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Marcati E, Meccariello G, Mastino L, Picano M, Giorgi PD, Talamonti G. Myelomeningocele: Long-Term Neurosurgical Management. Adv Tech Stand Neurosurg 2024; 49:95-122. [PMID: 38700682 DOI: 10.1007/978-3-031-42398-7_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Open spina bifida, also known as myelomeningocele (MMC), is the most challenging and severe birth defect of the central nervous system compatible with life and it is due to a failure in the dorsal fusion of the nascent neural tube during embryonic development. MMC is often accompanied by a constellation of collateral conditions, including hydrocephalus, Arnold - Chiari II malformation, brainstem disfunction, hydrosyringomyelia, tethered cord syndrome and scoliosis. Beyond early surgical repair of the dorsal defect, MMC requires lifelong cares. Several additional surgical procedures are generally necessary to improve the long-term outcomes of patients affected by MMC and multidisciplinary evaluations are crucial for early identification and management of the various medical condition that can accompany this pathology. In this chapter, the most common pathological entities associated with MMC are illustrated, focusing on clinical manifestations, treatment strategies and follow up recommendations.
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Affiliation(s)
- E Marcati
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - G Meccariello
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - L Mastino
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - M Picano
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
| | - P D Giorgi
- Department of Orthopedics, ASST Niguarda Hospital, Milan, Italy
| | - G Talamonti
- Department of Neurosurgery, ASST Niguarda Hospital, Milan, Italy
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Jeantet RE, Simon AL, Happiette A, Ilharreborde B. Bivertebral pedicle-supralaminar autostable claw for proximal fixation of magnetic growing rods in early-onset scoliosis. Orthop Traumatol Surg Res 2023; 109:103634. [PMID: 37172643 DOI: 10.1016/j.otsr.2023.103634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 05/15/2023]
Abstract
BACKGROUND The various methods for the proximal fixation of magnetic growing rods in patients with early-onset scoliosis (EOS) are associated with high rates of mechanical complications related to material failure or proximal junctional kyphosis (PJK). The bivertebral autostable claw (BAC) has been proven reliable in adolescent idiopathic scoliosis but has not been assessed when used with magnetic growing rods. The objective of this study was to describe the operative technique and outcomes of BAC proximal fixation of magnetic growing rods in children with EOS. HYPOTHESIS The BAC provides stable and effective proximal fixation in children with early-onset scoliosis. MATERIAL AND METHODS This retrospective observational study included 24 patients who had surgery in 2015-2019 for early-onset scoliosis with magnetic growing rod implantation and BAC proximal fixation. Radiological variables were measured in the coronal and sagittal planes before surgery, during the early postoperative period (<3months) and at last follow-up (≥2years). RESULTS No neurological complications were recorded. At last follow-up, four patients had radiological PJK, including one patient with clinical PJK due to material failure. DISCUSSION BAC proximal fixation is both effective and sufficiently stable (4.2% pull-out) to withstand the forces applied during distraction sessions and daily activities in children with EOS. Moreover, the polyaxial connecting rods ensure better BAC adaptation to the local proximal kyphosis, which is often marked in this population. CONCLUSION The BAC is a reliable proximal fixation device that is well-suited to magnetic growing rod fixation in children with EOS. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Rose-Elisabeth Jeantet
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France.
| | - Anne-Laure Simon
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Service de chirurgie infantile à orientation orthopédique, hôpital universitaire Robert-Debré, université de Paris, Assistance publique-Hôpitaux de Paris (AP-HP), 48, bouelvard Sérurier, 75019 Paris, France
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Wolff S, Moreau PE, Miladi L, Riouallon G. Is Minimally Invasive Bipolar Technique a Better Alternative to Long Fusion for Adult Neuromuscular Scoliosis? Global Spine J 2023:21925682231159347. [PMID: 36809191 DOI: 10.1177/21925682231159347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones. METHODS Adult cerebral palsy patients requiring spinal correction surgery were included prospectively between 2015 and 2019. The technique involved the use of a double-rod construct anchored proximally by four clawed hooks and distally by iliosacral screws, in a minimally invasive approach. Cobb angle and pelvic obliquity were measured before and after initial surgery and at final follow-up. Complications and functional results were reviewed. This group (P) was compared with a second group (R) of patients who underwent surgery between 2005 and 2015, for whom data were collected retrospectively. RESULTS Thirty-one patients were included in group P, and 15 in group R. The two groups were comparable for demographic data and deformity. At most recent follow-up (3 years for group P [2-6] and 5 years for group R [2-16]), neither correction nor surgical complications differed between the two groups. However, group P had 50% less blood loss and a lower medical complication rate than group R. CONCLUSIONS Our results confirm the effectiveness of this minimally invasive technique for neuromuscular scoliosis in adults. The results were similar to those obtained with the usual techniques, but with fewer medical complications. Confirmation of these results is now required for a longer follow-up period.
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Affiliation(s)
- Stéphane Wolff
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Lotfi Miladi
- Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France
| | - Guillaume Riouallon
- Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Ribesse A, Ismail K, Croonenborghs M, Irda N, Miladi L, Jacques PJ, Mousny M, Pardoen T. Fracture mechanisms in Ti and Co-Cr growing rods and impact on clinical practice. J Mech Behav Biomed Mater 2021; 121:104620. [PMID: 34119814 DOI: 10.1016/j.jmbbm.2021.104620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/15/2021] [Accepted: 05/28/2021] [Indexed: 12/29/2022]
Abstract
The widely used treatment of early onset scoliosis based on fusionless spinal instrumentation with growing rods suffers from severe complications due to premature rod failure. Only few studies have explored the fracture mechanisms in single rod constructs, while clinical practice urgently needs guidance. The objectives of this study are (i) to determine the failure mechanisms in Ti-6Al-4V alloy, Ti Cp 2 and Co-Cr alloy rods, and (ii) to propose strategies to reduce the risk of rod fracture. For this purpose, seven rods from three patients treated for early onset scoliosis were characterized by preoperative, pre-fracture X-rays and after-fracture X-rays. Fracture surface analysis, performed using scanning electron microscopy, revealed similar failure mechanisms for all rods, independent of composition and diameter. Fracture is caused by fatigue, associated to repeated bending action in the anteroposterior direction. Cracking initiates at multiple sites. Three-point bending fatigue tests on Ti-6Al-4V bent rods confirmed the fracture scenario. A beam bending model indicates that the failure process is controlled by the combination of cyclic vertical and horizontal forces with amplitudes from 200 N to 400 N and from 70 N to 150 N, respectively. Strategies to minimize fracture involve adaptations of material properties and rod geometry to scoliosis characteristics, including sagittal alignment, and spine behavior.
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Affiliation(s)
- Arnaud Ribesse
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Place Sainte Barbe 2 L5.02.02, 1348, Louvain-la-Neuve, Belgium.
| | - Karim Ismail
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Place Sainte Barbe 2 L5.02.02, 1348, Louvain-la-Neuve, Belgium.
| | - Maïté Croonenborghs
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Place Sainte Barbe 2 L5.02.02, 1348, Louvain-la-Neuve, Belgium.
| | - Nadia Irda
- Department of Orthopedics, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Bruxelles, Belgium.
| | - Lotfi Miladi
- Hôpital Necker, Service d'Orthopédie, 149 Rue de Sèvres, 75 015, Paris, France.
| | - Pascal J Jacques
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Place Sainte Barbe 2 L5.02.02, 1348, Louvain-la-Neuve, Belgium.
| | - Maryline Mousny
- Centre Plurisanté, 11 avenue de l'Andalousie, 1140, Bruxelles, Belgium.
| | - Thomas Pardoen
- Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Place Sainte Barbe 2 L5.02.02, 1348, Louvain-la-Neuve, Belgium.
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Bouthors C, Dukan R, Glorion C, Miladi L. Outcomes of growing rods in a series of early-onset scoliosis patients with neurofibromatosis type 1. J Neurosurg Spine 2020; 33:373-380. [PMID: 32330884 DOI: 10.3171/2020.2.spine191308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Early-onset scoliosis (EOS) is not uncommon in patients with neurofibromatosis type 1 (NF1). Despite conservative treatment, spinal deformities progress and require early surgical intervention. To avoid potential interference with chest and trunk growth, growing rods (GRs) have been used effectively in EOS of various etiologies. In this study the authors sought to analyze the outcomes of GRs in EOS patients with NF1. METHODS This was a retrospective single-center cohort study that included consecutive EOS patients with NF1 who were treated with GRs and were followed up for a minimum of 2 years. Clinical and radiological analyses were performed preoperatively and until the last follow-up. RESULTS From to 2008 to 2017, 18 patients (6 male, 12 female) underwent GR surgery (14 single GRs, 4 dual GRs) at a mean age of 8 ± 2.1 years. Mean follow-up was 5 ± 2.4 years. Fifty-five lengthenings were performed at a mean rate of 3 lengthenings per patient (range 0-7). Ten of 14 single GRs (71%) were converted into dual GRs during treatment. No patient underwent definitive posterior spinal fusion (PSF) at GR treatment completion. The mean initial and last follow-up major curves were 57° and 36°, respectively (p < 0.001, 37% correction). The average T1-S1 increase was 13 mm/yr. Six of 9 hyperkyphotic patients had normal kyphosis at last follow-up. There were 26 complications involving 13 patients (72%), with 1 patient who required unplanned revision. The primary complications were instrumentation related, consisting of 17 proximal hook dislodgments, 6 distal pedicle screw pullouts, and 2 rod fractures. Only 1 patient experienced a mechanical complication after dual GR implantation. There were no wound infections. CONCLUSIONS The GR technique provided satisfactory spinal deformity control in EOS patients with NF1 while allowing substantial spinal growth. Adequately contoured dual GRs with proximal hooks placed in nondystrophic regions should be used to minimize implant-related complications. Surgeons should not attempt to correct kyphosis at GR implantation.
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Outcomes at Skeletal Maturity of 34 Children With Scoliosis Treated With a Traditional Single Growing Rod. Spine (Phila Pa 1976) 2019; 44:1630-1637. [PMID: 31725685 DOI: 10.1097/brs.0000000000003148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To analyze the outcomes at skeletal maturity of patients treated with a single traditional growing rod (GR). To compare results of patients according to whether posterior spinal fusion (PSF) was performed at treatment completion. SUMMARY OF BACKGROUND DATA Few studies examined the end results of GRs at skeletal maturity. There is no agreement on requirement of PSF at GR treatment completion. METHODS Clinical and radiological analysis of consecutive patients with severe and/or progressive scoliosis treated initially with traditional single GR. Group comparisons of patients with PSF and without fusion surgery at treatment completion. RESULTS Thirty-four patients underwent traditional single GR implantation at a median age of 11.7 years. Median follow-up was 6.5 years. At last follow-up, T1-S1 distance was increased by a median 116 mm (P < 0.001) and median major curve Cobb angle was changed from 55° preoperatively to 30° (P < 0.001). Complications included 26 rod fractures, 1 implant prominence, 4 proximal junctional kyphosis, 2 proximal hook dislodgments, and 2 wound infections. At the beginning our experience, PSF was performed systematically in 17 patients. Relying on spinal ankylosis, 17 patients were subsequently not fused at GR treatment completion (single GR removed N = 2, single GR retained N = 7, dual GR surgery N = 8). There were no statistical differences between groups in improvements of radiological parameters from preoperative GR insertion to last follow-up. No GR fracture occurred after dual GR surgery. CONCLUSION Single GR allows curve control and promotes spinal growth. Dual GR is, however, recommended for rod fracture prevention and better correction maintenance. In patients with satisfactory deformity correction at skeletal maturity, one may consider retaining dual GR instead of performing PSF. LEVEL OF EVIDENCE 4.
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Wolff S, Habboubi K, Sebaaly A, Moreau PE, Miladi L, Riouallon G. Correction of adult spinal deformity with a minimally invasive fusionless bipolar construct: Preliminary results. Orthop Traumatol Surg Res 2019; 105:1149-1155. [PMID: 31153861 DOI: 10.1016/j.otsr.2019.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 01/13/2019] [Accepted: 02/01/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fusion in adult spinal deformity has a high rate of complications. Fusionless constructs in children and percutaneous fixation in adults are now being used routinely. The aim of this study was to evaluate the preliminary results of a minimally invasive fusionless surgical technique used to correct adult spinal deformity. MATERIALS AND METHODS Thirty-eight patients with an average age of 45 years (15-76) with major spinal deformity requiring extensive arthrodesis from the upper thoracic region to the pelvis were operated consecutively and followed prospectively. Two hooks were implanted at the top and two iliosacral screws at the bottom. Two large rods connected by dominos to two small rods joined the upper hooks to the lower screws. The surgical data (operative time and bleeding), the radiological findings (Cobb angle, sagittal parameters, C7-plumbline AP and lateral), the complication rate and the morbidity were evaluated at the last follow-up visit. RESULTS The primary curvature was reduced by 40% from a mean of 58.5° (26-146) to 35.2° (3-109) (p<0.001). A clear decrease in operating time (270min) and blood loss (50cc/level) were observed. The length of hospitalization averaged 18 days (6-66), including an 8-15 day long preoperative traction period for 11 patients. We found 7 infectious complications, 11 early mechanical complications and one case of paraplegia due to severe kyphoscoliosis. CONCLUSION The corrections obtained are comparable to those reported in the literature for standard constructs. Most patients had an uneventful postoperative course. The early complications observed led us to very carefully select the indications. Long-term follow-up is essential.
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Affiliation(s)
- Stéphane Wolff
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Khalil Habboubi
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Amer Sebaaly
- Faculté de médecine, université de Saint-Joseph, Beyrouth, Lebanon
| | - Pierre Emmanuel Moreau
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - Lofti Miladi
- Hôpital Necker-Enfants-Malades, AP-HP, 75015 Paris, France
| | - Guillaume Riouallon
- Service de chirurgie orthopédique, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France.
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Targeted Distraction: Spinal Growth in Children With Early-Onset Scoliosis Treated With a Tail-gating Technique for Magnetically Controlled Growing Rods. Spine (Phila Pa 1976) 2018; 43:E1225-E1231. [PMID: 29649083 DOI: 10.1097/brs.0000000000002668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study OBJECTIVE.: To understand the efficacy of a tail-gating technique (TGT) to mirror the normal spinal growth of children with early-onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGR). SUMMARY OF BACKGROUND DATA MCGR allow outpatient distraction and guided spinal growth without the need for repeat surgery. Two techniques (maximal and targeted) are currently employed to determine the distraction amount, however the efficacy of each is unknown. This study specifically assesses the ability of targeted distraction to achieve physiological growth. METHODS We performed a retrospective review of European children treated with MCGR using a TGT and analyzed the post-operative clinical and radiographic outcomes, including the sitting height, standing height, coronal Cobb angle, T1-T12 and T1-S1 height. Furthermore, we compared the post-operative sitting/standing height ratio every 6 months to those reported for normal age- and sex-matched European children. RESULTS Thirty-five children were included with a mean follow-up of 3.4 years (1.8-5.8 years). All clinical and radiographic parameters significantly (P < 0.05) improved immediately post-operatively and were maintained until final follow-up. The TGT mirrored the normative sitting/standing height ratios for expected spinal growth (Pearson correlation 0.95 for males and 0.90 for females). The mean difference between the reference values for the sitting/standing height ratio and our results was 0.0124 (P < 0.001) for males and 0.0068 (P = 0.010) for females. CONCLUSION MCGR can reliably improve the coronal deformity in children with EOS while maintaining spinal growth. A TGT to determine the distraction amount at follow-up accurately mirrors the normal growth pattern of age-, sex-, and ethnicity-matched children. However, patients treated with this technique have a statistically significant, but clinically insignificant, shorter than physiologically normal spinal height. LEVEL OF EVIDENCE 3.
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Thakar C, Kieser DC, Mardare M, Haleem S, Fairbank J, Nnadi C. Systematic review of the complications associated with magnetically controlled growing rods for the treatment of early onset scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2062-2071. [PMID: 29675673 DOI: 10.1007/s00586-018-5590-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/04/2018] [Accepted: 04/07/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To analyse the complication profile of magnetically controlled growing rods (MCGRs) in early onset scoliosis (EOS). METHODS This is a systematic review using PUBMED, Medline, Embase, Google Scholar and the Cochrane Library (keywords: MAGEC, Magnetically controlled growing rods and EOS) of all studies written in English with a minimum of five patients and a 1-year follow-up. We evaluated coronal correction, growth progression (T1-S1, T1-T12) and complications. RESULTS Fifteen studies (336 patients) were included (42.5% male, mean age 7.9 years, average follow-up 29.7 months). Coronal improvement was achieved in all studies (pre-operative 64.8°, latest follow-up 34.9° p = 0.000), as was growth progression (p = 0.001). Mean complication rate was 44.5%, excluding the 50.8% medical complication rate. The unplanned revision rate was 33%. The most common complications were anchor pull-out (11.8%), implant failure (11.7%) and rod breakage (10.6%). There was no significant difference between primary (39.8%) and conversion (33.3%) procedures (p = 0.462). There was a non-statistically significant increased complication rate with single rods (40 vs. 27% p = 0.588). CONCLUSIONS MCGRs improve coronal deformity and maintain spinal growth, but carry a 44.5% complication and 33% unplanned revision rate. Conversion procedures do not increase this risk. Single rods should be avoided. These slides can be retrieved under Electronic Supplementary material.
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Affiliation(s)
- Chrishan Thakar
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxfordshire, England, UK
| | - David Christopher Kieser
- Christchurch School of Medicine, University of Otago, Christchurch, New Zealand.
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch, 8011, New Zealand.
| | - Mihai Mardare
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxfordshire, England, UK
| | - Shahnawaz Haleem
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxfordshire, England, UK
| | - Jeremy Fairbank
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxfordshire, England, UK
| | - Colin Nnadi
- Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxfordshire, England, UK
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Proximal Junctional Kyphosis After Posterior Spinal Instrumentation and Fusion in Young Children With Congenital Scoliosis: A Preliminary Report on its Incidence and Risk Factors. Spine (Phila Pa 1976) 2017; 42:E1197-E1203. [PMID: 28187070 DOI: 10.1097/brs.0000000000002109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To determine the incidence and risk factors of proximal junctional kyphosis (PJK) in young children who underwent posterior instrumented spinal fusion. SUMMARY OF BACKGROUND DATA PJK is a well-recognized postoperative complication in adults and adolescents. However, there is a paucity of valid data with regard to PJK in young children with congenital scoliosis (CS) who were treated with posterior correction surgery. METHODS This study reviewed the charts and radiographs of a consecutive series of young children with CS who underwent posterior instrumentation and fusion (≥4 levels) from January 2008 to May 2013. The patients were followed up for more than 24 months. Radiographic measurements were made preoperatively and throughout the follow-up period. From sagittal images, the following values were obtained: proximal junctional angle, sagittal vertical axis, pelvic incidence, thoracic kyphosis, lumbar lordosis, and segmental kyphosis. RESULTS Totally 113 children were recruited in this study. The average age at surgery was 6.6 years, and the average follow-up period was 48.8 months. PJK occurred in 21 of the 113 patients and were mostly classified as ligamentous failure. In comparison with the non-PJK group, the PJK group showed greater preoperative Thoracic kyphosis (TK) (45.9° vs. 37.3°, P = 0.027), longer fusion levels (6.6 vs. 5.4, P < 0.01), and greater segmental kyphosis (SK) change (30.1° vs. 11.2°, P = 0.002). Both a change in SK greater than 30° and a preoperative TK greater than 40° were independent risk factors associated with PJK. In the PJK group, the average PJA increased by 12.4° at 3 months postoperatively and followed by slight improvement till the final follow-up. CONCLUSION This study demonstrates a high rate of PJK in young children after correction surgery for CS. PJK mainly occurs within 3 months postoperatively and its risk factors include preoperative hyperkyphosis, over-correction of kyphosis, and ligamentous failure. LEVEL OF EVIDENCE 4.
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Odent T, Ilharreborde B, Miladi L, Khouri N, Violas P, Ouellet J, Cunin V, Kieffer J, Kharrat K, Accadbled F. Fusionless surgery in early-onset scoliosis. Orthop Traumatol Surg Res 2015; 101:S281-8. [PMID: 26386889 DOI: 10.1016/j.otsr.2015.07.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical treatment of early-onset scoliosis has greatly developed in recent years. Early-onset scoliosis covers a variety of etiologies (idiopathic, neurologic, dystrophic, malformative, etc.) with onset before the age of 5 years. Progression and severity threaten respiratory development and may result in respiratory failure in adulthood. Many surgical techniques have been developed in recent years, aiming to protect spinal and thoracic development. MATERIAL AND METHODS Present techniques are based on one of two main principles. The first consists in posterior distraction of the spine in its concavity (single growing rod, or vertical expandable prosthetic titanium rib [VEPTR]), or on either side (dual rod); this requires iterative surgery, for lengthening, unless motorized using energy provided by a magnetic system. The second option is to use spinal growth force to lengthen the assembly; these techniques (Luque Trolley, Shilla), using a sliding assembly, are known as growth guidance. RESULTS These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.
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Affiliation(s)
- T Odent
- Service de chirurgie orthopédique pédiatrique, CHRU de Tours, université François-Rabelais de Tours, PRES Centre-Val de Loire université, 49, boulevard Béranger, 37044 Tours, France.
| | - B Ilharreborde
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Robert-Debré, université Paris-Diderot, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - L Miladi
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - N Khouri
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-Malades, université Paris-Descartes, Sorbonne Paris-Cité, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - P Violas
- Service de chirurgie pédiatrique, hôpital Sud, université Rennes 1, boulevard de Bulgarie, 35000 Rennes, France
| | - J Ouellet
- Shriner's Hospital, McGill University, Montreal, Canada
| | - V Cunin
- Service d'orthopédie pédiatrique, hôpital Femme-Mère-Enfant, université Lyon 1, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - J Kieffer
- Pediatric clinic, Luxembourg, Luxembourg
| | - K Kharrat
- Hôpital hôtel-Dieu, B.P. 166830, Beirut, Lebanon
| | - F Accadbled
- Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, Toulouse, France
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