Complications of dual growing rod with all-pedicle screw instrumentation in the treatment of early-onset scoliosis

Abstract

Background Treatment of early-onset scoliosis (EOS) is still a challenge to patients, families, and surgeons. Previous studies have indicated that EOS patients are at high risk for complications following growth-friendly surgery. This study was performed to evaluate the results and complications of all-pedicle screw dual growing rod instrumentation in the treatment of EOS. Methods In an IRB-approved retrospective study, we searched the electronic medical records of our institution for all patients who underwent posterior spinal instrumentation for scoliosis between March 2014 and March 2017. Patients under the age of 10 at the time of surgery who were treated with a growth-friendly technique were then selected. Patients with incomplete records and less than 2 years of follow-up were excluded. Charts, operative notes, clinic visits, and radiographs were extracted. Radiographs were reviewed, and the main curve Cobb angle, thoracic kyphosis, pelvic tilt, pelvic incidence, sacral slope, and proximal junctional angles were measured. We specifically looked for any intra-operative or post-operative complications. Statistical analysis was performed to determine the risk factors of complications. Results A total of 42 patients with a mean age of 4.8 ± 2.1 years (range, 1.5–8 years) were included in the final analysis. Patients were followed for a median of 34 months (range, 24–55). The major curve was corrected from a mean of 42.9° ± 10.7° to 28.8° ± 9.6° at the latest follow-up. Proximal junctional angles and thoracic kyphosis increased significantly during the follow-up period (both P values < 0.001). A total of 7 complications (17%) were observed. Four patients (10%) developed superficial surgical site infections, all of which resolved with antibiotics and one round of surgical debridement. Three cases (7%) of proximal junctional kyphosis (PJK) were encountered during the study period, none of which required revision surgery. Pre-operative thoracic kyphosis was the only significant risk factor for the development of PJK. Conclusions Our findings suggest that in settings without access to magnetically controlled growing rods, dual growing rods with all-pedicle screw instrumentation is still a viable treatment strategy with comparable results and complications. The most common complications are infection and PJK, with the latter being associated with a larger pre-operative thoracic kyphosis.

Benefits of Fixing 3 Proximal Vertebral Bodies vs. 2 in the Treatment of Early-Onset Scoliosis with Growing Rods

“…15,16 While various complications are associated with growing rods for the treatment of EOS, rates are reduced with careful patient selection. 10 In our practice we also observed that patients with severe scoliosis combined with kyphosis treated with growing rods had a higher anchor point-related complication rate. For this reason, for children with large coronal major scoliosis, especially for children with large thoracic scoliosis, we added 2 proximal anchor points for xation to reduce the possibility of complications and hence increase the effectiveness of the surgery.…”

“…However, in patients with severe scoliosis combined with kyphosis this xation method can result in the pedicle screw(s) cutting into the spinal canal when the patient moves. 10 In addition, the proximal screw(s) are easily pulled out due to the kyphosis deformity of the spine, and the growing rod technique is not effective for neuro bromatosis type 1 (NF-1) scoliosis, 11 the most common form of scoliosis with kyphosis.…”

Relook into the Risk Factors of Proximal Junctional Kyphosis in Early Onset Scoliosis Patients: Does the Location of Upper Instrumented Vertebra in Relation to the Sagittal Apex Matter?

“… 3 , 4 , 5 However, the complication rate of GRs treatment is reported as high as 50%, including implant‐related complications, alignment‐related complications, and general complication. 6 , 7 , 8 , 9 …”

“…[3][4][5] However, the complication rate of GRs treatment is reported as high as 50%, including implant-related complications, alignment-related complications, and general complication. [6][7][8][9] Proximal junctional kyphosis (PJK) is the most common alignment-related complication in EOS patients after GRs treatment. Although the current definition of PJK is mainly the imaging manifestations, severe PJK may cause vertebra collapse, acute subluxation or implant failure around the upper instrumented vertebra (UIV), also known as proximal junctional failure.…”

“…In past decades, traditional growing rods (GRs) treatment has been widely applied in EOS patients because of its effectiveness in controlling the progression of spinal deformity while allowing the growth of the spine 3–5 . However, the complication rate of GRs treatment is reported as high as 50%, including implant‐related complications, alignment‐related complications, and general complication 6–9 …”