Fusionless procedures for the management of early-onset spine deformities in 2011: What do we know?

Abstract

While attempts to understand them better and treat them more effectively, early-onset deformities have gained great pace in the past few years. Large patient series with long follow-ups that would provide high levels of evidence are still almost non-existent. That there is no safe treatment algorithm defined and agreed upon for this patient population continues to pose a challenge for pediatric spine surgeons. In this review, authors who are well known for their research and experience in the treatment of early-onset scoliosis (EOS) have come together in order to answer those questions which are most frequently asked by other surgeons. The most basic eight questions in this field have been answered succinctly by these authors and a current overview is provided.

Smaller Interval Distractions May Reduce Chances of Growth Rod Breakage Without Impeding Desired Spinal Growth: A Finite Element Study

“…Rod breakage is a main issue with the use of growth rods in patients. However, there is limited literature that sheds light on the failure mechanism [1][2][3][6][7][8]26]. Yang et al [6] found that the risk of rod fracture increases with single rods, stainless-steel rods, and smaller-diameter rods.…”

“…Dual growth rods are the most commonly used distraction-based, ''growth-friendly'' surgical instrumentation [1,2]. Growth rods are used to limit the progression of scoliosis without restraining spinal growth.…”

Growing rod concepts: state of the art

“…In an attempt to quantify the social consequences of the growing rod, the data of 265 patients from 16 international centers were studied [32]. More than 90 % of the patients undergoing growing surgery were found to be \10 years of age, and active treatment to take on average 5 years, which meant patients had the potential to undergo up to 12 procedures during this time frame.…”

Biomechanical Evaluation of 4 Different Foundation Constructs Commonly Used in Growing Spine Surgery: Are Rib Anchors Comparable to Spine Anchors?

“…Early fusion, especially when it includes the proximal thoracic spine, can significantly restrict pulmonary function [8]. Therefore, different growth-friendly techniques have been developed to avoid early definitive fusion of the immature spine [9].…”