Growing rods in early-onset scoliosis. Do they really help to control the deformity and spinal and thoracic growth?
ABSTRACT To determine the efficacy of growing rods in the treatment of early onset scoliosis.
A total of 32 patients were treated using fusion techniques that included double growing rods and Vertical Expandable Prosthetic Titanium Ribs (VEPTR), in our Early Onset Scoliosis Centre between 2004 and 2011. After analysing the clinical histories and x-rays, 20 patients were included due to meeting the inclusion criteria. All patients had previously received conservative treatment with cranial traction and a series of plasters/corsets. The deformity was analysed before and after the initial surgery, and in successive tightenings, using the x-rays of the coronal and sagittal planes by means of the Cobb angle, as well as the longitudinal and coronal growth of the thorax, and the growth of the spinal column. A series of 188 x-rays of 53 patients with cystic fibrosis were studied in order to perform a comparative analysis with the patients with early-onset scoliosis.
There was significant improvement in the angle (Cobb and kyphosis) and linear parameters (T1-S1 distance, T1-T12 distance, and coronal width of the thorax) after the initial surgery, but the successive tightenings had a minimal beneficial effect, losing effectiveness over a period of time. The patients with early-onset scoliosis showed a lower growth of the thorax compared to the patients with cystic fibrosis.
Treatment of early-onset scoliosis with expandable devices is mainly beneficial with the initial procedure and the first tightenings, but shows a loss of efficacy over a period time.
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ABSTRACT: Objective To create an experimental structural scoliosis model in mice to evaluate the efficacy of shape-memory metals to gradually correct the deformity over time. Material and method Experimental scoliosis was generated in 3 week-old mice by means of a suture between the left scapula and pelvis for 8 weeks. They were then randomised into two groups: a control group, in which the suture was cut, and another, in those that also had a Nitinol straight memory-wire implant fixed to the column. Serial X-rays were performed to determine the efficacy of the Nitinol in the correction of the scoliosis. In a second time, the histological changes at apical vertical body level and the adjacent discs were evaluated pre- and post-correction. Results A mean 81.5° kyphoscoliosis was gradually induced. In the control group, after cutting the suture, an initial reduction in the deformity was observed, but later it remained stable throughout the time (54° at two weeks). In the Nitinol group, a gradual reduction was observed in the scoliosis angle value, to a mean of 8.7° at two weeks. The curvature of the apical vertebral body and adjacent discs were partially corrected after two weeks of correcting the deformity. Conclusion This scoliosis model has demonstrated the efficacy of a straight Nitinol wire fixed to the spinal column in the gradual correction of kyphoscoliosis and in the changes in its adjacent structures.Revista Española de Cirugía Ortopédica y Traumatología 09/2013; 57(5):310–317. DOI:10.1016/j.recot.2013.07.001
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ABSTRACT: Objective Serial lengthening with growing rods is recommended every six months for the treatment of early onset scoliosis. The objective of this study was to evaluate the longitudinal growth of the thorax and control of the deformity in a series of patients with juvenile scoliosis when time intervals were increased between lengthenings. Material and methods Retrospective study of eight patients. The following variables were measured: the Cobb angle, the apical vertebral translation, the coronal balance, thoracic T1-L1 length, thoracic T5-T12 kyphosis, the proximal junctional kyphosis (PJK) angle, and the lumbar lordosis. Complications were recorded. Results Five idiopathic and three syndromic scoliosis cases (mean age 9.4 ± 1.5 years) were evaluated. The initial surgery was followed by with an average of two distractions per patient. The mean time between distractions was 15.7 months. The final coronal main curve correction was 58%. Apical translation and coronal balance were improved and maintained after the surgeries. The thoracic (T1-L1) preoperative length was 20.8 cm, the postoperative length was 24.4 cm, and the final length was 26 cm. At the end of follow-up, the average growth of the thorax was 5.2 cm. The preoperative (T5-T12) kyphosis was 33.5°, and final 32.1°. The change in the PJK angle was 2.5° at the end of follow-up. Most complications were related to instrumentation. Two superficial wound infections were encountered. Conclusion For less severe juvenile scoliosis patients treated with growing rods, spacing out lengthenings over more than a year can decrease the number of surgeries, while still controlling the deformity and allowing longitudinal thoracic growth.Revista Española de Cirugía Ortopédica y Traumatología 09/2014; 58(5). DOI:10.1016/j.recot.2014.03.007