 21° at a minimum followup of 2 years (mean, 4 years; range, 2-5.5 years). An average of 10 vertebrae was spanned allowing the spine to grow a mean of 3 cm over 4 years, representing a mean of 77% of the expected growth. Two of the five cases outgrew the construct requiring lengthening of rods. One patient had gradual recurrence of deformity without substantial axial growth that required revision surgery after 4 years. CONCLUSION: Modifications of the Luqué trolley may be useful for managing EOS without the morbidity of repetitive surgery. However, questions such as the effect of wear debris and the risk of spontaneous fusions still remain.
BACKGROUND: The challenge when managing early-onset scoliosis (EOS) is to prevent curve progression while maintaining spinal growth. Current surgical treatments (growing rods, VEPTR) require repetitive interventions to lengthen the implants. QUESTIONS/PURPOSES: We asked whether a modern Luqué trolley construct could achieve and maintain scoliosis correction in EOS during spinal growth without the need for repetitive surgeries, thus decreasing the morbidity of the surgical treatment. METHODS: We retrospectively reviewed five patients who underwent a modern Luqué trolley construct between 2003 and 2008. This construct consists of inserting apical gliding spinal anchors using muscle-sparing techniques to the proximal and distal fixed anchors found in the dual growing rod construct. We documented age at surgery, correction and maintenance of deformity, spinal growth, number of procedures, and complications. RESULTS: The primary curve was corrected from 60° to 21° and was maintained at 21° at a minimum followup of 2 years (mean, 4 years; range, 2-5.5 years). An average of 10 vertebrae was spanned allowing the spine to grow a mean of 3 cm over 4 years, representing a mean of 77% of the expected growth. Two of the five cases outgrew the construct requiring lengthening of rods. One patient had gradual recurrence of deformity without substantial axial growth that required revision surgery after 4 years. CONCLUSION: Modifications of the Luqué trolley may be useful for managing EOS without the morbidity of repetitive surgery. However, questions such as the effect of wear debris and the risk of spontaneous fusions still remain.
Authors: Matthew E Cunningham; Peter H B Frelinghuysen; Jeffrey S Roh; Oheneba Boachie-Adjei; Daniel W Green Journal: Curr Opin Pediatr Date: 2005-02 Impact factor: 2.856
Authors: Charles E Mackel; Ajit Jada; Amer F Samdani; James H Stephen; James T Bennett; Ali A Baaj; Steven W Hwang Journal: Childs Nerv Syst Date: 2018-08-04 Impact factor: 1.475