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Chiu CK, Tan RL, Gani SMA, Chong JSL, Chung WH, Chan CYW, Kwan MK. Feasibility of Single-Stage Posterior Passive Correction and Fusion Surgery for Congenital Scoliosis in Adolescent Patients Who Have Attained Skeletal Maturity. Asian Spine J 2021; 16:315-325. [PMID: 33957021 PMCID: PMC9260400 DOI: 10.31616/asj.2020.0649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 11/23/2022] Open
Abstract
Study Design Retrospective study. Purpose To report the perioperative and radiological outcomes of single-stage posterior passive correction and fusion (SSPPCF) in adolescent patients who present with congenital scoliosis. Overview of Literature The surgical treatment for congenital scoliosis is complex. There is no definitive guide on surgical options for skeletally matured adolescent patients who have congenital scoliosis. Methods Patients with congenital scoliosis who underwent SSPPCF using a pedicle screw system were reviewed. We identified the following three surgical indications: (1) hemivertebra or wedge vertebra over the thoracic or thoracolumbar region with structural lumbar curves, (2) hemivertebra or wedge vertebra at the lumbar region with significant pelvic obliquity or sacral slanting, and (3) mixed or complex congenital scoliosis. The demographic, perioperative, and radiographic data of these patients were collected. Results Thirty-four patients were reviewed. The mean patient age was 14.6±3.4 years. There were 13 hemivertebrae, three wedged vertebrae, two butterfly vertebrae, three hemivertebrae with butterfly vertebra, eight unsegmented bars, and five multiple complex lesions. The average surgical duration was 219.4±68.8 minutes. The average blood loss was 1,208.4±763.5 mL. Seven patients required allogeneic blood transfusion. The mean hospital stay duration was 6.1±2.5 days. The complication rate was 11.8% (4/34): one patient had severe blood loss, one had rod breakage, and two had distal adding-on. The Cobb angle reduced from 65.9°±17.4° to 36.3°±15.3° (p<0.001) with a correction rate (CR) of 44.8%±17.4%. The regional kyphotic angle decreased from 39.9°±20.5° to 27.5°±13.9° (p=0.001) with a CR of 19.3%±49.6%. Radiographic parameters (radiographic shoulder height, clavicle angle, T1 tilt, cervical axis, pelvic obliquity, coronal balance, and apical vertebral translation) showed significant improvement postoperatively. Conclusions SSPPCF was a feasible option for adolescent patients with congenital scoliosis who were skeletally matured.
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Affiliation(s)
- Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rommel Lim Tan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Davao Doctors Hospital, Davao City, Philippines
| | - Siti Mariam Abd Gani
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jessamine Sze Lynn Chong
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Weng Hong Chung
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Nikova A, Chatzipaulou V, Malkots B, Mustafa RM, Valsamidou C, Birbilis T. Correlation between Age and Surgical Approach for Thoracic and Lumbar Hemivertebra. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1710103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective Hemivertebra (HV) is a congenital defect of the formation of the spinal vertebra, which can result in scoliosis or kyphosis along with the related symptomatology of spine deformity. More often than not, it is linked to other abnormalities and requires attention. Its management is surgical and it is of great importance for the physician to choose the right approach at the right time, due to its deteriorative prognosis.
Methods Due to the interest of the subject, the authors investigated the world literature between 1990 and 2018 and found 45 articles, reporting thoracic, thoracolumbar, and lumbar HV in children and its postsurgical outcome, aiming to show whether the approaches are equal in terms of the final outcome.
Results The chosen surgical method depends much on the level of the pathology. Despite this fact, after analyzing the included data, we found that the surgical techniques are unequal with regard to the purpose of achieving improvement. Age, caudal and cranial curves, segmental kyphosis, and scoliosis are factors playing a major role in this.
Conclusion If not treated, HV leads to deterioration and dysfunction. The most optimal result, however, is achieved only when the surgical approach is applied according to age and rest of the accompanying factors, which should be considered in future management planning.
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Affiliation(s)
- Alexandrina Nikova
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Varvara Chatzipaulou
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Belkis Malkots
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Reichan Molla Mustafa
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Christina Valsamidou
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Theodosis Birbilis
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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Karaarslan UC, Gurel IE, Yucekul A, Demirkiran HG, Samdani A, Yilgor C, Alanay A. Team Approach: Contemporary Treatment of Congenital Scoliosis. JBJS Rev 2019; 7:e5. [PMID: 31663918 DOI: 10.2106/jbjs.rvw.19.00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Umut Can Karaarslan
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ipek Ege Gurel
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Altug Yucekul
- Comprehensive Spine Center, Acibadem Maslak Hospital, Istanbul, Turkey
| | - H Gokhan Demirkiran
- Department of Orthopedics and Traumatology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Amer Samdani
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, Pennsylvania
| | - Caglar Yilgor
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Ahmet Alanay
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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Mackel CE, Jada A, Samdani AF, Stephen JH, Bennett JT, Baaj AA, Hwang SW. A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst 2018; 34:2155-2171. [PMID: 30078055 DOI: 10.1007/s00381-018-3915-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To provide the reader with a comprehensive but concise understanding of congenital scoliosis METHODS: We have undertaken to summarize available literature on the pathophysiology, epidemiology, and management of congenital scoliosis. RESULTS Congenital scoliosis represents 10% of pediatric spine deformity and is a developmental error in segmentation, formation, or a combination of both leading to curvature of the spine. Treatment options are complicated by balancing growth potential with curve severity. Often associated abnormalities of cardiac, genitourinary, or intraspinal systems are concurrent and should be evaluated as part of the diagnostic work-up. Management balances the risk of progression, growth potential, lung development/function, and associated risks. Surgical treatment options involve growth-permitting systems or fusions. CONCLUSION Congenital scoliosis is a complex spinal problem associated with many other anomalous findings. Treatment options are diverse but enable optimization of management and care of these children.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, 800 Washington St, Boston, 02111, MA, USA
| | - Ajit Jada
- Department of Neurological Surgery, Weill Cornell Medical College, Box 99, 525 E 68th St, New York, 10065, NY, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - James H Stephen
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, 19104, PA, USA
| | - James T Bennett
- Department of Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, 19140, PA, USA
| | - Ali A Baaj
- Department of Neurological Surgery, Weill Cornell Medical College, Box 99, 525 E 68th St, New York, 10065, NY, USA
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA.
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Convex Instrumented Hemiepiphysiodesis With Concave Distraction: A Treatment Option for Long Sweeping Congenital Curves. J Pediatr Orthop 2016; 36:226-31. [PMID: 25812144 DOI: 10.1097/bpo.0000000000000441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Convex hemiepiphysiodesis has been reported to have mixed results in the treatment of congenital spine deformities. Multiple modifications of the original technique were suggested to improve the results. The purpose of this study is to report the results and complications of an instrumented convex growth arrest procedure modified with concave distraction. METHODS The records of 11 patients with long sweeping congenital curves (involving multiple anomalous vertebrae) who underwent convex instrumented hemiepiphysiodesis with concave distraction were evaluated. Mean age at index operation was 58 months (range, 29 to 101 mo). Lengthening of the concave distraction rod was done every 6 months. The magnitude of coronal/sagittal deformity and T1-T12 height were measured on the preoperative, postoperative, and latest follow-up radiographs. Average follow-up was 44.9 months (range, 24 to 89 mo). RESULTS In the coronal plane, the convex hemiepiphysiodesis segment was corrected from an average of 60.5 to 40.4 degrees postoperatively and further improved to 35.5 degrees at the latest follow-up. The distracted segment was corrected from 33.4 to 15.2 degrees postoperatively and to 12.7 degrees at the latest follow-up. Sagittal plane alignment was minimally affected. The average T1-T12 height was 157.1 mm in the early postoperative period and 181.1 mm at last follow-up. During follow-up, we identified partial pull-out of screws on the distraction side in 5 of the 11 patients and rod breakages in 3 patients. These were revised during planned lengthenings. There were no unplanned surgeries, deep wound infections, nor neurological complications. CONCLUSIONS Convex instrumented hemiepiphysiodesis with concave distraction resulted in good curve correction while maintaining the growth of thorax. The correction of the anomalous segment improved over time, proving the effectiveness of the hemiepiphysiodesis. Addition of a concave distraction construct appears to enhance spinal growth, thereby augmenting the hemiepiphysiodesis effect.
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One-stage posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis: the preliminary clinical outcomes of a hybrid technique. Spine (Phila Pa 1976) 2014; 39:E294-9. [PMID: 24253799 DOI: 10.1097/brs.0000000000000119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To evaluate the clinical outcomes of the hybrid technique of 1-stage posterior osteotomy with short segmental fusion and dual growing rod (GR) technique for severe rigid congenital scoliosis. SUMMARY OF BACKGROUND DATA As some types of congenital scoliosis consist of long curve including sharp deformities producing enormous asymmetric growth at apex, they cannot be well corrected with osteotomy and short segmental fusion. GR technique may be the best option. However, enormous asymmetric growth potential due to the sharp deformities at the apex will increase risk of complications, especially implant failures. METHODS Seven patients (2 males, 5 females) undergoing this hybrid technique for severe rigid congenital scoliosis were retrospectively reviewed. The patients' charts were reviewed. The analysis included age at initial surgery and the latest follow-up, number and frequency of lengthening, and complications. Radiographical evaluation included measured changes in scoliosis Cobb angle, thoracic kyphosis, lumbar lordosis, trunk shift, length of T1-S1, and instrumentation. RESULTS The mean follow-up was 53.3 (30-77) months. The mean age at the initial surgery is 5.9 (2-10) years. The averaged lengthenings were of 5.3 per patient. The mean scoliosis improved from 81.4° to 40.1° after initial surgery and was 41.0° at the latest follow-up. The average T1-S1 length was of 1.23 cm per year. The space available for lung ratio increased from 0.86 to 0.96. CONCLUSION Osteotomy with short fusion could help to improve the correction of the GR and eliminate the large asymmetric growth potential around the apex, with little influence to the length of the spine. Dual GR technique could maintain correction achieved at initial surgery while allowing spinal growth to continue. This hybrid technique may be an option for young patients who present sharp deformities with large asymmetric growth potential in a long congenital spinal deformity. LEVEL OF EVIDENCE 4.
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Zhu X, Wei X, Chen J, Li C, Li M, Qiao Y, Ran B. Posterior hemivertebra resection and monosegmental fusion in the treatment of congenital scoliosis. Ann R Coll Surg Engl 2014; 96:41-4. [PMID: 24417829 PMCID: PMC5137654 DOI: 10.1308/003588414x13824511650173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Posterior hemivertebra resection combined with multisegmental or bisegmental fusion has been applied successfully for congenital scoliosis. However, there are several immature bones and their growth can be influenced by long segmental fusion in congenital patients. Posterior hemivertebra resection and monosegmental fusion was therefore suggested for treatment of congenital scoliosis caused by hemivertebra. METHODS Between June 2001 and June 2010, 60 congenital scoliosis patients (aged 2-18 years) who underwent posterior hemivertebra resection and monosegmental fusion were enrolled in our study. A standing anteroposterior x-ray of the whole spine was obtained preoperatively, postoperatively and at the last follow-up appointment to analyse the Cobb angle in the coronal and sagittal planes as well as the trunk shift. RESULTS The mean preoperative coronal plane Cobb angle was 41.6°. This was corrected to 5.1° postoperatively and 5.3° at the last follow-up visit (correction 87.3%). The compensatory cranial curve was improved from 18.1° preoperatively to 7.1° postoperatively and 6.5° at the last follow-up visit while the compensatory caudal curve was improved from 21.5° to 6.1° after surgery and 5.6° at the last follow-up visit. The mean sagittal plane Cobb angle was 23.3° before surgery, 7.3° after surgery and 6.8° at the last follow-up visit (correction 70.1%). The trunk shift of 18.5mm was improved to 15.2mm. CONCLUSIONS Posterior hemivertebra resection and monosegmental fusion seems to be an effective approach for treatment of congenital scoliosis caused by hemivertebra, allowing for excellent correction in both the frontal and sagittal planes.
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Affiliation(s)
- X Zhu
- Department of Orthopedic, Changhai Hospital, The Second Military Medical University, Shanghai, China
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Dual growing rods technique for congenital scoliosis: more than 2 years outcomes: preliminary results of a single center. Spine (Phila Pa 1976) 2012; 37:E1639-44. [PMID: 22990366 DOI: 10.1097/brs.0b013e318273d6bf] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To evaluate clinical outcomes of dual growing rod (GR) technique in treating children with congenital scoliosis (CS). SUMMARY OF BACKGROUND DATA Published reports on the dual GR technique results of early-onset scoliosis demonstrate it to be safe and effective. However, the use of GR in congenital spinal deformities is controversial, and there have been no reports on the results and complications of dual GR technique for CS with large series of patients. METHODS During 2004 to 2009, a total of 30 patients with CS underwent dual GR procedures. Of the 159 total procedures conducted within the treatment period, 125 were lengthenings with an average of 4.2 lengthenings per patient. Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion. The analysis included age at initial surgery and final fusion (if applicable), number and frequency of lengthenings, and complications. Radiographical evaluation was conducted. RESULTS The mean scoliosis improved from 72.3° to 34.9° after initial surgery and was 35.2° at the last follow-up or after final fusion. T1-S1 length increased from 25.42 to 29.03 cm after initial surgery and to 33.32 cm at last follow-up or after final fusion with an average T1-S1 length increase of 1.49 cm per year. The space available for lung ratio in patients with thoracic curves improved from 0.84 to 0.96 at the latest follow-up. Three patients reached final fusion. Complications occurred in 7 of the 30 patients, and they had a total of 13 complications. CONCLUSION The dual GR technique is safe and effective in the treatment of selected cases of long, complex CS. It maintains correction achieved at initial surgery while allowing spinal growth to continue. And it has an acceptable rate of complications. The osteotomy at the apex vertebra with short segmental fusion of the severe rigid scoliosis or the patients with kyphosis could help to improve the correction and decrease the implant failures, with little influence on the length of the spine.
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Convex instrumented hemiepiphysiodesis with concave distraction: a preliminary report. Clin Orthop Relat Res 2012; 470:1144-50. [PMID: 21484474 PMCID: PMC3293962 DOI: 10.1007/s11999-011-1878-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 03/15/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The convex growth arrest (CGA) procedure has been well accepted for treatment of congenital scoliosis as it is a simpler procedure with successful results. However, unpredictability of curve behavior, slow and usually inadequate correction, and necessity of anterior surgery for completeness of the epiphysiodesis are its shortcomings. QUESTIONS/PURPOSES In a preliminary study we asked whether a modification of the CGA procedure using convex instrumented hemiepiphysiodesis with concave distraction would correct the coronal plane Cobb angles and would correct or maintain sagittal plane local and global kyphosis angles. We also identified complications. PATIENTS AND METHODS We retrospectively reviewed five female patients who underwent the modified procedure. Their mean age at the index operation was 40 months (range, 17-55 months). The patients underwent concave distractions every 6 months. The magnitude of the convex instrumented and concave distracted curves and sagittal plane parameters were determined on the preoperative and most recent followup radiographs. Minimum followup was 26 months (mean, 34 months; range, 26-40 months). RESULTS In the coronal plane, the preoperative magnitude of the convex instrumented congenital curve averaged 48°. It was corrected to 36° (25%) postoperatively and was further improved to 27° (44%) at the latest followup. For the distracted segment, the mean preoperative curve was 35°, corrected to 16° postoperatively and to 8° at the latest followup, for an average correction of 77%. Sagittal plane alignment was minimally affected from the procedure. In four of the five patients we identified partial pullout of screws for the concave distraction; these were revised at the time of planned lengthening. CONCLUSIONS This procedure may obviate the need for multiple osteotomies and long thoracic fusions in young children with long sweeping thoracic deformities involving multiple anomalous vertebrae. Implant-related complications on the concave side may be avoided using paired pedicle screws at the proximal and distal anchor sites. LEVEL OF EVIDENCE Level IV, therapeutic study. See the guidelines online for a complete description of level of evidence.
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Abstract
BACKGROUND Growing rod surgery is a modern alternative treatment for young children with early onset scoliosis. This is the first study focused on its use in progressive congenital spinal deformities. METHODS A retrospective study of 19 patients from the international multicenter Growing Spine Study Group with progressive congenital spinal deformities undergoing growing rod surgery who had a minimum of 2 years follow-up. We analyzed demographic and radiographic data including age at initial surgery, number of abnormal vertebrae per patient, number of lengthenings postoperatively, Cobb angle of the major curve preoperative, postoperative initial and at last follow-up, T1-S1 length, space available for the lung (SAL), length of follow up, and complications. RESULTS The mean age at surgery was 6.9 years (range: 3.2 to 10.7 y). The mean number of affected vertebrae per patient was 5.2 (range: 2 to 9 vertebrae). The mean number of lengthening was 4.2 (range: 1 to 10 lengthening) per patient. The major Cobb angle improved from 66 degrees (range: 40 to 95 degrees) preoperatively to 45 degrees (range: 13 to 79 degrees) initial postoperative and 47 degrees (range: 18 to 78 degrees) at the last follow-up. The mean T1-S1 length increased from 268.3 mm (range: 192 to 322 mm) postoperatively to a mean of 315.4 mm (range: 261 to 357 mm) at last follow-up. The mean T1-S1 length increase was 11.7 mm/y. The SAL ratio increased from 0.81 preoperatively to 0.94 at latest follow-up. The mean postoperative follow-up was 4 years (range: 2 to 6.6 y). Five patients (38%) had undergone final fusion and 14 are still under treatment. Complications have occurred in 8 patients (42%). There were 14 (14%) complications in 100 procedures: 11 implant related, 2 pulmonary, and 1 postoperative infection. There were no neurological complications. CONCLUSIONS Growing rods are a safe and effective treatment technique in selected patients with congenital spinal deformities. The deformity, spinal growth, and the SAL improved. The incidence of complication was relatively low. LEVEL OF EVIDENCE Level IV, case series.
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Abstract
STUDY DESIGN A review of current medical and surgical preoperative planning knowledge and protocols for children with early-onset scoliosis (EOS; onset less than 5 years of age). OBJECTIVE To describe the preoperative planning process to undertake safe and effective treatment for the EOS patient. SUMMARY OF BACKGROUND DATA Children with EOS present with a myriad of medical and orthopedic conditions associated with their specific diagnosis, and frequently require intensive preoperative evaluation and nutritional, pulmonary, and other support to prepare them for safe and effective treatment of the spinal/chest wall deformity. Such patients are among the most difficult and complex to treat effectively. METHODS A literature review of known conditions associated with EOS, and a summary of current surgical techniques to maintain deformity control while promoting spine and thoracic growth, was undertaken. Current recommendations for preoperative support and postoperative management of these complex patients are summarized, drawn from the experiences of the author and members of study groups focusing on EOS. RESULTS Preoperative assessment of respiratory function, potential for respiratory failure, and determination of objective criteria to indicate surgical management (deformity progression, lack of growth of spine and/or thoracic volume, lack of weight gain) are weighed against the potential for development of thoracic insufficiency syndrome. Magnetic resonance imaging evaluation for neuraxis abnormalities is considered on the basis of diagnosis. Nutritional status, osteopenia, and airway management are evaluated to minimize postoperative complications. Current general recommendations for implants and constructs for specific deformities are reviewed. CONCLUSION Thorough preoperative evaluation of EOS patients provides the surgeon with the knowledge to produce a sound surgical plan for this difficult and complex to treat patient population.
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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. Spine (Phila Pa 1976) 2009; 34:1800-7. [PMID: 19644331 DOI: 10.1097/brs.0b013e3181978ec9] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Review of relevant literature including personal opinions. OBJECTIVE 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. SUMMARY OF BACKGROUND DATA 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. METHODS Peer-reviewed research articles and major international meeting presentations were reviewed. Methods were compared in terms of advantages and limitations. RESULTS 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. CONCLUSION 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.
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Akel I, Yazici M. Growth modulation in the management of growing spine deformities. J Child Orthop 2009; 3:1-9. [PMID: 19308606 PMCID: PMC2656840 DOI: 10.1007/s11832-008-0145-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 10/22/2008] [Indexed: 02/03/2023] Open
Abstract
The Hueter-Volkmann law explains the physiological response of the growth plate under mechanical loading. This law mainly explains the pathological mechanism for growing long-bone deformities. Vertebral endplates also show a similar response under mechanical loading. Experimental studies have provided information about spinal growth modulation and, now, it is possible to explain the mechanism of the curvature progression. Convex growth arrest is shown to successfully treat deformities of the growing spine and unnecessary growth arrest of the whole spine is prevented. Both anterior and posterior parts of the convexity should be addressed to achieve a satisfactory improvement in the deformity, albeit epiphysiodesis effect cannot be stipulated at all times. Anterior vertebral body stapling without fusion yielded better results with new shape memory alloys and techniques. This method can be used with minimally invasive techniques and has the potential advantage of producing reversible physeal arrest. Instrumented posterior hemiepiphysiodesis seems to be as effective as classical combined anterior and posterior arthrodesis, where it is less invasive and morbid. Convex hemiepiphysiodesis with concave-side distraction through growing rod techniques provide a better control of the curve immediately after surgery. This method has the advantages of posterior instrumented hemiepiphysiodesis, but necessitates additional surgeries. Concave-side rib shortening and/or convex-side lengthening is an experimental method with an indirect effect on spinal growth. To conclude, whatever the cause of the spinal deformity, growth modulation can be used to manage the growing spine deformities with no or shorter segment fusions.
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Affiliation(s)
- Ibrahim Akel
- />Orthopedics and Traumatology Unit, Ministry of Health, Ankara Training and Research Hospital, Ulucanlar, 06340 Ankara, Turkey
| | - Muharrem Yazici
- />Orthopedics and Traumatology Department, Hacettepe University, 06100 Ankara, Sihhiye, Turkey
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Short anterior instrumented fusion and posterior convex non-instrumented fusion of hemivertebra for congenital scoliosis in very young children. 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 2008; 17:1507-14. [PMID: 18820956 DOI: 10.1007/s00586-008-0760-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 07/22/2008] [Accepted: 08/10/2008] [Indexed: 01/11/2023]
Abstract
A variety of treatments has been described in the literature for the treatment of HV. We report the results of early surgical anterior instrumented fusion with partial preservation of the HV and posterior non-instrumented fusion in the treatment of progressive congenital scoliosis in children below the age of six. Between 1996 and 2006, 31 consecutive patients with 33 lateral HV and progressive scoliosis underwent short segment fusions. Mean age at surgery was 2 years and 10 months. Mean follow-up period was 6.1 years. The major scoliotic curve improved from 41 degrees preoperatively to 17 degrees on follow-up. Preoperative segmental Cobb angle averaging 39 degrees was corrected to 15 degrees after surgery, being 15 degrees at the last follow-up (62% of improvement). Compensatory cranial and caudal curves corrected by 47 and 45%, respectively. The angle of segmental kyphosis averaged 16 degrees before surgery, 11 degrees after surgery, and 11 degrees at follow-up. There were two wound infections requiring surgical debridment, one intraoperative fracture of the vertebral body and one case lost correction due to implant failure. All went on to stable bony union. There were no neurological complications. Early diagnosis and early and aggressive surgical treatment are mandatory for a successful treatment of congenital scoliosis and prevention of the development of secondary compensatory deformities. Anterior instrumentation is a safe and effective technique capable of transmitting a high amount of convex compression allowing short segment fusion, which is of great importance in the growing spine.
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Bollini G, Docquier PL, Viehweger E, Launay F, Jouve JL. Thoracolumbar hemivertebrae resection by double approach in a single procedure: long-term follow-up. Spine (Phila Pa 1976) 2006; 31:1745-57. [PMID: 16816773 DOI: 10.1097/01.brs.0000224176.40457.52] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of patients records with clinical and radiographic assessment. OBJECTIVE To evaluate the long-term result of thoracolumbar hemivertebrae resection using a double approach in a single procedure. SUMMARY OF BACKGROUND DATA Thoracolumbar hemivertebrae resection by a combined posterior and anterior approach has been previously described, but this is the largest series of hemivertebrae reported. METHODS From 1987 to 2003, a consecutive series of 34 congenital scoliosis or kyphoscoliosis due to thoracolumbar hemivertebrae were managed by hemivertebra resection using a combined posterior and anterior approach and short anterior and posterior convex fusion in the same day/same anesthesia. RESULTS The mean age at surgery was 3.5 years. The mean follow-up period was 6.0 years. There was a mean improvement of 69.3% in the segmental curve from a mean angle of 34.8 degrees before surgery to 10.7 degrees at the latest follow-up assessment. The global scoliosis curve improved of 33.4% from 40.4 degrees to 26.9 degrees, respectively. Trunk shift was significantly improved. The mean final kyphosis was within normal values. CONCLUSIONS This procedure is safe and offers a persistent correction with a short segment fusion. Surgery should be performed as early as possible to avert severe local deformities and prevent secondary structural deformities in order to avoid extensive fusions.
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Affiliation(s)
- Gérard Bollini
- Department of Paediatric Orthopaedic Surgery, Hôpital Timone Enfants, University of Marseille, Marseille, France.
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Bollini G, Docquier PL, Viehweger E, Launay F, Jouve JL. Lumbosacral hemivertebrae resection by combined approach: medium- and long-term follow-up. Spine (Phila Pa 1976) 2006; 31:1232-9. [PMID: 16688037 DOI: 10.1097/01.brs.0000217616.17692.a0] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of patients records with clinical and radiographic assessment. OBJECTIVES To evaluate the long-term result of lumbosacral hemivertebrae resection using a combined approach. SUMMARY OF BACKGROUND DATA Lumbosacral hemivertebrae resection by a combined posterior and anterior approach have been previously described, but only one study is concerning such a large series of hemivertebrae. METHODS From 1980 to 2001, a consecutive series of 17 congenital scolioses due to lumbosacral hemivertebrae were managed by hemivertebrae resection using a combined approach and short anterior and posterior convex fusion. RESULTS The mean age at surgery was 4.9 years. The mean follow-up period was 7.6 years. One postoperative complication was encountered: a patient had motor deficit and recovery was incomplete. The mean segmental scoliosis curve was 27.5 degrees before surgery, 10.7 degrees after surgery, and 8.9 degrees at the latest follow-up assessment. This represents a mean improvement of 61.1% after surgery and of 67.6% at the latest follow-up. The total main scoliosis curve improved from 28.4 degrees to 12.7 degrees and 11.4 degrees , respectively. It represents a mean improvement of 55.3% and 59.9%, respectively. The mean final lordosis was within normal values. CONCLUSIONS This procedure offers a persistent correction with a short-segment fusion. The early surgery is able to avert severe local deformities and prevent secondary structural deformities in order to avoid extensive fusions.
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Affiliation(s)
- Gérard Bollini
- Department of Paediatric Orthopedic Surgery, Timone Children Hospital, University of Marseille, Marseille, France
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17
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BOLLINI GÉRARD, DOCQUIER PIERRELOUIS, VIEHWEGER ELKE, LAUNAY FRANCK, JOUVE JEANLUC. LUMBAR HEMIVERTEBRA RESECTION. J Bone Joint Surg Am 2006. [DOI: 10.2106/00004623-200605000-00015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Abstract
BACKGROUND A single lumbar hemivertebra can be expected to cause progressive scoliosis. The aim of this study was to evaluate the results of a lumbar hemivertebra resection and short-segment fusion through a combined posterior and anterior approach. METHODS From 1987 to 2002, a consecutive series of twenty-one patients with congenital scoliosis or kyphoscoliosis due to a lumbar hemivertebra were managed by resection of the hemivertebra through a combined posterior and anterior approach and with the use of a short anterior and posterior convex-side fusion. RESULTS The mean age at the time of surgery was 3.3 years (range, twelve months to 10.2 years). The mean followup period was 8.6 years. There was a mean improvement of 71.4% in the segmental scoliosis curve from a mean angle of 32.9 degrees before surgery to 9.4 degrees at the time of the latest follow-up assessment, and a mean improvement of 63.9% in the global scoliosis curve from 34.1 degrees to 12.3 degrees. The mean final lordosis was within normal values. CONCLUSIONS Excision of a lumbar hemivertebra is safe and provides stable correction when combined with a short-segment fusion. Surgery should be performed as early as possible to avert the development of severe local deformities and prevent secondary structural deformities that would require a more extensive fusion later.
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Affiliation(s)
- Gérard Bollini
- Department of Paediatric Orthopedic Surgery, Hôpital Timone Enfants, 264, rue Saint-Pierre, 13385 Marseille Cedex 5, France.
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Bollini G, Docquier PL, Launay F, Viehweger E, Jouve JL. Résultats à maturité osseuse après résection d’hémivertèbres par double abord. ACTA ACUST UNITED AC 2005; 91:709-18. [PMID: 16552992 DOI: 10.1016/s0035-1040(05)84481-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF THE STUDY The natural history of congenital scoliosis or kypho-scoliosis resulting from a hemivertebra is well documented. The spinal deformation generally worsens in children with a free or semi-segmented hemivertebra situated in the thoraco-lumbar, lumbar or lumbosacral region. MATERIAL AND METHODS From 1982 to 1997, fifteen pediatric patients with 15 hemivertebrae causing progressive scoliosis or kypho-scolisosis underwent hemivertebral resection via a double posterior and anterior approach associated with convex fusion. Mean age at surgery was 4.4 years. The fifteen patients were reviewed at bone maturity (Risser 4 or 5) to assess outcome. RESULTS Genitourinary tract anomalies were associated in five of the 15 patients and intrathecal anomalies in two. Mean follow-up was 12.1 years. Segmental scoliosis was 30.2 degrees preoperatively, 12.3 degrees postoperatively and 8.9 degrees at last follow-up. The values for total scoliosis were 30.5 degrees, 12.3 degrees and 12.6 degrees respectively. This was a 70.5% improvement at last follow-up for segmental scoliosis and 58.7% for total scoliosis. The real trunk imbalance improved from 31% preoperatively to 9% at last follow-up. All these differences were significant. DISCUSSION The main objective of surgical treatment for congenital scoliosis due to hemivertebra is to prevent the development of severe deformation which would necessitate a dangerous and difficult procedure to achieve correction. Resection of the hemivertebra via a double approach is the ideal method for early correction. The procedure not only corrects the spinal deformation but also prevents later deterioration. Correction should be performed as early as possible. The result is sustained over time if there is no other associated spinal anomaly. The procedure is safe and the technique well controlled in experimented hands. Patients need to wear a corset for only six months after resection of the hemivertebra.
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Affiliation(s)
- G Bollini
- Département de Chirurgie Orthopédique Pédiatrique, Hôpital Timone Enfants, Université de Marseille.
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Leung YL, Buxton N. Combined diastematomyelia and hemivertebra: a review of the management at a single centre. ACTA ACUST UNITED AC 2005; 87:1380-4. [PMID: 16189312 DOI: 10.1302/0301-620x.87b10.16050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A combination of hemivertebrae and diastematomyelia is rare. We have identified 12 such patients seen during a period of 11 years in the orthopaedic, spinal and neurosurgical units in Nottingham and analysed their treatment and outcome.
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Affiliation(s)
- Y L Leung
- Department of Orthopaedics and Trauma, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.
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Affiliation(s)
- Francis H Shen
- University of Virginia Health Systems, Charlottesville, VA, USA
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Arlet V, Odent T, Aebi M. Congenital 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 2003; 12:456-63. [PMID: 14618384 PMCID: PMC3468011 DOI: 10.1007/s00586-003-0555-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2003] [Accepted: 03/07/2003] [Indexed: 11/25/2022]
Abstract
Congenital scoliosis is the most frequent congenital deformity of the spine. Congenital curvatures are due to anomalous development of the vertebrae (failure of formation and/or segmentation). Congenital scoliosis is believed to be related to an insult to the fetus during spine embryological development, and associated malformations (heart, spinal cord, kidney.) are frequently observed. A perfect understanding of the natural history of the deformity and the treatment principles will allow best management of these complex spine deformities. New imaging techniques like three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) are important tools for analyzing the underlying deformity and understanding the evolution of the complex deformities. The mainstay of treatment is either observation or, in case of curve progression (>10 degrees /year), surgery. Different surgeries are described with two main principles: (1) prophylactic surgeries like hemiepiphysiodesis or in situ fusions that will prevent worsening or allow progressive correction over time, and (2) corrective surgeries, with spinal fusion with or without spinal resection. Exceptional procedures (e.g. spinal column resection or halo distraction) can be attempted in cases of very severe deformity. Congenital curves must be carefully observed to choose the least invasive procedure at the right time and to minimize spinal cord risks.
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Affiliation(s)
- V Arlet
- Division of Orthopedic Surgery, McGill University Health Center, 2300 Tupper Street, Suite 512, H3H 1P3, Montreal, Quebec, Canada.
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