Fusionless Instrumentation Systems for Congenital Scoliosis Expandable Spinal Rods and Vertical Expandable Prosthetic Titanium Rib in the Management of Congenital Spine Deformities in the Growing Child
ABSTRACT Review of relevant literature including personal opinions.
To review the current researches investigating the efficacy of growing rod and thoracic expansion techniques in the treatment of congenital spine deformity of young children, and to highlight the contrasting advantages and limitations in the fusionless treatment of progressive congenital scoliosis.
Congenital scoliosis has the potential for severe spinal deformity and thoracic insufficiency syndrome (TIS). Conventional fusion treatments in children tend to shorten the spine further exacerbating trunk shortening and TIS. In the surgical treatment of congenital spinal deformities in young children, while reconstructing the spinal deformity, one should simultaneously pursue preserving the growth potential of the vertebrae, improving the volume, symmetry, and functions of the thorax, and protecting this improvement during the growth. Today, employed in the treatment of spinal deformities of young children, there are 2 deformity reconstruction methods serving these targets: Growing rod technique and vertical expandable prosthetic titanium rib (VEPTR) with or without expansion thoracostomy.
Peer-reviewed research articles and major international meeting presentations were reviewed. Methods were compared in terms of advantages and limitations.
The growing rod technique is a safe and reliable method in the treatment of congenital spine deformity of young children who present some flexibility in the anomalous segment, or when the congenital anomaly involves a vertebral segment too long for resection, or with compensating curve with structural pattern concomitant to the congenital deformity. Expansion thoracostomy and VEPTR are the appropriate choice for severe congenital spine deformity when a large amount of growth remains. Although ventilator dependence is significantly decreasing, thoracic volume and space available for the lung are increased after expansion thoracostomy and VEPTR.
Growing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other words, if the primary problem involves the thoracic cage, expansion thoracostomy and VEPTR should be an appropriate option.
SourceAvailable from: Barbara Szaraniec[Show abstract] [Hide abstract]
ABSTRACT: Interaction of host cells with a biomaterial surface is important for biocompatibility and thus is essential for biomedical applications. Therefore investigations are undertaken to scrutinize for an appropriate surface coating with physical and chemical properties minimizing undesirable activation of immunological response. For this the current study was aimed at examining the effects of different surface modifications of titanium by its coating with ceramic materials - hydroxyapatite, bioglass and CaO-SiO2 on osteoblast morphology and secretory activity. Titanium is known for its excellent mechanical properties but its surface has low bioactivity. We report that CaO-SiO2 coating decreased a number of attached osteoblasts and altered their morphology. Moreover, the ceramic coatings temporarily upregulated release of pro-inflammatory cytokines IL-6 (all of them) and TNF-α (CaO-SiO2). However, overall the levels of the cytokines were low. In contrast, levels of neutrophil-attracting chemokine IL-8 were the highest. IL-8 was produced mostly by cells incubated with hydroxyapatite titanium coating in contrary to those incubated with either bioglass or CaO-SiO2 titanium modifications. In conclusion, the titanium coated with ceramics such as hydroxyapatite or bioglass had the best effect on cell adhesion; however, hydroxyapatite might potentially stimulate destructive neutrophils while CaO-SiO2-coating has a negative effect on cell adhesion.
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ABSTRACT: Background Currently, there are many reports about congenital scoliosis (CS) treatment, but there are still controversies existing with respect to selecting its surgical methods.Methods Retrospective analyses were conducted on 31 CS patients. The surgical treatments included the following: posterior instrumentation (10 patients; group 1), pedicle subtraction osteotomy (11 patients; group 2) and vertebral column resection (10 patients; group 3).ResultsAll patients had remarkable improvements in morphology, image findings, visual analogue scale and American Spinal Injury Association classification. Groups 2 and 3 had greater preoperative sagittal Cobb's angle (25.0, 62.2 and 9.2°, respectively), greater intra-operative blood loss (604.5, 620.0 and 460.0 mL, respectively) and fewer fused segments (5.8, 6.3 and 9.2, respectively) than group 1. As compared with group 1, groups 2 and 3 had greater correction rate of coronal Cobb's angle (79.6 ± 12.8, 78.2 ± 10.1% versus 56.1 ± 11.1%), and coronal trunk inclination (77.6 ± 14.2, 85.2 ± 11.0% versus 45.0 ± 42.5%). The sagittal Cobb's angle correction rates of three groups were 67.7 ± 42.9, 79.3 ± 27.6, 84.3 ± 12.1%, respectively, which showed no significant difference (P = 0.461). With an average follow-up of 3.5, 3.2 and 4.0 years, the correction loss rate of coronal Cobb's angle in group 1 was higher than those of groups 2 and 3.Conclusion For CS patients, osteotomy procedure had less fused segments, along with a greater correction rate and lower correction loss, which were more advantageous for those with severe deformity in sagittal plane or nerve decompression requirements.ANZ Journal of Surgery 11/2014; 85(4). DOI:10.1111/ans.12886 · 1.12 Impact Factor
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ABSTRACT: The presented work demonstrates preliminary results on manufacturing and mechanical properties assessment of pure PLLA and PLLA/TCP composite plates, as potential candidates for maxillofacial surgery application. Biodegradable, thermoplastic polymer poly-L-lactide (PLLA, Biomer) and tricalcium phosphate (TCP, Fluka) particles were applied for the samples manufacturing in injection moulding process. The plates were investigated using universal testing machine Zwick 1435 – in static tensile and creep tests. The mechanical properties (tensile strength, Young modulus, elongation) of the polymer and its composite were determined and the lifetime, performed with the scope of their potential application in osteosynthesis, were predicted.