Temporary Flexible Rods for Correction of Severe Pediatric Spinal Deformity

Abstract

Surgical correction of large, rigid scoliotic and kyphotic curves carries an increased risk of perioperative complications, such as neurological injury and excessive blood loss, compared with correction of less severe curves. Titanium temporary flexible rods (TFRs), designed for pediatric long bone fracture fixation, may be helpful as adjuncts to achieve gradual, stepwise intraoperative correction of severe pediatric spinal deformities. A retrospective review was conducted of spinal fusion cases for pediatric scoliosis or kyphosis at our institution that used TFRs as a correction technique from 2007 to 2019. Patients underwent posterior spinal fusion with predominantly pedicle screw instrumentation. Intraoperatively, a non-contoured titanium elastic nail was temporarily positioned in the screws unilaterally to achieve partial correction while the contralateral side was instrumented. Then, the TFR was removed and replaced with a permanent rod. Thirty-four patients with severe spinal deformities underwent posterior spinal fusion. Seventeen had scoliosis (mean major Cobb angle, 89.3°) and 17 had kyphosis (mean T5–T12 kyphosis, 73.8°). Idiopathic deformity was the most common etiology; neuromuscular, syndromic, and postsurgical causes contributed to the remainder of cases. All patients had Ponte osteotomies. Four patients (11.8%) had neuromonitoring alerts, 1 of which was related to insertion of the TFR; all were reversible. For patients with scoliosis, the mean postoperative Cobb angle measured 40.2° (53.6% correction). For patients with kyphosis, the mean postoperative T5–T12 angle measured 43.3° (30.4° of correction). TFRs appear to be helpful adjuncts for correction of severe pediatric spinal deformities, facilitating gradual intraoperative correction in a single-stage operation. Neuromonitoring alerts are common but reversible. [ Orthopedics . 202x;4x(x):xx–xx.]

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents

“…Various authors have also explored the application of TID rods for severe scoliosis treatment. Kwong et al [18] assessed patients who underwent posterior spinal fusion using a non-contoured titanium elastic nail on one side, performed in a single-stage surgery to achieve partial correction, while the contralateral side was instrumented, resulting in a 53.6% correction in the coronal plane. The authors suggested that temporary internal distraction in a single-stage setting could aid in gradually correcting severe pediatric spinal deformities during surgery.…”

“…The authors suggested that temporary internal distraction in a single-stage setting could aid in gradually correcting severe pediatric spinal deformities during surgery. Although common, neuromonitoring alerts are in fact reversible [18]. In a separate study involving 51 patients with severe scoliosis [19], temporary internal distraction rods were utilized in the surgical treatment, leading to an average Cobb reduction of up to 81%, surpassing that of Halo traction, and this improvement was maintained over long-term follow-up.…”

“…The preferred treatment approach for severe and rigid spinal curvatures is the utilization of preoperative Halo gravity traction (HGT) [9][10][11][12][13][14][15]. However, various alternative methods have also been introduced for managing severe spinal deformities, such as temporary internal distraction (TID) and its various adaptations, anterior release (AR), posterior release (PR), and thoracoplasty with rib osteotomy (TP), as well as different forms of three-column osteotomies like pedicle subtraction osteotomy (PSO) and vertebrectomy (commonly known as vertebral column resection (VCR)) [16][17][18][19][20][21][22][23][24][25]. Techniques involving gradual traction, whether external or internal, are typically viewed as safer compared with the more aggressive three-column osteotomy (3CO) approach, with a confined and acceptable incidence of complications [3,4,6,[10][11][12][15][16][17]20,24,26].…”