Mohammad Zarei1, Mehdi Tavakoli1, Ehsan Ghadimi1, Alireza Moharrami1, Ali Nili1, Ali Vafaei1, Seyed Saeed Tamehri Zadeh1, Soroush Baghdadi2,3. 1. Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Blvd, Tehran, 1419733141, Iran. 2. Joint Reconstruction Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Blvd, Tehran, 1419733141, Iran. Baghdadi.soroush@gmail.com. 3. Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. Baghdadi.soroush@gmail.com.
Abstract
BACKGROUND: Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. METHODS: In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. RESULTS: A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5-8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24-55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. CONCLUSIONS: Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.
BACKGROUND: Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. METHODS: In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. RESULTS: A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5-8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24-55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. CONCLUSIONS: Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.
Authors: Behrooz A Akbarnia; Burt Yaszay; Muharrem Yazici; Nima Kabirian; Laurel C Blakemore; Kevin R Strauss; Diana Glaser Journal: Spine Deform Date: 2014-10-27
Authors: B A Hickey; C Towriss; G Baxter; S Yasso; S James; A Jones; J Howes; P Davies; S Ahuja Journal: Eur Spine J Date: 2014-01-11 Impact factor: 3.134
Authors: Mohamed Mediouni; Daniel R Schlatterer; Henning Madry; Magali Cucchiarini; Balwant Rai Journal: Curr Med Res Opin Date: 2017-11-01 Impact factor: 2.580
Authors: R Chris Glattes; Keith H Bridwell; Lawrence G Lenke; Yongjung J Kim; Anthony Rinella; Charles Edwards Journal: Spine (Phila Pa 1976) Date: 2005-07-15 Impact factor: 3.468
Authors: Yongjung J Kim; Lawrence G Lenke; Keith H Bridwell; Junghoon Kim; Samuel K Cho; Gene Cheh; Joonyoung Yoon Journal: Spine (Phila Pa 1976) Date: 2007-11-15 Impact factor: 3.468