Idiopathic Early-onset Scoliosis: Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-year Follow-up

Bachabi, Malick; McClung, Anna; Pawelek, Jeff; Hawary, Ron El; Thompson, George H.; Smith, John T.; Vitale, Michael G.; Akbarnia, Behrooz A.; Sponseller, Paul D.

doi:10.1097/bpo.0000000000001202

Cited by 22 publications

(5 citation statements)

References 26 publications

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“…The incidence of IF in the present cohort was lower than those of previous studies; this may be attributed to the same cause as the low incidence in TGRs. In contrast, the results of this study were consistent with those of a previous study comparing TGRs and VEPTRs, which found no significant difference in IF incidence between the two surgical methods [ 18 ]. Magnetically controlled growth rods, which eliminate the need for multiple lengthening surgeries and the accompanying general anesthesia and skin incisions, have recently been implemented in Europe and the United States; however, the complication rates were reported not to be lower than those of TGRs [ 7 , 19 , 20 ].…”

Section: Discussionsupporting

confidence: 92%

Instrumentation failure following pediatric spine deformity growth-sparing surgery using traditional growing rods or vertical expandable prosthetic titanium ribs

Yokogawa,

Demura,

Ohara

et al. 2024

BMC Musculoskelet Disord

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Background Instrumentation failure (IF) is a major complication associated with growth-sparing surgery for pediatric spinal deformities; however, studies focusing on IF following each surgical procedure are lacking. We aimed to evaluate the incidence, timing, and rates of unplanned return to the operating room (UPROR) associated with IF following each surgical procedure in growth-sparing surgeries using traditional growing rods (TGRs) and vertical expandable prosthetic titanium ribs (VEPTRs). Methods We reviewed 1,139 surgical procedures documented in a Japanese multicenter database from 2015 to 2017. Of these, 544 TGR and 455 VEPTR procedures were included for evaluation on a per-surgery basis. IF was defined as the occurrence of an implant-related complication requiring revision surgery. Results The surgery-based incidences of IF requiring revision surgery in the TGR and VEPTR groups were 4.3% and 4.0%, respectively, with no significant intergroup difference. Remarkably, there was a negative correlation between IF incidence per surgical procedure and the number of lengthening surgeries in both groups. In addition, rod breakage in the TGR group and anchor-related complications in the VEPTR group tended to occur relatively early in the treatment course. The surgery-based rates of UPROR due to IF in the TGR and VEPTR groups were 2.0% and 1.5%, respectively, showing no statistically significant difference. Conclusions We found that IF, such as anchor related-complications and rod breakage, occurs more frequently earlier in the course of lengthening surgeries. This finding may help in patient counseling and highlights the importance of close postoperative follow-up to detect IF and improve outcomes.

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Section: Discussionsupporting

confidence: 92%

Instrumentation failure following pediatric spine deformity growth-sparing surgery using traditional growing rods or vertical expandable prosthetic titanium ribs

Yokogawa,

Demura,

Ohara

et al. 2024

BMC Musculoskelet Disord

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“…At a mean follow-up of eight years, growing rod patients had a significantly greater correction in Cobb angle (50% versus 27%; p = 0.001) as well as greater gain in thoracic height compared to VEPTR patients (24% versus 12%; p = 0.024). VEPTR patients also had a greater progression in their kyphosis postoperatively [9].…”

Section: Discussionmentioning

confidence: 89%

“…McElroy et al found that 19 (70%) of 27 patients experienced a complication following growing rod surgery, which predominantly included deep wound infections necessitating early fusion and instrument removal in a few patients, as well as rod exchange and rod fracture [6]. However, Bachabi et al found a higher complication rate in VEPTRs when directly compared to growing rod surgery (82% versus 66%) and specifically in wound complications (41% versus 14%; p = 0.011) [9].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Vertical Expandable Prosthetic Titanium Ribs in Children With Early-Onset Scoliosis Secondary to Cerebral Palsy

Elmallah

Fortin

Thimothee

et al. 2021

Cureus

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Purpose Patients who have neuromuscular scoliosis, such as cerebral palsy (CP), often develop spinal deformities that negatively impact quality of life. The vertical expandable prosthetic titanium rib (VEPTR) was designed for thoracic insufficiency syndrome (TIS), but it has also been utilized in patients with CP with restrictive lung disease and spine deformity. Few studies report on VEPTRs in neuromuscular scoliosis; however, none reports on their utilization specifically in patients with CP. Our purpose was to assess if VEPTRs can improve spinal deformity and TIS in these patients. Methods A retrospective chart review was performed of all patients with CP and scoliosis treated with a VEPTR between 2008 and 2017. Eight patients were eligible for this study. The mean follow-up was four years. Outcomes evaluated were Cobb angle, pelvic obliquity, space available for lung ratio (SAL), T1-S1 height, and complication rates. A p-value of less than 0.05 was used for statistical significance. Results There were significant postoperative improvements in Cobb angle, pelvic obliquity, and T1-S1 height, but no statistical difference in SAL. Prior to final fusion, the mean number of VEPTR lengthening procedures was 3. The mean time from index surgery to final fusion was 3.7 years. The most common complications were infection (62.5%) and wound dehiscence (25%). Only 25% of patients did not have a complication. Conclusion VEPTRs demonstrated significant improvement in almost all parameters and may be valuable in improving TIS in patients with CP. The complication and reoperation rates were similar to those of VEPTRs used for other pathological conditions.

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“…As in the main texts, the data were not separated out, so we included them in the TGR group, as the vast majority were treated with this system. Papers by Akbarnia et al [ 10 ], Bachabi et al [ 11 ], Haapala et al [ 12 ], Andras et al [ 13 ], and Luhmann et al [ 14 ], dealt with comparisons between TGR and MCGR, TGR, and VEPTR, Shilla and MCGR, and TGR and Shilla, respectively, so they appear in the table for the applicable system. The demographic findings of the included articles are summarized in Table 1 .…”

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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Idiopathic Early-onset Scoliosis: Growing Rods Versus Vertically Expandable Prosthetic Titanium Ribs at 5-year Follow-up

Abstract: Level III.

Cited by 22 publications

References 26 publications

Instrumentation failure following pediatric spine deformity growth-sparing surgery using traditional growing rods or vertical expandable prosthetic titanium ribs

Instrumentation failure following pediatric spine deformity growth-sparing surgery using traditional growing rods or vertical expandable prosthetic titanium ribs

Outcomes of Vertical Expandable Prosthetic Titanium Ribs in Children With Early-Onset Scoliosis Secondary to Cerebral Palsy

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

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