Submuscular Isola Rod With or Without Limited Apical Fusion in the Management of Severe Spinal Deformities in Young Children

Blakemore, Laurel C.; Scoles, Peter V.; Poe-Kochert, Connie; Thompson, George H.

doi:10.1097/00007632-200109150-00021

Cited by 93 publications

(35 citation statements)

References 13 publications

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“…The "Luque trolley" technique of segmental spinal instrumentation without fusion has been used with some success [13,14,18]. Blakemore et al [1] and Morin [15] introduced segmental spinal instrumentation systems (Cotrel-Dubousset, Isola, etc) for severe spinal deformities in young children. However, in all of these procedures, spontaneous bony fusion can occur before the patients reach maturity [7,14], also causing posterior ankylosis and crankshaft [5].…”

Section: Introductionmentioning

confidence: 99%

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Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Zou

Egund

et al. 2004

European Spine Journal

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IntroductionBecause of the associated disturbance of spinal growth, surgery for progressive spinal deformities in very young children is a challenging task. Most foregoing studies report having used a "growing spinal instrumentation without fusion" technique in order to avoid interference with spinal growth. Harrington first described the procedure, which used a Harrington rod [10]. The "Luque trolley" technique of segmental spinal instrumentation without fusion has been used with some success [13,14,18]. Blakemore et al [1] and Morin [15] introduced segmental spinal instrumentation systems (Cotrel-Dubousset, Isola, etc) for severe spinal deformities in young children. However, in all of these procedures, spontaneous bony fusion can occur before the patients reach maturity [7,14], also causing posterior ankylosis and crankshaft [5].Abstract "Spinal instrumentation without fusion" techniques, which do not interfere with spinal growth, have been used extensively in the treatment of progressive spinal scoliosis in very young children. Due to subperiosteal exposure, the process of spinal instrumentation may induce spontaneous bony fusion. Instrumentation and surgical techniques have been modified in order to prevent spontaneous posterior fusion from occurring in children. An absorbable ADCON-L gel has been shown to inhibit scar and epidural adhesions following spinal surgeries. However, little is known about its influence on spinal fusion. In the present study, a single-level intertransverse arthrodesis at L4-5 on both sides was performed on each of nine pigs. Each side was randomly designed to receive autogenous bone graft with or without ADCON-L gel. The animals were followed for 10 weeks postoperatively. A fusion rate of 78% (7/9) was obtained in the autograft treatment by plain X-ray and CT evaluation, while the autograft/ADCON-L treatment yielded a 0% (0/9) fusion rate (p=0.001). Histomorphometric evaluation revealed that the addition of ADCON-L gel to bone graft decreased bone and bone marrow formation and significantly increased fibrous tissue formation. No statistical difference between the two treatments was found in cartilage, bone surface density, osteoid surfaces or osteoclast-covered surfaces in any zone. We conclude that ADCON-L gel mixed into autogenous bone graft can delay or decrease bone formation at spinal arthrodesis sites, thus influencing the extent of spinal fusion. This accords with our hypothesis that the use of ADCON-L gel can prevent not only the occurrence of spontaneous fusion in very young scoliosis patients after instrumentation without fusion, but also re-ossification of a decompressed spinal canal.

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Section: Introductionmentioning

confidence: 99%

“…Other authors designed an operative technique to prevent the spontaneous posterior fusion from occurring [1]. Prevention of bone growth in relation to a decompressed spinal canal also has clinical implications, since re-stenosis has occurred in up to 20% of patients who have received decompression.…”

Section: Introductionmentioning

confidence: 99%

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Zou

Egund

et al. 2004

European Spine Journal

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“…The literature supports the use of both techniques but also documents complications in this population including proximal migration of devices with rib fractures, and skin problems secondary to recurrent surgery and hardware [3,8,10,13]. The complication rates ranged from 8% to 50% [2,3,8,10,13]. The literature also suggests the growing rod systems are associated with a high complication rate (ie, 8% to 50%) with the majority being minor; these systems appear to halt curve progression but not reduce curve magnitude [10,13].…”

Section: Introductionmentioning

confidence: 77%

“…The authors of one report recommend placement of growing rod instrumentation on the concave side of the spine only to expand the smallest hemithorax [2], whereas others report better radiographic correction and fewer complications with bilateral constructs [15]. An opening wedge thoracostomy sometimes is performed as part of distraction thoracoplasty [10], but some surgeons prefer not opening the thoracic cavity as they are concerned by the potential for scarring and subsequent restriction this could cause [8].…”

Section: Introductionmentioning

confidence: 99%

Variability of Expert Opinion in Treatment of Early-onset Scoliosis

Vitale

Gómez

Matsumoto

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling.Questions/purposes Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis. Methods We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed. Results All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy. Conclusions Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.

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“…This occurred to MC initially as a suspected superficial infection, which failed to completely settle on intravenous antibiotics and so underwent definitive sinus tract excision. Infection rates for posterior instrumentation in the literature vary from 2 to 10% [4,9]; however, in none of these papers was the paediatric ISOLA system employed.…”

Section: Discussionmentioning

confidence: 99%

Infantile scoliosis in Beals syndrome: the use of a non-fusion technique for surgical correction

et al. 2005

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Beals syndrome (congenital contractural arachnodactyl) is a genetic disorder of the connective tissue phenotypically related to Marfan syndrome. It is characterised by dolichostenomelia, arachnodactyly, multiple joint contractures, crumpled ears, hypoplastic muscles and scoliosis. The latter, the most important clinical feature of this rare condition, presents in the infantile and juvenile age group and has a tendency to rapid progression. Bracing often fails to control the scoliosis and surgery is the recommended treatment. We present our experience of two cases managed with the paediatric Isola instrumentation and a non-fusion technique.

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Submuscular Isola Rod With or Without Limited Apical Fusion in the Management of Severe Spinal Deformities in Young Children

Abstract: This technique is useful in the management of severe spinal deformities in young children who have either failed, or have a contraindication to, orthotic management. Complications are relatively frequent but well tolerated.

Cited by 93 publications

References 13 publications

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Inhibition of spinal fusion by use of a tissue ingrowth inhibitor

Variability of Expert Opinion in Treatment of Early-onset Scoliosis

Infantile scoliosis in Beals syndrome: the use of a non-fusion technique for surgical correction

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