Growing-Rod Graduates: Lessons Learned from Ninety-nine Patients Who Completed Lengthening

Flynn, John M.; Tomlinson, Lauren A.; Pawelek, Jeff; Thompson, George H.; McCarthy, R.; Akbarnia, Behrooz A.

doi:10.2106/jbjs.l.01386

Cited by 130 publications

(76 citation statements)

References 8 publications

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“…29,30,[38][39][40][41][42][43] Implant complications such as anchor malfunction (pullout from the spine, erosion through the rib) and rod breakage are common (Fig 9). Distraction-based posterior implants often produce kyphosis, which may result in an unfavorable overall sagittal plane balance.…”

Section: Complications Of Distraction-based Implantsmentioning

confidence: 99%

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

et al. 2016

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Early-onset scoliosis (EOS) is defined as curvature of the spine in children >10° with onset before age 10 years. Young children with EOS are at risk for impaired pulmonary function because of the high risk of progressive spinal deformity and thoracic constraints during a critical time of lung development. The treatment of EOS is very challenging because the population is inhomogeneous, often medically complex, and often needs multiple surgeries. In the past, early spinal fusion was performed in children with severe progressive EOS, which corrected scoliosis but limited spine and thoracic growth and resulted in poor pulmonary outcomes. The current goal in treatment of EOS is to maximize growth of the spine and thorax by controlling the spinal deformity, with the aim of promoting normal lung development and pulmonary function. Bracing and casting may improve on the natural history of progression of spinal deformity and are often used to delay surgical intervention or in some cases obviate surgery. Recent advances in surgical implants and techniques have led to the development of growth-friendly implants, which have replaced early spine fusion as the surgical treatment of choice. Treatment with growth-friendly implants usually requires multiple surgeries and is associated with frequent complications. However, growth-friendly spine surgery has been shown to correct spinal deformity while allowing growth of the spine and subsequently lung growth.

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Section: Complications Of Distraction-based Implantsmentioning

confidence: 99%

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

et al. 2016

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“…Until recently, the literature was sparse, but Flynn et al reported a series of 99 patients, aged 11-13 years, undergoing lengthening over a mean of 5 years [31].…”

Section: Definitive Fusion Surgerymentioning

confidence: 99%

Fusionless surgery in early-onset scoliosis

Odent

Ilharreborde

Miladi

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

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These techniques are effective in controlling early scoliotic deformity, and to some extent restore spinal growth. However, they show a high rate of complications: infection, rod breakage, spinal fixation pull out and, above all, progressive spinal stiffness, reducing long-term efficacy. Respiratory gain is harder to assess, as thoracic expansion does not systematically improve respiratory function, particularly due to impaired compliance of the thoracic cage.

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“…Proximally hooks supplemented with or without wires can be used to prevent complications of proximal screw pull out or migration. 30 Complications of growing-rod techniques are largely related to the need for multiple procedures. 27 Lengthening procedures usually are performed every 6-9 mo until the child reaches appropriate size or age for spinal fusion.…”

Section: Operative Managementmentioning

confidence: 99%

Early onset scoliosis

Flynn

Kushare

Patel

2013

Current Orthopaedic Practice

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There are few areas within the field of pediatric orthopaedics that have had more profound advancements in the past 15 years than the care of children with early onset scoliosis. Although the number of underlying diagnoses and associated comorbidities are numerous, there are several essential underlying principles: comprehensive initial evaluation, close and ongoing communication with caregivers, exhausting the nonoperative methods before moving to surgery, diligent informed consent, preparing the family for potential complications and unplanned surgery, and a thoughtful approach to the end of lengthening or expansion, with final fusion surgery in most cases. This review aims to present the state-of-the-art in the care of early onset scoliosis, including evaluation, operative decision-making, and management of complications. Although the care is complex, and problems are common, many children successfully treated would not have survived into adulthood without the modern methods available to manage their severe spinal and chest wall deformities. Advances on the horizon, including new imaging modalities, the possibility of nonoperative lengthening, and increasingly sophisticated final fusion procedures, offer even more hope for the next generation of children with early onset scoliosis.

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Growing-Rod Graduates: Lessons Learned from Ninety-nine Patients Who Completed Lengthening

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 130 publications

References 8 publications

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

Early-Onset Scoliosis: A Review of History, Current Treatment, and Future Directions

Fusionless surgery in early-onset scoliosis

Early onset scoliosis

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