Effectiveness and safety of a one-yearly elongation approach of growing rods in the treatment of early-onset scoliosis: A case series of 40 patients with definitive fusion

Abstract

BackgroundEarly onset scoliosis (EOS) can lead to marked spine and chest wall deformity and often to profound cardiopulmonary compromise. Nowadays, treatment benefits from the possibility of a growth-friendly surgical approach to avoid early spinal fusion. Growing rod spinal implants allow maximizing spine and thorax growth during childhood, performing lengthening procedures traditionally approximately every 6 months.MethodsWe retrospectively evaluated 40 patients affected by EOS who underwent growing rod implantations from 2000 to 2020. A 1-year interval between lengthening procedures was adopted. Data about the age at the first and final surgeries, T1-T12 length pre- and post-surgery, T1-S1 pre- and post-surgery, major coronal curve, pre- and post-surgery rate of complications, and unplanned surgeries were collected and compared with those reported in the literature to determinate the effectiveness and safety of this long period between distractions.ResultsThe lengthening procedures were performed, on average, every 12.3 months; children underwent an average of 4.6 lengthening procedures each. Major curve pre-first surgery was 78°, post-first surgery 45°, pre-final surgery 55°, and post-final surgery 43°. The mean absolute difference between pre-initial to post-final major curve was 35°, representing a mean relative difference of 42%. On average, the T1-T12 segment measured 15 cm before the first surgery and 24 cm after the final surgery, while the T1-S1 segment was 25 cm before the growing rods implantation and reached 37 cm after treatment. During treatment, the adverse events affected 27 of the 40 total patients (67%) who experienced at least one complication. No differences were shown concerning both outcomes and complications, comparing these data with the available literature concerning most frequent elongations. This approach avoided four to five surgical procedures in this population.ConclusionOur results related to deformity correction and complication rate are comparable with those found in the literature, where lengthening procedures are performed approximately every 6 months rather than with a 1-year interval between distractions. We also demonstrate a higher risk of complications for patients with implants before the age of 6.

Autofusion in growing rod surgery for early onset scoliosis; what do we know so far?

“…Correction, albeit modest, is attained through rigorous and prolonged procedures involving multiple osteotomies. In a study by Vittoria et al [ 34 ], out of 40 patients undergoing definitive fusion after growing rods, 15 patients required at least one osteotomy. Similarly, Cahill et al [ 10 ] reported performing an average of 7 Smith-Petersen osteotomies to achieve a Cobb angle correction of 44% at the time of definitive surgery.…”

Early-onset scoliosis

“…Among all the described nonfusion surgical techniques, traditional growing rods (TGRs) are still the most widely accepted and used. Usually between three and six lengthenings are needed and can be spaced between 3 to more than 12 months [19]. The surgical technique has been widely described in the literature [20] with different variations depending on patient characteristics and surgeon's experience and preferences [21].…”