Comparison of Single and Dual Growing Rod Techniques Followed Through Definitive Surgery

Thompson, George H.; Akbarnia, Behrooz A.; Kostial, Patricia; Poe-Kochert, Connie; Armstrong, Douglas G.; Roh, Jeffrey S.; Lowe, Robert; Asher, Marc A.; Marks, David

doi:10.1097/01.brs.0000179082.92712.89

Cited by 294 publications

(142 citation statements)

References 14 publications

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“…The authors concluded that the dual growing rod technique was safe and effective, and had an acceptable rate of complications compared with previous reports while preserving near-normal growth [10]. Consistently better results have been reported with the use of double rods instead of a single one [11,12].…”

Section: Conception and Historysupporting

confidence: 52%

Growing rod concepts: state of the art

Yazıcı

Olgun

2012

Eur Spine J

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Introduction Early-onset spinal deformities present multiple challenges to the surgeon. They may be rapidly progressive and unresponsive to conservative treatment, necessitating surgical intervention at an early age. Materials and methods This text attempts to provide a review of current literature and to summarize the authors' opinions. Results This paper attempts to concisely review available literature regarding the growing rod's inception, evolution, technique, results, and complications and answers some of the controversy still surrounding it. Conclusions The growing rod is one of the first, most evolved, most popular and one of the most heatedly discussed technique of fusionless spinal instrumentation.

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Section: Conception and Historysupporting

confidence: 52%

Growing rod concepts: state of the art

Yazıcı

Olgun

2012

Eur Spine J

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“…The dilemma of simultaneously providing three-dimensional stability and enhancing growth in a mixed population of idiopathic, neuromuscular and syndromic disorders seems to be best challenged by dual growing rods [14,21]. However, the risk of placement and pull-out of pedicle screws in patients with small anatomy, repetitive surgery, the rigidity of fixation and a complication rate of 20% per surgery [10] promotes the search for alternatives.…”

Section: Discussionmentioning

confidence: 99%

“…However, VEPTR's safety and efficacy remains still to be shown for non-congenital deformities. It thereby competes with a variety of established or evolving growth respecting methods such as serial casting [9], growing rods [10][11][12][13][14][15][16] and growth guiding implants [12,17,18].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions

2009

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This retrospective study analyses 23 children treated with vertical expandable prosthetic titanium rib (VEPTR) for correction of non-congenital early onset spine deformities. After the index procedure (IP), the device was lengthened at 6-month intervals. The average (av) age at the time of IP was 6.5 years (1.11-10.5). The av follow-up time was 3.6 years (2-5.8). Diagnosis included 1 early onset idiopathic scoliosis, 11 neuromuscular, 2 post-thoracotomy scoliosis, 1 Sprengel deformity, 2 hyperkyphosis, 1 myopathy and 5 syndromic. Surgeries (187) included 23 IPs, av 6.5 (4-10) device expansions per patient (149) and 15 unplanned surgeries. 23 complications (0.13 per surgery) included 10 skin sloughs, 5 implant dislocations, 2 rod breakages and 6 infections. Coronal Cobb angle was av 68°(11°-111°), at follow-up av 54°(0°-105°). Pelvic obliquity was av 33°( 13°-60°), at follow-up av 16°(0°-42°). T1 tilt was av 29°( 5°-84°), two remained unchanged, the remainder improved 10°-68°. Sagittal plane: All but two had stable profiles, two hyperkyphosis of 110°/124°improved to 56°/86°. Space available for lung ratio was less than 90% in ten before the IP, improved in nine and deteriorated in one. Originally designed for thoracic insufficiency syndromes related to rib and vertebral anomalies, VEPTR proved to be a valuable alternative to dual growing rods for non-congenital early onset spine deformities. The complication rate was lower, the control of the sagittal plane and the pelvic obliquity was as good, but the correction of the coronal plane deformity was less than growing rods. However, VEPTR's spine-sparing approach might provoke less spontaneous spinal fusion and ease the final correction at maturity.

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“…Historically, early fusion frequently was recommended for treatment of EOS [16]. However, there is a growing consensus that early spinal fusion results in negative thoracopulmonary consequences to children [15], and most surgeons now use fusion as a last resort in the young child. Hemiepiphysiodesis, hemivertebral resection, and short segment fusions continue to be used in selected patients.…”

Section: Introductionmentioning

confidence: 99%

“…The authors of one report recommend placement of growing rod instrumentation on the concave side of the spine only to expand the smallest hemithorax [2], whereas others report better radiographic correction and fewer complications with bilateral constructs [15]. An opening wedge thoracostomy sometimes is performed as part of distraction thoracoplasty [10], but some surgeons prefer not opening the thoracic cavity as they are concerned by the potential for scarring and subsequent restriction this could cause [8].…”

Section: Introductionmentioning

confidence: 99%

Variability of Expert Opinion in Treatment of Early-onset Scoliosis

Vitale

Gómez

Matsumoto

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling.Questions/purposes Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis. Methods We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed. Results All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy. Conclusions Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.

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Comparison of Single and Dual Growing Rod Techniques Followed Through Definitive Surgery

Cited by 294 publications

References 14 publications

Growing rod concepts: state of the art

Growing rod concepts: state of the art

Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions

Variability of Expert Opinion in Treatment of Early-onset Scoliosis

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