Five or more proximal anchors and including upper end vertebra protects against reoperation in distraction-based growing rods

Harris, Liam; Andras, Lindsay M.; Sponseller, Paul D.; Emans, John B.; Skaggs, David L.

doi:10.1007/s43390-020-00064-x

Cited by 16 publications

(9 citation statements)

References 21 publications

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“…Data extracted from these papers were assigned to the appropriate system. Harris et al [ 8 ], 2020, in their paper analyzed the impact of patient and surgical factors on the proximal complications and revision rates of early-onset scoliosis patients using a multicenter database. Total 353 patients met the inclusion criteria: growing rods = 318 and VEPTR = 35.…”

Section: Resultsmentioning

confidence: 99%

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Latalski¹,

Fatyga²,

Sowa³

et al. 2021

WJO

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BACKGROUND The treatments for early-onset scoliosis (EOS), defined as curvature of the spine with onset before 10 years of age, continue to pose a great challenge for pediatric orthopedics. The treatment goals for EOS include minimizing spinal deformity while maximizing thoracic volume and pulmonary function. Different surgical techniques have different advantages and drawbacks; however, the two major concerns in the management of EOS are repeated surgeries and complications. AIM To review the current literature to assess the safety of EOS surgical treatment in terms of the rate of complications and unplanned surgeries. METHODS In January 2021 two independent reviewers systematically searched three electronic medical databases (PubMed, the Cochrane Library, and Embase) for relevant articles. Every step of the review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Due to the heterogeneity of articles and topics after data analysis, a descriptive (synthetic) analysis was performed. RESULTS A total of 2136 articles were found. Forty articles were included in this systematic review, after applying our inclusion and exclusion criteria. EOS surgery has a varying but high rate of complications. The most frequent complications were categorized as implant (54%), general (17%), wound (15%) and alignment (12%). The rate of complications might have been even higher than reported, as some authors do not report all types of complications. About 54% of patients required unplanned surgeries due to complications, which comprised 15% of all surgeries. CONCLUSION The literature concerning the definitions, collection, and interpretation of data regarding EOS surgery complications is often difficult to interpret. This creates problems in the comparison, analysis, and improvement of spine surgery practice. Additionally, this observation indicates that data on the incidence of complications can be underestimated, and should be interpreted with caution. Awareness of the high rate of complications of EOS surgery is crucial, and an optimal strategy for prevention should become a priority.

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Section: Resultsmentioning

confidence: 99%

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Latalski¹,

Fatyga²,

Sowa³

et al. 2021

WJO

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“…These average growth and curve correction rates, although not statistically significant due to the low numbers, were lower than the corresponding rates in the rest of the patient population. Therefore, we discontinued the use of MCGR in this patient population and currently use TGR which was shown to be effective in this type of patients by Yazici et al 13 …”

Section: Discussionmentioning

confidence: 99%

“…These average growth and curve correction rates, although not statistically significant due to the low num- bers, were lower than the corresponding rates in the rest of the patient population. Therefore, we discontinued the use of MCGR in this patient population and currently use TGR which was shown to be effective in this type of patients by Yazici et al 13 Our results showed that patients who were converted to MCGR from other growth systems yielded similar total growth [54.2 ± 25.3 mm in the converted group compared with 52.6 ± 21.4 mm in the primary MCGR group (P = 0.86)]. The converted group, however, had a lower final T1 to 12 height by an average of 37.6 mm (P = 0.02), a major curve correction percent lower by an average of 25% (P = 0.005), and a non-significant tendency for an increased complication rate [0.33 and 0.2 in the converted and primary MCGR groups, respectively (P = 0.41)].…”

Section: Discussionmentioning

confidence: 99%

“…And that Proximal anchor placement at or above the UEV resulted in a significant decrease in rates of proximal extension of the construct. 13 Schelfaut and colleagues published a retrospective series 15 patient with EOS who were treated by a staged procedure to decrease proximal anchor failure. During Stage 1, pairs of end vertebra were instrumented, grafted, and fused.…”

Section: Discussionmentioning

confidence: 99%

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Magnetically Controlled Growing Rods Graduation: Lessons From a Single-center Series of 48 Patients

Gurel,

Elbaz,

Sigal

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Magnetically controlled growing rod (MCGR) treatment for early-onset scoliosis (EOS) has become a widely utilized method of deformity control, but long-term follow-up reports are sparse. We evaluated the outcomes of a large group of consecutive pediatric patients diagnosed with EOS who were treated by MCGR to the endpoint of definitive spinal fusion in a single center. We hypothesized that lessons learned from treating a large volume of MCGR patients would lower the complication rate in comparison to what was previously reported by other studies. Methods: The records of 48 EOS patients with varied etiologies who were treated by MCGR between 2012 and 2022 and reached the end of treatment were analyzed retrospectively for baseline and final radiographic measurements and surgery-related complications. Results: The mean percent of improvement in the major coronal deformity was 51.7±25.0% and the mean T1 to T12 total growth was 52.9±21.9 mm. The total complication rate was 22.9% of which 12.5% required a single unplanned surgery, 6.3% required multiple unplanned surgeries, and 4% did not require any unplanned surgery. Conclusion: MCGR treatment provides adequate control of EOS, enabling satisfactory growth of the thoracic spine. The complication rate in a single large volume center is moderate. Level of Evidence: IV.

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“…Meza et al 12 studied the impact of proximal anchor location and density in patients treated with magnetically controlled growing rods, and reported that proximal spine anchors and greater anchor density impart superior deformity correction but do not signi cantly impact the risk of device complications. Harris et al 13 reported that 5 or more proximal anchors, and including the upper end vertebra (UEV), reduced the risk of screw pullout and the risk of reoperation in patients treated with distraction-based growing rods.…”

Section: Introductionmentioning

confidence: 99%

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

Cao

Zhu

Zhang

et al. 2021

Preprint

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Background The outcomes of early-onset scoliosis (EOS) treated with growing rods in which 6 proximal anchor points on 3 vertebrae were used vs. 4 proximal anchor points on 2 vertebra were compared. Methods The records of patients with EOS treated surgically from January 2016 to December 2017 were retrospectively reviewed. In the Proximal 4 group, 2 vertebral bodies were anchored proximally with 4 anchor points; in the Proximal 6 group, 3 vertebral bodies were anchored proximally with 6 anchor points. Results Forty-two patients (mean age 5.11 ± 1.93 years) were included; 22 Proximal 4 group, 20 Proximal 6 group. Mean follow-up was 40.86 ± 13.49 months. The decrease in main curve Cobb angle postoperatively was significantly greater in the Proximal 6 group (33.22° vs. 19.08°) (P < 0.05). Cobb thoracic kyphosis (TK) was significantly decreased postoperatively in the Proximal 6 group (mean 20.70°); no significant decrease occurred in the Proximal 4 group. The main curve Cobb angle decrease at last follow-up was significantly greater in the Proximal 6 group (37.84° vs. 24.23°) (P < 0.05). Cobb TK was significantly decreased at last follow-up in the Proximal 6 group (mean 25.17°, P < 0.05); no significant decrease occurred in the Proximal 4 group. Instrument complications were lower in the Proximal 6 group (15.00% vs. 45.45%) (P < 0.05). No proximal junctional kyphosis was noted. Conclusion Fixing 3 proximal vertebral bodies with 6 anchors improves outcomes of EOS treated with growing rods, and has a lower rate of instrument-related complications.

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Five or more proximal anchors and including upper end vertebra protects against reoperation in distraction-based growing rods

Cited by 16 publications

References 21 publications

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Complications in growth-friendly spinal surgeries for early-onset scoliosis: Literature review

Magnetically Controlled Growing Rods Graduation: Lessons From a Single-center Series of 48 Patients

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

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