A New Technique for the Surgical Management of Deformities in the Growing Spine

Abstract

The Luque procedure was developed to correct the deformity without the need of bracing and maintaining that correction with growth. However many authors are disappointed by their results and the complications which appear in the management of infantile scoliosis with Luque trolley alone. Besides failed implants, pseudarthrosis, modest spinal growth and protuberant rods and wires, the major problem of the Luque Systems is the high incidence of loss of correction by postoperative rotation. Therefore a new application technique is recommended. A Standard posterior extraperiostal approach is chosen. Sublaminar titanium cables are passed at each level except the caudal lamina. Then the rods are precontoured in shape of the planed curve correction. We use a Iow profile titanium Instrumentation with 5.0 mm diameter rods and 4.2 mm pedicle screws. In contrast to the conventional use of two antiparallel "L"rods we recommend the use of one reversed BU"-rod securing the laminae with sublaminar titanium cables of the upper end vertebrae. For fixation of the Iower spine a dual-opening pedicle screw System is used. Using a holding forceps the distal rods are introduced and fixed into the side opening of the screws then secured by sublaminar wires. In addition both single rods are stabilized by a Iow profile cross link bar. This technique allows to correct pelvic obliquity and a stable anchorage of two screws reduces risk of postoperatively rotation or caudal rod slippage due to gravity forces.Schlüsselwörter: Luque-Trolley, Wirbelsäule, Deformität, operative Therapie Die operative Technik nach Luque-Trolley wurde zur Therapie von Wirbelsäulendeformitäten im Wachstumsalter entwickelt und soll eine Immobilisation im Korsett ersetzen. Einige Autoren berichten jedoch über enttäuschende Ergebnisse sowie erhöhte Komplikationsraten bei alleiniger operativer Therapie von Patienten mit infantiler Skoliose durch das Luque-Trolley-System. Neben Implantatbrüchen, Pseudarthrosen, Wachstumsverzögerungen und kutanhervorstehenden Implantatanteilen besteht das Hauptproblem dieses Korrektursystems in der hohen Inzidenz von Korrekturverlusten durch eine postoperativ stattfindende Rotation. Zur Vermeidung der genannten Komplikationen empfehlen die Autoren eine neue Technik. Über einen extraperiostalen, standardisierten posterioren Zugang werden zur Fixation der Einzelsegmente sublaminare Titankabel mit Ausnahme des kaudalen Wirbels eingebracht, die zur Fixierung des zur Korrektur entsprechend vorgebogenen Stabsystems dienen. Die Autoren empfehlen hierzu die Verwendung von 0.5 mm dicken Titanstäben sowie den Einsatz von 4,2-mm-Pedikelschrauben. Im Gegensatz zur konventionellen Anordnung zweier L-förmiger, antiparalleler Stäbe wird die Verwendung eines umgekehrt-Uförmigen Stabes empfohlen, dessen kraniales Ende durch Laminakabel gesichert wird. Die beiden zur Fixierung der distalen Bewegungssegmente eingesetzten parallelen Einzelstäbe werden hingegen durch ein dual-offenes Pedikelschraubensystem fixiert, mittels Konnektionsmodul miteinander verbund...

Guided-growth implants in the treatment of early childhood scoliosis – pilot study

“…Ce lem le cze nia dzie ci ze sko lio zą wcze sno dziecię cą jest ste ro wa nie wzro stem krę go słu pa. Jed nak pre cy zyj ne zgra nie w cza sie ko lej nych eta pów opera cyj nych ze wzro stem dziec ka jest trud ne i za wsze na le ży się li czyć z ko niecz no ścią do dat ko wych in terwen cji ope ra cyj nych. Sta le po szu ku je się za tem metod ko rek cji de for ma cji krę go słu pa umo żli wia ją cych jed no cze śnie nie za ha mo wa ny je go wzrost do uzyska nia doj rza ło ści szkie le to wej [2][3][4].…”

The Shilla Growth Guidance Technique for Early-Onset Spinal Deformities at 2-Year Follow-Up

“…[2][3][4][5][6] The growth guidance concept for growing spinal rods is based upon utilization of the inherent growth potential of the child's vertebral column as the engine and grew out of the sliding technique of the Luque trolley. [10][11][12][13] The problem of wire anchors causing interlaminar ankylosis and eventually autofusion diminished the effect of the Luque trolley; however, the use of an extraperiostally placed pedicle screw as an anchor instead of a sublaminar wire can allow for continued spinal growth while fixing the vertebra to a rod guiding its growth in a straight alignment. Because of the heterotopic bone from periosteal stripping of the spine used to place the implants, the results were inconsistent and the technique has fallen into disuse except in a few centers.…”

How to Prevent Small Stature in Rett Syndrome—Associated Collapsing Spine Syndrome

“…This reduces the complication rates, such as implant failure, pseudarthrosis, loss of correction, and modest spinal growth with small stature. 17 In view of the disease-related polymorbidity of patients with Rett syndrome, we recommend an early operative treatment of the spine deformity with growth-adapted instrumentation. In addition, an interdisciplinary treatment concept, including orthopedic surgeons, pediatricians, and neurosurgeons, may help to reduce the risk of potentially irreversible damage to these patients and guarantees a successful pre-and postoperative treatment of the deformities in these young patients.…”

“…Two weeks later, a posterior instrumented correction of the curve and fusion from T3 to L5 followed. To allow for further spinal growth, we used the Small Stature USS II System (Synthes, West Chester, Pa), as has been described by Wild et al 17 Pedicle screws were applied in the computer navigation technique (Medivision, Oberdorf, Switzerland) to minimize intraoperative risks.…”