Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients

Braun, Sebastian; Brenneis, Marco; Schönnagel, Lukas; Caffard, Thomas; Diaremes, Panagiotis

doi:10.3390/life13061341

Cited by 4 publications

(6 citation statements)

References 104 publications

(168 reference statements)

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“…In the past decade, dynamic deformity correction has received more interest as a surgical treatment approach in AIS [14,17]. While fusion procedures provide sustainable longterm outcomes, the associated reduced spinal mobility can only be addressed via the use of dynamic procedures [18].…”

Section: Discussionmentioning

confidence: 99%

“…Dynamic systems use a variety of surgical approaches to achieve curve correction while preserving the residual growth capacity and mobility of the spine. The vertebral body stapling (VBS) method uses a complex anterolateral approach, which is similar in principle to temporary epiphysiodesis for the axial correction of the lower extremities [14]. The staples are anchored in the vertebra on the convex side of the spine which reduces the pressure on the concave side and is intended to result in the axisaligned growth of the spine.…”

Section: Introductionmentioning

confidence: 99%

“…Vertebral body tethering (VBT) represents an advancement from VBS; however, the principle used to correct deformity as well as its specific operative access are still the same as those in VBS [15]. In VBT, screws are inserted laterally into the vertebrae and connected with a flexible cord (tether) [14,16,17]. VBT is most commonly recommended for a single major thoracic curve with a nonstructural lumbar and proximal thoracic curve [18].…”

Section: Introductionmentioning

confidence: 99%

“…While VBS and VBT represent compression-based techniques, other dynamic systems, including the ApiFix system (Figure 1), use distraction-based techniques in the fusionless surgical treatment of AIS [14]. The ApiFix system was designed as a posterior dynamic device for single curves which, in contrast to fusion instrumentations, permits the movement of the curve itself [17,22,23].…”

Section: Introductionmentioning

confidence: 99%

“…For patients who are skeletally immature, the capacity for spinal growth is furthermore supposed to have a positive influence on the growth of the vertebral bodies themselves (growth modulation). Therefore, the ApiFix device is considered to be a so-called "internal brace", i.e., a device that allows growth control until skeletal maturity is reached and the possibility of subsequent removal after the cessation of growth without a consecutive loss of the correction [11,14]. After surgical treatment, no external brace is necessary.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Adolescent Idiopathic Scoliosis with the ApiFix Minimal Invasive Dynamic Correction System—A Preliminary Report of a 24-Month Follow-Up

Froehlich,

Mittelmeier,

Desai

et al. 2023

Life

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Adolescent idiopathic scoliosis (AIS) is a three-dimensional growth disorder. Corrective surgical procedures are the recommended treatment option for a thoracic angle exceeding 50° and a lumbar major curve of 40°. Over the past few years, dynamic growth modulation implants have been developed as alternatives to permanent fusion. The ApiFix system was designed as a 2D “posterior dynamic device” for curve correction. After implantation in a minimally invasive procedure, it uses polyaxial joints and a self-adjusting rod to preserve the degree of motion and to accommodate the patient’s growth. It provides an effective method of controlling deformity and fills the gap between the conservative treatment of major curves that are >35° and the fusion procedure. The objective of the two-center cohort study was the analysis of the correction results of patients, who underwent surgical intervention with the ApiFix system. The inclusion criteria were AIS, Lenke type 1 or type 5, a major curve on bending films of ≤30°, and an angle of the major curve of between 35° and 60°. Postoperative radiograph data were obtained longitudinally for up to 24 months of follow-up and compared to preoperative (preop) values. For comparisons of the different time points, non-parametric tests (Wilcoxon) or paired t-tests for normally distributed values were used to analyze repeated measures. Overall, 36 patients (25 female and 11 male) were treated with the ApiFix system from April 2018 to October 2020. Lenke type 1 was identified in 21 (58%) cases and Lenke type 5 was identified in 15 (42%) cases. The average angle of the thoracic major curve for Lenke 1 was 43°. The preoperative lumbar major curve (Lenke 5) was determined to be 43°. Over a follow-up of 24 months, a correction of the major curve to an average of 20° was observed for Lenke 1 and that to an average of 15° was observed for Lenke 5. Lenke type 1 and type 5 showed significant changes in the major curve over the individual test intervals in the paired comparisons compared to the starting angle (Lenke 1: preop—24 months, 0.002; Lenke 5: preop—24 months, 0.043). Overall, 11 events were recorded in the follow-up period, that required revision surgery. We distinguished between repeated interventions required after reaching the maximum distraction length of the implant due to the continued growth of the patient (n = 4) and complications, such as infections or problems associated with the anchorage of the implant (n = 7). The results from the present cohort revealed a statistically significant improvement in the postoperatively measured angles of the major and minor curves in the follow-up after 24 months. Consequently, the results were comparable to those of the already established vertebral body tethering method. Alignment in AIS via dynamic correction systems in combination with a possible growth modulation has been a treatment alternative to surgical fusing procedures for more than a decade. However, the long-term corrective effect has to be validated in further studies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Adolescent Idiopathic Scoliosis with the ApiFix Minimal Invasive Dynamic Correction System—A Preliminary Report of a 24-Month Follow-Up

Froehlich,

Mittelmeier,

Desai

et al. 2023

Life

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LIV selection in ‘tweener’ patients treated with magnetically controlled growing rods vs. posterior spinal fusion

Yoshida,

Leonardi,

Valenzuela-Moss

et al. 2024

Spine Deform

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Purpose The purpose of this study was to compare the LIV selection in ‘tweener’ patients treated with MCGR or PSF. Methods A multicenter pediatric spine database was queried for ambulatory patients ages 8–11 years treated by MCGR or PSF with at least 2-year follow-up. The relationship between the LIV and preoperative spinal height, curve magnitude, and implant type were assessed. The relationship between the touched vertebrae (TV), the last substantially touched vertebrae (LSTV), the stable vertebrae (SV), and the LIV were evaluated. Results One hundred and fifty-nine patients met inclusion criteria. Preoperative curve magnitude was similar between groups (MCGR 68 ± 19.0° vs. PSF 66 ± 17.2°, p = 0.6). Preoperative curve magnitude was associated with LIV, as larger curves were associated with a more caudal LIV (p = 0.0004). Distribution of the LIV was more varied in PSF compared to MCGR. L3 was the LIV in 43% of MCGR patients compared to 27% of PSF patients. A thoracic LIV was more common in the PSF group (PSF 13% vs. MCGR 1.2%, p = 0.0038). The LIV was cephalad to the SV in 68% of PSF compared to 48% of MCGR patients (p = 0.02). Conclusion The majority of LIV selection in ‘tweener’ patients was at L3 or below regardless of surgical strategy, likely driven by curve magnitude. However, ‘tweener’ patients treated with PSF had more cephalad LIV selections compared to patients treated with MCGR. Potential LIV differences should be considered when selecting MCGR vs. PSF in ‘tweener’ patients. Level of evidence III.

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Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies

Toriya,

Vissarionov,

Manukovskiy

et al. 2024

Pediatr Traum Orthop Reconstr Surg

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BACKGROUND: In children, progressive congenital deformities of the thoracic spine combined with thoracic anomalies require surgical intervention to correct the curvature and prevent further progression during the child’s growth. Surgical correction of congenital deformity caused by segmentation disorders of the lateral surfaces of the vertebral bodies with unilateral rib synostosis aims at full correction of the existing curvature using the transpedicular spinal system and is an effective and reliable treatment option for these patients. However, this technology requires precise and correct installation of the supporting elements of the metal structure to exclude possible irreversible complications. A solution is the use of template guides in the installation of the support elements of the spinal metal structure. AIM: This study aimed to conduct a comparative analysis of the results of using template guides for the placement of transpedicular screws with the free-hand method in children during surgical correction of congenital spinal deformities combined with thoracic anomalies. MATERIALS AND METHODS: The results of surgical treatment of 20 patients, aged 3–9 years, were analyzed retrospectively to compare the time and accuracy of spinal metal support element placement with and without the use of template guides. The data collected included demographic information, time of bone canal formation, accuracy of spinal transpedicular screw placement, and various complications. RESULTS: Compared with the free-hand method, the use of template guides in the surgical correction of congenital spinal deformities combined with thoracic anomalies in children reduces the time of bone canal formation and increases the accuracy of metal screw placement. These results confirm the efficacy and safety of using template guides during spinal surgery in children with these congenital malformations. CONCLUSIONS: The use of template guides is an effective and reliable method of inserting transpedicular metal screws in the correction of congenital spinal deformities combined with thoracic anomalies in children, which increases the accuracy of implantation of support elements and reduces the surgical time. These results confirm the necessity of using template guides in the correction of congenital spinal deformities in children.

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Surgical Treatment of Spinal Deformities in Pediatric Orthopedic Patients

Cited by 4 publications

References 104 publications

Surgical Treatment of Adolescent Idiopathic Scoliosis with the ApiFix Minimal Invasive Dynamic Correction System—A Preliminary Report of a 24-Month Follow-Up

Surgical Treatment of Adolescent Idiopathic Scoliosis with the ApiFix Minimal Invasive Dynamic Correction System—A Preliminary Report of a 24-Month Follow-Up

LIV selection in ‘tweener’ patients treated with magnetically controlled growing rods vs. posterior spinal fusion

Advantages of using template guides in children for the correction of congenital spinal deformities and thoracic anomalies

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